Risk stratification and treatment strategy of pulmonary embolism

Andrea Penaloza, Pierre Marie Roy, Jeffrey Kline

Research output: Contribution to journalReview article

18 Scopus citations

Abstract

PURPOSE OF REVIEW: Pulmonary embolism remains one of the leading causes of cardiovascular mortality. The wide range of reported mortality rates reflects heterogeneity in comorbidity and severity of pulmonary embolism. Optimizing risk stratification to prognose pulmonary embolism patients appears to be important to improve management, treatment and clinical outcome. RECENT FINDINGS: Hemodynamic status is the most important short-term prognostic factor. High-risk pulmonary embolism or massive pulmonary embolism is defined by the patient response more than the clot size: patients with circulatory shock including sustained hypotension should receive thrombolytic therapy in absence of contraindications. Nonmassive or normotensive pulmonary embolism can be further stratified using clinical features, imaging (echocardiography, computed tomography) and biomarkers (troponins, natriuretic peptides): low-risk pulmonary embolism, evaluated by clinical model (Pulmonary Embolism Severity Index; PESI) can potentially be treated as outpatients; and intermediate-risk pulmonary embolism, which can be further stratified into less-severe and more-severe intermediate risk. The last may benefit from intensive clinical surveillance but the risk-benefit ratio for thrombolysis has been inadequately quantified to make any strong recommendation. New anticoagulants may transform traditional pulmonary embolism treatment. SUMMARY: Optimizing risk stratification of patients with normotensive pulmonary embolism before they develop overt hemodynamic instability is the challenge of current pulmonary embolism management. Treatment strategy has to integrate this risk stratification and new anticoagulants arrival.

Original languageEnglish (US)
Pages (from-to)318-325
Number of pages8
JournalCurrent Opinion in Critical Care
Volume18
Issue number4
DOIs
StatePublished - Aug 1 2012
Externally publishedYes

Keywords

  • pulmonary embolism
  • risk stratification
  • treatment

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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