Current Management of Acute Pulmonary Embolism

被引:121
作者
Licha, Carlos R. Martinez [1 ]
McCurdy, Chelsea M. [1 ]
Maldonado, Sarina Masso [1 ]
Lee, Lawrence S. [1 ]
机构
[1] Indiana Univ Sch Med, Indiana Univ Hlth Methodist Hosp, Div Cardiothorac Surg, Indianapolis, IN 46202 USA
关键词
pulmonary embolism; fibrinolysis; catheter thrombolysis; surgical pulmonary embolectomy; SURGICAL EMBOLECTOMY; OUTCOMES; DIAGNOSIS;
D O I
10.5761/atcs.ra.19-00158
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Purpose: Acute pulmonary embolism (PE) remains a significant cause of morbidity and requires prompt diagnosis and management. While non-surgical approaches have supplanted surgery as primary treatment, surgical pulmonary embolectomy (SPE) remains a vital option for select patients. We review the current management of acute PE, with a focus on surgical therapy. Methods: A PubMed search was performed to identify literature regarding PE and treatment. Results were filtered to include the most comprehensive publications over the past decade. Results: PE is stratified based on presenting hemodynamic status or degree of mechanical pulmonary arterial occlusion. Although systemic or catheter- guided fibrinolysis is the preferred first-line treatment for the majority of cases, patients who are not candidates should be considered for SPE. Studies demonstrate no mortality benefit of thrombolysis over surgery. Systemic anticoagulation is a mainstay of treatment regardless of intervention approach. Following surgical embolectomy, direct oral anticoagulants (DOACs) have been shown to reduce recurrence of thromboembolism. Conclusions: Acute PE presents with varying degrees of clinical stability. Patients should be evaluated in the context of various available treatment options including medical, catheter-based, and surgical interventions. SPE is a safe and appropriate treatment option for appropriate patients.
引用
收藏
页码:65 / 71
页数:7
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