Therapeutic management of acute pulmonary embolism

ABSTRACT

Introduction: Acute pulmonary embolism (PE) is a potentially fatal manifestation of venous thromboembolism. Prompt anticoagulant treatment is crucial for PE patients, which can decrease morbidity and mortality. Risk assessment is the cornerstone of the therapeutic management of PE. It guides physicians to the most appropriate treatment and selects patients for early discharge or home treatment.

Areas covered: Here, we review the current treatments of acute PE according to contemporary risk stratification strategies, highlighting each step of PE therapeutic management.

Expert commentary: Currently, direct oral anticoagulants (DOACs) represent the first-line therapy of patients presenting with non-high risk PE with a better risk-benefit ratios than vitamin K antagonists (VKAs) due to lower risk of major bleeding. Only high-risk patients with PE who present in shock should be treated with systematic thrombolysis, while surgical thrombectomy or catheter direct thrombolysis (CDT) should only be considered when thrombolysis is contraindicated because of too high bleeding risk.

Declaration of interest

C. Tromeur reports research grants from Fondations de dotation 2016 bourse, Recherche en Santé respiratoire and Fondation du souffle and by Institut Archipel, Brest, France. F. Klok reports research grants from Bayer, BMS and Boehringer-Ingelheim as well as non-financial research support from Daiichi-Sankyo, all outside the submitted work. M. Huisman has received honoraria for presentations as well as research grants from Boehringer Ingelheim, Bayer HealthCare, Pfizer–Bristol-Myers Squibb, GlaxoSmithKline, Aspen, and Actelion Pharmaceuticals. F. Couturaud reports having received research grant support from Pfizer and fees for board memberships or symposia from Bayer and Astra Zeneca and having received travel support from Bayer, Daiichi Sankyo, Leo Pharma, Intermune and Actelion. 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.

Additional information

Funding

Cecile Tromeur is supported by fond de dotation “Recherche en santé respiratoire et fondation du souffle” and “institut archipel”, Brest, France.