Pulmonary embolism: current and new treatment options

Abstract

Background:

Pulmonary embolism (PE) can be a life-threatening emergency. Accurate diagnostic techniques and patient-specific management strategies are necessary to ensure favorable clinical outcomes.

Methods:

Relevant guidelines, articles, reviews, and abstracts were identified using a narrative approach in PubMed/MEDLINE, Google Scholar, clinicaltrials.gov and nice.org.uk. English-language articles published in 2000–2014 were initially identified using the search terms: novel OAC, pulmonary embolism, venous thromboembolism, diagnosis, treatment, rivaroxaban, apixaban, dabigatran, and edoxaban. The initial literature search was supported by a ‘snowballing’ style literature search, and relevant articles were included based on a professional judgment of relevance.

Scope:

We discuss the diagnosis of PE and the categorization of risk for subgroups, which may assist with making treatment decisions. We review current guidance on acute and long-term treatment, possible limitations of traditional anticoagulant therapy, and the development of direct oral anticoagulants, which may significantly alter the management of patients with PE. Finally, we discuss special considerations in high-risk and hard-to-treat subpopulations that may benefit from the improved benefit–risk profile offered by these newer agents.

Conclusions:

The direct oral anticoagulants may overcome several of the limitations associated with traditional anticoagulant therapy, potentially improving the standard of care for PE patients, including high-risk and hard-to-manage subgroups.

Keywords::

• Anticoagulation
• Diagnosis
• Pulmonary embolism
• Treatment

Transparency

Declaration of funding

Funding for editorial support was provided by Bayer HealthCare Pharmaceuticals and Janssen Scientific Affairs LLC. The authors received no honorarium for the development of this manuscript.

Declaration of financial/other relationships

R.J.W. and L.K.M. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article. D.J. has disclosed that he has served as an advisor or consultant for Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibb, Leo Pharma, ROVI, and Sanofi; served as a speaker or a member of a speakers bureau for Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Leo Pharma, ROVI, and Sanofi; and received grants for clinical research from Sanofi and ROVI.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors wish to acknowledge Sarah Atkinson, who provided editorial support with funding from Bayer HealthCare Pharmaceuticals and Janssen Scientific Affairs LLC.