Pulmonary embolism: a practical approach to update risk stratification and treatment decisions based on the guidelines

ABSTRACT

Introduction

Pulmonary embolism (PE) is a prevalent condition with a substantial morbi-mortality worldwide. Proper risk stratification of PE is essential for identifying the most suitable therapeutic strategy and the optimal care setting for the patient. This process entails evaluating various factors, including symptoms, comorbidities, and right heart dysfunction.

Areas covered

This review assesses the tools and methods utilized to identify and stratify individuals based on the probability of developing deterioration or death related to PE. Current guidelines divide PE into three groups: high-risk (previously termed massive) PE, intermediate-risk (sub-massive) PE, and low-risk PE. Various risk scores, such as the simplified pulmonary embolism severity index (sPESI), Bova score, and the FAST score (incorporating Heart-Fatty Acid binding protein [H-ABP], Syncope, Tachycardia), aid in identifying patients at higher risk. Additionally, the Hestia score is instrumental in pinpointing low-risk patients.

Expert opinion

Presently, there is a dearth of high-quality frameworks for the optimal management and treatment of PE patients at risk of hemodynamic collapse. A consortium of experts is in the process of formulating a new conceptual model for risk stratification, taking into account a comprehensive array of variables and outcomes to facilitate more individualized management of acute PE.

KEYWORDS:

• Pulmonary embolism
• prediction tools
• prognosis
• risk stratification
• thrombolysis
• treatment

Article highlights

• Pulmonary embolism (PE) encompasses a diverse group of patients with elevated morbidity and mortality rates.

• Risk stratification for PE is essential to determinate the appropriate management.

• Intermediate-risk PE involves haemodynamically stable patients with right ventricular dysfunction.

• Current risk stratification schemes have limitations. A new conceptual model for risk stratification represents a promising avenue for individualized management of acute PE.

• Pulmonary Embolism Response Teams (PERT) offer a multidisciplinary evaluation for determining the optimal treatment of PE.

Declaration of interest

L Jara-Palomares has received grants from Leo Pharma and MSD, as well as personal fees from Daichii, Rovi, GlaxoSmithKline, and Actellion outside the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.