Risk stratification to optimize the management of acute pulmonary embolism

ABSTRACT

Introduction

Pulmonary embolism (PE) is a life-threatening disease. Risk stratification in patients with acute PE can guide clinical decisions. Clinical assessment, including hemodynamics, respiratory parameters, patient history, and right ventricle evaluation, has a pivotal role in this scope.

Areas covered

This review aims to describe: i) the role of individual tools for prognostic stratification, from simple clinical parameters to the models suggested by international guidelines; ii) the implications of risk stratification in terms of patient disposition and treatment. The bleeding risk assessment in acute PE was also reviewed. The literature search was performed in PubMed and Embase to address these issues.

Expert opinion

Prognostic assessment is essential to proceed with life-saving treatments in hemodynamically unstable patients and consider home treatment or short hospital stay in patients at low risk for death. In hemodynamically stable patients, risk stratification allows the implementation of personalized treatment pathways to reduce the risk of death, early PE recurrence, and bleeding. With the aim of optimizing healthcare resources, risk stratification may suggest appropriate patient disposition.

KEYWORDS:

• bleeding risk
• prognostic score
• pulmonary embolism
• risk stratification
• right ventricle dysfunction

Article Highlights

• Early identification and treatment of patients with acute pulmonary embolism at high risk of death can reduce mortality.

• Patients with impending hemodynamic compromise should be monitored to rapidly recognize the need for treatment upgrading.

• Clinical assessment has good accuracy in identifying patients with acute pulmonary embolism at low risk for death who may be candidates for home treatment or early discharge.

• Right ventricle assessment improves risk stratification when used in patients at low risk by means of clinical scores.

• The risk of bleeding should be assessed before starting anticoagulant therapy, but currently available scores have limited value, mainly in the acute phase.

Declaration of Interest

C Becattini has received consulting fees and honoraria for lectures by Bayer HealthCare, Bristol Myers Squibb, and Daiichi Sankyo.

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.