Risk stratification for acute pulmonary embolism

Jeffrey Kline, David W. Miller

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

This article discusses state-of-the-art techniques for predicting risk of death after acute pulmonary embolism (PE), with special attention to how underlying malignancy adversely affects survival after an episode. Current methods of risk stratification generally categorize patients with PE as low-, moderate-, and high-risk for inhospital adverse outcomes of respiratory failure, circulatory shock, and death. Published risk stratification studies find that patients with PE and an underlying malignancy have a worse prognosis, but no validated risk stratification criteria have been published specifically for these patients. Standard treatment is full-dose heparin followed by oral anticoagulation. The term escalated treatment refers to the use of systemic or intrapulmonary fibrinolytic agents, catheter-based treatment, or surgical embolectomy. Most patients with low-risk PE (normal vital signs and normal serum troponin, brain natriuretic peptide, and normal echocardiography) are treated successfully with standard anticoagulation, and many can be treated as outpatients. In contrast, patients with high-risk PE (systolic blood pressure <90 mm Hg and no contraindications) often benefit from escalated treatment. Treatment decisions for patients with moderate-risk PE (normotension with evidence of right ventricular damage or dysfunction) are most controversial. Most patients in this category of risk recover with standard therapy, but some benefit from escalated treatment. Patients with cancer with an incidentally discovered PE should be risk stratified the same as those who have clinically suspected PE.

Original languageEnglish (US)
Pages (from-to)800-810
Number of pages11
JournalJNCCN Journal of the National Comprehensive Cancer Network
Volume9
Issue number7
StatePublished - Jul 1 2011
Externally publishedYes

Fingerprint

Pulmonary Embolism
Therapeutics
Blood Pressure
Embolectomy
Neoplasms
Troponin
Fibrinolytic Agents
Vital Signs
Brain Natriuretic Peptide
Respiratory Insufficiency
Echocardiography
Heparin
Shock
Outpatients
Catheters
Survival
Serum

Keywords

  • Acute pulmonary embolism
  • Anticoagulation
  • Heparin
  • Respiratory failure
  • Risk stratification

ASJC Scopus subject areas

  • Oncology

Cite this

Risk stratification for acute pulmonary embolism. / Kline, Jeffrey; Miller, David W.

In: JNCCN Journal of the National Comprehensive Cancer Network, Vol. 9, No. 7, 01.07.2011, p. 800-810.

Research output: Contribution to journalArticle

@article{d7f2ce36ab014eb59aecb1c9899b0cc4,
title = "Risk stratification for acute pulmonary embolism",
abstract = "This article discusses state-of-the-art techniques for predicting risk of death after acute pulmonary embolism (PE), with special attention to how underlying malignancy adversely affects survival after an episode. Current methods of risk stratification generally categorize patients with PE as low-, moderate-, and high-risk for inhospital adverse outcomes of respiratory failure, circulatory shock, and death. Published risk stratification studies find that patients with PE and an underlying malignancy have a worse prognosis, but no validated risk stratification criteria have been published specifically for these patients. Standard treatment is full-dose heparin followed by oral anticoagulation. The term escalated treatment refers to the use of systemic or intrapulmonary fibrinolytic agents, catheter-based treatment, or surgical embolectomy. Most patients with low-risk PE (normal vital signs and normal serum troponin, brain natriuretic peptide, and normal echocardiography) are treated successfully with standard anticoagulation, and many can be treated as outpatients. In contrast, patients with high-risk PE (systolic blood pressure <90 mm Hg and no contraindications) often benefit from escalated treatment. Treatment decisions for patients with moderate-risk PE (normotension with evidence of right ventricular damage or dysfunction) are most controversial. Most patients in this category of risk recover with standard therapy, but some benefit from escalated treatment. Patients with cancer with an incidentally discovered PE should be risk stratified the same as those who have clinically suspected PE.",
keywords = "Acute pulmonary embolism, Anticoagulation, Heparin, Respiratory failure, Risk stratification",
author = "Jeffrey Kline and Miller, {David W.}",
year = "2011",
month = "7",
day = "1",
language = "English (US)",
volume = "9",
pages = "800--810",
journal = "Journal of the National Comprehensive Cancer Network : JNCCN",
issn = "1540-1405",
publisher = "Cold Spring Publishing LLC",
number = "7",

}

TY - JOUR

T1 - Risk stratification for acute pulmonary embolism

AU - Kline, Jeffrey

AU - Miller, David W.

PY - 2011/7/1

Y1 - 2011/7/1

N2 - This article discusses state-of-the-art techniques for predicting risk of death after acute pulmonary embolism (PE), with special attention to how underlying malignancy adversely affects survival after an episode. Current methods of risk stratification generally categorize patients with PE as low-, moderate-, and high-risk for inhospital adverse outcomes of respiratory failure, circulatory shock, and death. Published risk stratification studies find that patients with PE and an underlying malignancy have a worse prognosis, but no validated risk stratification criteria have been published specifically for these patients. Standard treatment is full-dose heparin followed by oral anticoagulation. The term escalated treatment refers to the use of systemic or intrapulmonary fibrinolytic agents, catheter-based treatment, or surgical embolectomy. Most patients with low-risk PE (normal vital signs and normal serum troponin, brain natriuretic peptide, and normal echocardiography) are treated successfully with standard anticoagulation, and many can be treated as outpatients. In contrast, patients with high-risk PE (systolic blood pressure <90 mm Hg and no contraindications) often benefit from escalated treatment. Treatment decisions for patients with moderate-risk PE (normotension with evidence of right ventricular damage or dysfunction) are most controversial. Most patients in this category of risk recover with standard therapy, but some benefit from escalated treatment. Patients with cancer with an incidentally discovered PE should be risk stratified the same as those who have clinically suspected PE.

AB - This article discusses state-of-the-art techniques for predicting risk of death after acute pulmonary embolism (PE), with special attention to how underlying malignancy adversely affects survival after an episode. Current methods of risk stratification generally categorize patients with PE as low-, moderate-, and high-risk for inhospital adverse outcomes of respiratory failure, circulatory shock, and death. Published risk stratification studies find that patients with PE and an underlying malignancy have a worse prognosis, but no validated risk stratification criteria have been published specifically for these patients. Standard treatment is full-dose heparin followed by oral anticoagulation. The term escalated treatment refers to the use of systemic or intrapulmonary fibrinolytic agents, catheter-based treatment, or surgical embolectomy. Most patients with low-risk PE (normal vital signs and normal serum troponin, brain natriuretic peptide, and normal echocardiography) are treated successfully with standard anticoagulation, and many can be treated as outpatients. In contrast, patients with high-risk PE (systolic blood pressure <90 mm Hg and no contraindications) often benefit from escalated treatment. Treatment decisions for patients with moderate-risk PE (normotension with evidence of right ventricular damage or dysfunction) are most controversial. Most patients in this category of risk recover with standard therapy, but some benefit from escalated treatment. Patients with cancer with an incidentally discovered PE should be risk stratified the same as those who have clinically suspected PE.

KW - Acute pulmonary embolism

KW - Anticoagulation

KW - Heparin

KW - Respiratory failure

KW - Risk stratification

UR - http://www.scopus.com/inward/record.url?scp=79960173356&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79960173356&partnerID=8YFLogxK

M3 - Article

C2 - 21715726

AN - SCOPUS:79960173356

VL - 9

SP - 800

EP - 810

JO - Journal of the National Comprehensive Cancer Network : JNCCN

JF - Journal of the National Comprehensive Cancer Network : JNCCN

SN - 1540-1405

IS - 7

ER -