Materiały źródłowe

• #1 Pulmonary embolism – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/diagnosis-treatment/drc-20354653

  Treatment of a pulmonary embolism focuses on keeping the blood clot from getting bigger and preventing new clots from forming. Prompt treatment is essential to prevent serious complications or death. […] Treatment can include medicines, surgery and other procedures, and ongoing care. […] Medicines include different types of blood thinners and clot dissolvers. […] Blood thinners. These blood-thinning medicines called anticoagulants prevent existing clots from getting bigger and new clots from forming while your body works to break up the clots. Heparin is a frequently used anticoagulant that can be given through a vein or injected under the skin. It acts quickly and is often given along with an oral anticoagulant, such as warfarin (Jantovin), until the oral medicine becomes effective. This can take several days.

• #1 Acute Management of Pulmonary Embolism

  https://www.acc.org/Latest-in-Cardiology/Articles/2017/10/23/12/12/Acute-Management-of-Pulmonary-Embolism

  Anticoagulation therapy is the primary treatment option for most patients with acute PE. The utilization of factor Xa antagonists and direct thrombin inhibitors, collectively termed Novel Oral Anticoagulants (NOACs) are likely to increase as they become incorporated into societal guidelines as first line therapy. Adoption of these newer agents may mitigate the major limitation of VKA therapy, frequently found in studies of VTE/PE to have sub-therapeutic INRs in a significant number of patients. Low molecular weight heparin is superior to unfractionated heparin in both treatment and thrombo-prophylaxis in cancer patients. This is reflected in the recommendations made by the American College of Chest Physicians who recommend the use of low molecular weight heparin on the basis of the strength of evidence available. The importance of prompt initiation of anticoagulation cannot be over emphasized; objective assessment of bleeding risk, set in the context of the risk of choosing not to use anticoagulation, should prevent overly conservative practices founded upon theoretical concerns over bleeding.

• #1 List of 15 Pulmonary Embolism Medications Compared

  https://www.drugs.com/condition/pulmonary-embolism.html

  Medications for Pulmonary Embolism […] The medications listed below are related to or used in the treatment of this condition. […] Eliquis to treat Pulmonary Embolism […] Xarelto to treat Pulmonary Embolism […] apixaban to treat Pulmonary Embolism […] rivaroxaban to treat Pulmonary Embolism […] Pradaxa to treat Pulmonary Embolism […] Arixtra to treat Pulmonary Embolism […] Activase to treat Pulmonary Embolism […] alteplase to treat Pulmonary Embolism […] dabigatran to treat Pulmonary Embolism […] fondaparinux to treat Pulmonary Embolism

• #1 Pulmonary Embolism (PE) Treatment & Management: Approach Considerations, Thrombolysis for Pulmonary Embolism, Anticoagulation for Pulmonary Embolism

  https://emedicine.medscape.com/article/300901-treatment

  Even in patients who are fully anticoagulated, however, DVT and pulmonary embolism (PE) can and often do recur. Anticoagulants are the treatment of choice in most children with pulmonary emboli. Thrombolytics are rarely used. Thrombolytic therapy should be used in patients with acute PE associated with hypotension (systolic BP 90 mm HG) who do not have a high bleeding risk. Thrombolytic therapy is suggested in select patients with acute PE not associated with hypotension and with a low bleeding risk whose initial clinical presentation or clinical course after starting anticoagulation suggests a high risk of developing hypotension. Thrombolytic therapy is not recommended for most patients with acute PE not associated with hypotension. Direct oral anticoagulants (DOACs) are now considered the first-line treatment for PE and preferred over vitamin K antagonists (VKAs) (eg, warfarin) for nearly all patients. Rivaroxaban is an oral factor Xa inhibitor approved by the FDA in November 2012 for the treatment of DVT or PE, and to reduce risk of recurrent DVT and PE following initial treatment. Pregnant patients diagnosed with DVT or pulmonary embolism may be treated with LMWH throughout their pregnancy. Warfarin is contraindicated, because it crosses the placental barrier and can cause fetal malformations. Surgical embolectomy is performed with coronary bypass or venoarterial extracorporeal membrane oxygenation (VA-ECMO). Older guidelines recommend surgical embolectomy only as salvage treatment in high-risk PE when other treatments have failed or are contraindicated. However, a 2023 scientific statement published by the American Heart Association has concluded that considering surgical embolectomy earlier may help improve survival for patients with acute high-risk PE. Catheter-directed thrombolysis delivers thrombolysis directly into the pulmonary arteries, reducing the dosage of the thrombolytic agent and the risk of bleeding. It is indicated in the treatment of intermediate- and high-risk PE. Patients with acute PE should not routinely receive vena cava filters in addition to anticoagulants. An ideal IVC filter should be easily and safely placed using a percutaneous technique, biocompatible and mechanically stable, and able to trap emboli without causing occlusion of the vena cava.

• #1 Cutting-Edge Techniques and Drugs for the Treatment of Pulmonary Embolism: Current Knowledge and Future Perspectives

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11012374/

  The introduction of DOACs radically changed PE treatment, offering a safe and effective alternative to traditional anticoagulation agents such as heparin and VKA. DOACs have a rapid onset of action, predictable pharmacokinetics, and a lower risk of major bleeding. They have been shown to be non-inferior or superior to traditional anticoagulation therapy in large randomized controlled trials (RCTs) and are now recommended as first-line therapy for most patients with acute PE. […] Fibrinolysis is currently suggested in high-risk PE, while its use in intermediate-risk is still object of debate. […] Currently, the most debated topics in VTE management are represented by (i) the optimal treatment of patients with high- or intermediate-high-risk PE, (ii) PE management in subjects at a high risk of bleeding, (iii) the assessment and management of the bleeding risk in certain populations, and (iv) the management of VTE in specific, complement-mediated diseases.

• #1 Pulmonary Embolism (PE) Medication: Anticoagulants, Thrombolytics, Direct Thrombin Inhibitors and Factor Xa Inhibitors

  https://emedicine.medscape.com/article/300901-medication

  Empiric thrombolysis may be indicated in selected hemodynamically unstable patients, particularly when the clinical likelihood of pulmonary embolism is overwhelming and the patient’s condition is deteriorating. The overall risk of severe complications from thrombolysis is low and the potential benefit in a deteriorating patient with pulmonary embolism is high. […] Rivaroxaban is indicated for treatment of PE and for prevention of recurrence (following initial 6 months of treatment). Additionally, it is indicated for a variety of treatment and prophylaxis VTE indications, including the following: […] Apixaban is indicated for treatment of PE and for prevention of recurrence (following initial 6 months of treatment). […] Dabigatran is indicated for treatment of DVT and PE in patients who have been treated with a parenteral anticoagulant for 5-10 days. It is also indicated to reduce the risk of recurrence of DVT and PE in patients who have been previously treated.

• #1 Pulmonary Embolism (PE) Medication: Anticoagulants, Thrombolytics, Direct Thrombin Inhibitors and Factor Xa Inhibitors

  https://emedicine.medscape.com/article/300901-medication

  Edoxaban is a factor Xa inhibitor indicated for treatment of DVT and PE in patients who have been initially treated with a parenteral anticoagulant for 5-10 days. […] Betrixaban is indicated for prophylaxis of venous thromboembolism (VTE) in adults hospitalized for acute medical illness who are at risk for thromboembolic complications owing to moderate or severe restricted mobility and other risk factors that may cause VTE.

• #1 DOACs: Oral Anticoagulant Treatment of Choice for Pulmonary Embolism? – Endovascular Today

  https://evtoday.com/articles/2019-july-supplement/doacs-oral-anticoagulant-treatment-of-choice-for-pulmonary-embolism

  The choice of DOAC must be made in the context of the specific patient, and DOACs are either contraindicated or have not yet been extensively evaluated in certain patient populations. […] The treatment of patients with active malignancy and VTE can be challenging. Present evidence indicates that, at least in the short term, edoxaban and rivaroxaban seem as effective as standard anticoagulation with dalteparin. […] No DOACs have been evaluated during pregnancy. There is evidence that they are present in breast milk. For this reason, they are best avoided during pregnancy and breastfeeding. […] Patients with liver impairment should not receive DOACs because the international normalized ratio may be prolonged due to liver synthetic defect during the course of treatment. […] VTE is a common disorder and is associated with significant morbidity and mortality. DOACs have emerged as the treatment of choice for many patients given their convenience, predictable pharmacokinetics and pharmacodynamics, and their similar effectiveness in reducing VTE compared to VKAs, with significantly less major bleeding.

• #1 Pulmonary Embolism: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17400-pulmonary-embolism

  If a PE is life-threatening, or if other treatments aren’t working, your provider may recommend using surgery or a catheter to remove the blood clot from your pulmonary artery. Thrombolytic therapy is another option. […] Thrombolytic medications (clot busters), including tissue plasminogen activator (TPA), dissolve the clot. […] Bleeding is a possible side effect of medications for pulmonary embolism treatment. […] You should feel better within a week of treatment. But a pulmonary embolism can take months or years to go away completely. […] You’ll need to take a blood thinner for three to six months or longer. Don’t stop taking it unless your provider instructs you to. […] Follow their recommendations to reduce the risk of another PE.

• #1 Pulmonary Embolism – Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/pulmonary-embolism-treatment/

  Anticoagulation should be continued for a minimum of 3 months, after which risk/benefits of treatment should be re-assessed. […] If thrombolysis required, IV unfractionated heparin (UFH) preferred. Otherwise, choice of anticoagulant should not depend on severity of PE or clot burden. […] Generally, DOACs are preferred over warfarin (lower risk of bleeding), unless contraindications. […] Thrombolysis is generally only indicated for massive PE. […] If patient has submassive PE, with persistent signs/symptoms of right heart failure or cardiopulmonary deterioration: consult hematologist/internal medicine. […] Thrombolytic therapy can be completed with recombinant tPA (rt-PA), OR tenecteplase. […] Considered with massive PE in consultation with a specialist in multidisciplinary setting. Lower risk of bleeding compared to systemic thrombolytic therapy.

• #1 Acute Management of Pulmonary Embolism

  https://www.acc.org/Latest-in-Cardiology/Articles/2017/10/23/12/12/Acute-Management-of-Pulmonary-Embolism

  There are no comparative studies or societal recommendations to suggest the type, dose and duration of anticoagulation therapy or antiplatelet therapy following catheter based endovascular therapies with or without angioplasty and stenting. Current recommendations suggest therapy based on VTE stratification: 1) VTE associated with reversible risk factor or „provoked” DVT (at least 3 months); 2) unprovoked or recurrent VTE (6 to 12 months); and 3) VTE in the setting of cancer (indefinitely with LMWH). […] VTE is increasingly recognized as a cause of significant morbidity and mortality in the United States. An interventional approach to managing both acute LE-iliofemoral DVT and massive and submassive PE has great promise. There remains a paucity of robust long-term evidence, particularly addressing safety outcomes in therapies utilizing drugs and delivery systems that can result in bleeding complications. A highly individualized approach encompassing patient selection, type of therapy, operator and hospital level of experience should be followed to maximize the benefits of an interventional strategy as well as minimize the risk of harm.

• #1 Deep Venous Thrombosis and Pulmonary Embolism: Current Therapy | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0301/p295.html

  If there are no contraindications, current guidelines recommend anticoagulation for a minimum of three months for PE and proximal DVT. […] Extended anticoagulation is recommended for patients with an unprovoked VTE and low risk of bleeding. […] Indefinite anticoagulation is recommended for patients with a second VTE and low or moderate risk of bleeding.

• #1 Pulmonary embolism – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/pulmonary-embolism/

  The selection of the initial anticoagulant depends on the severity of the PE, patient comorbidities, and/or planned concurrent treatment. […] Long-term anticoagulation with LMWH is preferred over VKA in patients with cancer if a DOAC cannot be used. […] Reassess the need for anticoagulation after 3 months, then annually. […] Thrombolysis for PE is associated with a high risk of major bleeding. […] Systemic thrombolytic therapy: alteplase 100 mg IV over 2 hours. […] Consult interventional radiology and/or surgery to perform embolectomy for PE.

• #1 Pulmonary embolism – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/diagnosis-treatment/drc-20354653

  Newer oral anticoagulants work more quickly and have fewer interactions with other medicines. Some have the advantage of being given by mouth until they’re effective, without the need for heparin. However, all anticoagulants have side effects, and bleeding is the most common. […] Clot dissolvers. While clots usually dissolve on their own, sometimes thrombolytics medicines that dissolve clots given through a vein can dissolve clots quickly. Because these clot-busting medicines can cause sudden and severe bleeding, they usually are reserved for life-threatening situations. […] If you have a large, life-threatening clot in your lung, your health care provider may remove it using a thin, flexible catheter threaded through your blood vessels. […] A catheter also can be used to position a filter in the body’s main vein, the inferior vena cava, that leads from your legs to the right side of your heart. The filter can help keep clots from going to your lungs. This procedure is usually only used for people who can’t take anticoagulant drugs or those who get blood clots even with the use of anticoagulants. Some filters can be removed when no longer needed.

• #1 Acute pulmonary embolism in adults: Thrombolytic therapy in intermediate- and high-risk patients – UpToDate

  https://www.uptodate.com/contents/acute-pulmonary-embolism-in-adults-thrombolytic-therapy-in-intermediate-and-high-risk-patients

  Acute pulmonary embolism in adults: Thrombolytic therapy in intermediate- and high-risk patients […] Thrombolytic therapy is used in patients with acute pulmonary embolism (PE) to rapidly dissolve thrombus and improve cardiorespiratory hemodynamics. While anticoagulant therapy is sufficient in most patients, a select proportion may benefit from thrombolytic therapy. However, it is associated with bleeding, which can be catastrophic. Thus, careful patient selection is critical to the success of this therapy. […] Should the diagnosis be confirmed? — Because the adverse effects of thrombolytic therapy-related bleeding can be devastating, we prefer that the diagnosis of acute PE be confirmed on radiographic imaging. […] During emergencies, when PE is highly suspected but not diagnosed and obtaining imaging is unsafe or not available, thrombolytic therapy may be administered if a presumptive diagnosis is made with bedside transthoracic echocardiography (TTE) or transesophageal echocardiography that shows right ventricular (RV) enlargement/hypokinesis and/or regional wall motion abnormalities that spare the RV apex (McConnell sign). […] Rarely, thrombolytic therapy may be administered in the absence of imaging using an empiric clinical diagnosis during cardiopulmonary resuscitation.

• #1 Pulmonary embolism – Wikipedia

  https://en.wikipedia.org/wiki/Pulmonary_embolism

  In recent years, many anticoagulants have been introduced that offer similar to warfarin but without a need for titration to the INR. […] Anticoagulation therapy is usually continued for 36 months, or „lifelong” if there have been previous DVTs or PEs, or none of the usual transient risk factors is present. […] Massive PE causing hemodynamic instability (shock and/or low blood pressure, defined as a systolic blood pressure 90 mmHg or a pressure drop of 40 mmHg for 15 min if not caused by new-onset arrhythmia, hypovolemia, or sepsis) is an indication for thrombolysis, the enzymatic destruction of the clot with medication. […] Catheter-directed thrombolysis (CDT) is a new technique found to be relatively safe and effective for massive PEs. […] There are two situations when an inferior vena cava filter is considered advantageous, and those are if anticoagulant therapy is contraindicated (e.g. shortly after a major operation), or a person has a pulmonary embolus despite being anticoagulated. […] Surgical management of acute pulmonary embolism (pulmonary thrombectomy) is uncommon and has largely been abandoned because of poor long-term outcomes.

• #1 Cutting-Edge Techniques and Drugs for the Treatment of Pulmonary Embolism: Current Knowledge and Future Perspectives

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11012374/

  Pulmonary embolism (PE) is a potentially life-threatening condition requiring prompt diagnosis and treatment. Recent advances have led to the development of newer techniques and drugs aimed at improving PE management, reducing its associated morbidity and mortality and the complications related to anticoagulation. This review provides an overview of the current knowledge and future perspectives on PE treatment. Anticoagulation represents the first-line treatment of hemodynamically stable PE, direct oral anticoagulants being a safe and effective alternative to traditional anticoagulation: these drugs have a rapid onset of action, predictable pharmacokinetics, and low bleeding risk. Systemic fibrinolysis is suggested in patients with cardiac arrest, refractory hypotension, or shock due to PE.

• #1 Acute Pulmonary Embolism Treatment Options | Temple Health

  https://www.templehealth.org/services/conditions/acute-pulmonary-embolism/treatment-options

  There are several ways to treat an acute pulmonary embolism, including lifestyle changes, medications and surgery. Your doctor will work with you to determine which approach will yield the best results for you. […] Blood thinners, such as Heparin, are prescribed to prevent new clots from forming while your body works to break up existing clots. These medications can work quickly and are often taken for several days with an oral anticoagulant, such as warfarin. […] In addition, clot dissolvers, such as Streptokinase, are prescribed to quickly dissolve the existing clots. Because these medications can cause sudden and severe bleeding, they usually are reserved for life-threatening situations. […] When lifestyle changes and medications do not reduce the frequency or severity of your symptoms, you may require surgery.

• #1 Acute Management of Pulmonary Embolism

  https://www.acc.org/Latest-in-Cardiology/Articles/2017/10/23/12/12/Acute-Management-of-Pulmonary-Embolism

  Careful patient selection should be the foundation upon which an individualized endovascular strategy is adopted in clinical practice. Systemic thrombolysis is associated with lower all-cause mortality in patients with massive PE and should be the treatment of choice in this subset of patients. Current US and European societal guidelines recommend endovascular treatment strategies in the event of treatment failure in this subset of patients. A pulmonary embolism response team (PERT) approach, whereby a multi-disciplinary team determines the optimal course of action in critically ill patients with massive PE, should be considered when extracorporeal membrane oxygenation (ECMO) and/or surgical pulmonary embolectomy can be life-saving alternatives. In submassive PE, use of systemic thrombolysis is associated with a mortality benefit yet significantly increases the risk of major bleeding, including intracranial hemorrhage. For this subset of patients ACCP guidelines currently recommend systemic thrombolytic therapy when cardiopulmonary deterioration is evident yet frank hypotension has not occurred. The ACC/AHA guidelines suggest that catheter embolectomy can be considered when cardiopulmonary deterioration is evident or in submassive PE when patients have clinical evidence of adverse prognosis.

• #1 Cutting-Edge Techniques and Drugs for the Treatment of Pulmonary Embolism: Current Knowledge and Future Perspectives

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11012374/

  Catheter-directed thrombolysis (CDT) is a minimally invasive technique that involves the insertion of a catheter into the pulmonary artery to deliver a thrombolytic agent, such as rtPA, directly to the site of the blood clot, aiming to quickly restore the lung perfusion. […] European (ESC) and American (AHA) guidelines suggest considering CDT use in patients with high- or intermediate-high risk PE associated with hemodynamic and respiratory deterioration despite anticoagulation, but also in subjects with high-risk PE with contraindications to systemic rtPA or in whom systemic fibrinolysis has failed.

• #1 Acute Management of Pulmonary Embolism

  https://www.acc.org/Latest-in-Cardiology/Articles/2017/10/23/12/12/Acute-Management-of-Pulmonary-Embolism

  For patients without an absolute contraindication to systemic thrombolysis, ultrasound-assisted catheter-directed thrombolysis (UA-CDT) can be considered. Low energy ultrasound disaggregates fibrin within acute thrombi, this is exploited by the EKOS device, which combines emission of low energy ultrasound and infusion of a thrombolytic agent via a multi side-hole containing catheter. This strategy has been evaluated in the ULTIMA trial, which demonstrated superiority to anticoagulation alone in improving hemodynamics without a significant increase in bleeding complications. […] Given the available evidence for UA-CDT in the treatment of acute PE, the use of an ultrasound assisted CDT strategy should be explored on a highly individualized basis. The common femoral vein should be accessed with a 6F single lumen sheath for unilateral therapy or two 6F sheaths or single 10F dual lumen sheath for bilateral therapy. Standard right heart catheterization with simultaneous mixed venous and systemic oxygen saturation should be obtained. A 0.035 inch guide wire along with a standard diagnostic angiographic catheter should be used to cross the diseased segment.

• #1 Pulmonary Embolism | Deep Vein Thrombosis | MedlinePlus

  https://medlineplus.gov/pulmonaryembolism.html

  Procedures: Catheter-assisted thrombus removal uses a flexible tube to reach a blood clot in your lung. Your health care provider can insert a tool in the tube to break up the clot or to deliver medicine through the tube. Usually you will get medicine to put you to sleep for this procedure. […] A vena cava filter may be used in some people who cannot take blood thinners. Your health care provider inserts a filter inside a large vein called the vena cava. The filter catches blood clots before they travel to the lungs, which prevents pulmonary embolism. But the filter does not stop new blood clots from forming.

• #1 Interventional therapies for pulmonary embolism | Nature Reviews Cardiology

  https://www.nature.com/articles/s41569-023-00876-0

  CDT, USCDT and pharmacomechanical CDT reduce the dose of thrombolytics used, whereas aspiration thrombectomy eliminates the use of thrombolytics. […] Large, adequately powered, randomized controlled trials investigating low-dose thrombolysis, CDT, USCDT and large-bore thrombectomy are ongoing and more are planned.

• #1 Cutting-Edge Techniques and Drugs for the Treatment of Pulmonary Embolism: Current Knowledge and Future Perspectives

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11012374/

  In the acute phase, several studies have explored the role of mechanical (MT) and catheter-directed thrombolysis (CDT) in the context of massive or submassive PE, and several devices are currently under investigation. […] Both MT and CDT seem effective in treating patients with intermediate- or high-risk PE. However, more information from larger trials is required to completely support their use. […] MT is currently reserved for patients with massive PE with hemodynamic impairment in whom thrombolysis failed, in pregnancy, or with other contraindications to systemic thrombolysis. […] CDT is a minimally invasive technique that involves the delivery of thrombolytic agents directly into the pulmonary arteries via catheterization, which can dissolve the clot, reduce bleeding risk, and improve hemodynamics in subjects with massive and submassive PE.

• #1 Acute Management of Pulmonary Embolism

  https://www.acc.org/Latest-in-Cardiology/Articles/2017/10/23/12/12/Acute-Management-of-Pulmonary-Embolism

  The role of inferior vena cava filters (IVCF) in the contemporary management of acute VTE has not been truly defined owing to a paucity of high quality evidence. At present the benefit of IVCF use seems to be in reducing the risk of acute PE in patients who have a clear contraindication to anticoagulation in the form of active bleeding. In the absence of such a contraindication there appears to be no clear benefit and non-retrieval of IVCF exposes the patient to risk of recurrent VTE, PTS and other mechanical complications such as filter fracture or migration. […] Several percutaneous approaches have been used alone or in combination in patients with an absolute contraindication to thrombolysis. These include: thrombus fragmentation with a rotating pigtail catheter; aspiration thrombectomy; rheolytic thrombectomy; and suction embolectomy. Thrombus fragmentation techniques using balloon angioplasty or rotation of pigtail catheters are probably the earliest examples of catheter-based intervention for acute PE. This technique is rarely utilized as a stand-alone procedure and carries a significant risk of distal and proximal embolization. Advanced fragmentation catheters such as the Amplatzer-Helix thrombectomy catheter improves upon clot fragmentation through use of an impeller to macerate the thrombus but lacks the capability of aspirating the resultant debris and cannot be advanced over a wire.

• #1 Pulmonary Embolism and CTEPH

  https://www.uofmhealth.org/conditions-treatments/pulmonary-embolism-and-cteph

  At the University of Michigan Health, pulmonary embolism patients are treated with a specialized multidisciplinary team-based approach. […] Our ability to work in a multidisciplinary fashion differentiates our program and allows patients access to various specialists and therapies. […] Acute PE often needs immediate treatment with clot busters and blood thinning medications. […] Patients with a pulmonary embolism can be treated with blood thinners, also known as anticoagulants. These medications can be given intravenously or by mouth. Blood thinners help our body to break down existing blood clots and prevent new clots from forming. […] Catheter-directed thrombolysis is a minimally invasive treatment to dissolve vascular blood clots and improve blood flow to prevent damage to tissues and organs. […] Catheter-based thrombus removal, or thrombectomy, involves a novel thin tube, or catheter, used to remove large blood clots from an artery.

• #1

  https://www.thompsonhealth.com/Health-Services/Diagnostic-Imaging/Interventional-Radiology/DVT-PE-Treatment

  The FlowTriever procedure is a clinically proven, minimally-invasive and safe approach for intermediate-risk and high-risk pulmonary embolism patients. The procedure is typically a one-hour, single session procedure that is completed under conscious sedation. The device disrupts and aspirates the clot using nitinol mesh disks and catheters to rapidly remove the clot and restore blood flow. […] Patients now have a safer, less invasive option for the treatment of pulmonary embolism that can immediately relieve their symptoms and improve their vital signs, with low bleeding risk, immediate symptom improvement and faster patient recovery. […] F.F. Thompson Hospital is among the first in the region to use FlowTriever for the treatment of pulmonary embolism. The FlowTriever is the first mechanical thrombectomy device FDA indicated, and purpose built for the treatment of pulmonary embolism, removing large clots from large vessels such as the pulmonary arteries, without the need for thrombolytic drugs and consequent ICU stay.

• #1 Management of patients with high-risk pulmonary embolism: a narrative review | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-018-0286-8

  Thrombolytic treatment of acute PE restores pulmonary perfusion more rapidly than anticoagulation with UFH alone. […] Catheter-directed treatment (CDT) can be performed as an alternative to thrombolysis when a patient has absolute contraindications to thrombolysis, as adjunctive therapy when thrombolysis has failed to improve hemodynamics, or as an alternative to surgery if immediate access to cardiopulmonary bypass is unavailable. […] Traditionally, surgical embolectomy has been reserved for patients with PE who may need cardiopulmonary resuscitation. It is also performed in patients with contraindications or inadequate responses to thrombolysis and in those with patent foramen ovale and intracardiac thrombi. […] In general, inferior vena cava (IVC) filters are indicated in patients with acute PE who have absolute contraindications to anticoagulant drugs and in patients with objectively confirmed recurrent PE despite adequate anticoagulation treatment.

• #1 Percutaneous interventions for pulmonary embolism | EuroIntervention

  https://eurointervention.pcronline.com/article/percutaneous-interventions-for-pulmonary-embolism

  Surgical embolectomy is a potential treatment option for high-risk PE patients who cannot receive systemic thrombolysis due to contraindications or for whom this therapy previously failed. […] Surgical embolectomy is recommended for cases with a high proximal thrombus burden, thrombus in transit, paradoxical embolism, or haemodynamic instability, as it can improve RV function similarly to thrombolysis, with comparable 30-day mortality and 5-year survival rates. […] In recent years, percutaneous catheter-based approaches have gained attention as an alternative to anticoagulation, systemic thrombolysis, and surgical embolectomy, due to their lower risk and potential benefits. […] These approaches provide a minimally invasive treatment option for high-risk PE patients who have a contraindication to systemic thrombolysis or in whom this therapy has failed. Factors such as overall patient condition, operator experience, local availability, and thrombus burden and location should be considered when selecting the appropriate approach.

• #1 Acute Pulmonary Embolism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560551/

  Surgical embolectomy is usually indicated in a patient with hemodynamically unstable PE in whom thrombolysis (systemic or catheter-directed) is contraindicated or in patients with failed thrombolysis. […] The aim of anticoagulation after the acute management of PE is to complete the treatment of the acute episode and prevent the recurrence of VTE over the long term.

• #1 Advanced Management Options for Massive and Submassive Pulmonary Embolism | USC Journal

  https://www.uscjournal.com/articles/advanced-management-options-massive-and-submassive-pulmonary-embolism?language_content_entity=en

  Surgical embolectomy is an open surgical procedure in which clots are removed from the right atrium or ventricle or main/proximal pulmonary arteries. It is indicated in patients with massive PE (and possibly in select patients with submassive PE) who have a contraindication to thrombolysis or when thrombolysis or catheter-based mechanical clot disruption has failed. […] In patients with acute PE who cannot safely receive anticoagulation, placement of an inferior vena cava (IVC) filter is indicated (even in the absence of lower extremity clot).

• #1 Management of PE

  https://www.acc.org/Latest-in-Cardiology/Articles/2020/01/27/07/42/Management-of-PE

  Anticoagulation should be initiated as soon as the diagnosis of PE is suspected. Unfractionated heparin may be preferred in patients who are candidates for further advanced therapies such as thrombolysis, catheter-directed thrombolytics or embolectomy, or surgical embolectomy because it provides more flexibility for procedures. Direct oral anticoagulants are first-line therapy for low-risk patients and intermediate- and high-risk patients once they have achieved hemodynamic stability. Systemic thrombolytic therapy should be considered in massive PE due to observed reduction in mortality and recurrence. […] Surgical embolectomy is recommended in patients with high-risk or intermediate-high-risk PE with absolute contraindications to thrombolytic therapy, failed thrombolytic therapy, or cardiogenic shock that may cause death prior to thrombolytic therapy.

• #1 Pulmonary Embolism (PE) – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/pulmonary-embolism/pulmonary-embolism-pe

  Surgical embolectomy is reserved for patients with PE who are hypotensive despite supportive measures or on the verge of cardiac or respiratory arrest. […] Extracorporeal membrane oxygenation (ECMO) is sometimes used in catastrophic acute pulmonary embolism when thrombolysis is contraindicated or failed.

• #1 Deep Vein Thrombosis & Pulmonary Embolism | UC San Diego Health

  https://health.ucsd.edu/care/heart-vascular/deep-vein-thrombosis-pulmonary-embolism/

  In these situations, the following therapies may be recommended: Tissue plasminogen activator (tPA): A clot-dissolving medication. […] Ultrasonic catheter: Administered by an interventional radiologist. Helps break up clots with ultrasonic waves. Often used jointly with tPA. […] Surgical embolectomy: Blood clot is removed with surgery. […] Vacuum catheter: A tiny vacuum is threaded through the veins and used to draw out blood clots. […] Inferior vena cava (IVC) filter: A small, cone-shaped device designed to catch blood clots is implanted by an interventional radiologist in the inferior vena cava, the large vein that carries blood back to the heart, using a catheter. This minimally invasive procedure is done while the patient is awake. […] An IVC filter can be permanently or temporarily implanted. While an IVC filter cannot prevent new blood clots from forming, it can help prevent deep venous thrombosis from moving into your lungs.

• #1 Pulmonary Embolism – Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/pulmonary-embolism-treatment/

  If thrombolysis is contraindicated, surgical embolectomy may be considered. […] Patients should receive therapy for 3-6 months, and may be extended if: Concurrent systemic chemotherapy, Metastatic disease, Progressive/relapsed disease, Other prothrombotic risk factors. […] LMWH or UFH are safe during pregnancy. LMWH is the drug of choice unless: Patient has heparin induced thrombocytopenia (HIT) /history of HIT, Severe renal dysfunction. […] Anticoagulation should be continued for a minimum of 3 months. Often continued until at least 6 weeks postpartum due to increased risk of VTE in pregnancy. […] Warfarin is contraindicated in pregnancy, okay during breastfeeding. […] DOACs should be avoided in pregnancy and breastfeeding. […] Patients with massive PE, or those receiving thrombolytic treatment are generally placed in the ICU. Patients deemed to be low-risk and are able to adhere to treatment are generally treated as outpatients and are discharged.

• #1 Pulmonary embolism: An update

  https://www.racgp.org.au/afp/2017/november/pulmonary-embolism

  LMWH reduces complications and thrombus size, compared with unfractionated heparin, for the initial treatment of VTE without altering mortality. The Therapeutic Guidelines recommendations for the treatment of acute pulmonary embolism are dalteparin 200 U/kg, up to 18,000 U daily or 100 U/kg, up to 9000 U twice daily; or enoxaparin 1.5 mg/kg daily or 1 mg/kg twice daily. Twice-daily dosing is preferred if the risk of bleeding or thrombus extension is high (eg older age, obesity, malignancy). If creatinine clearance is 30 mL/min, dose adjustment is required. […] The ACCP recommends that clinical surveillance is preferred to anticoagulation for patients with SSPE (no involvement of proximal pulmonary arteries) and no proximal DVT with low risk for recurrent VTE. The ACCP adds that ultrasound scanning of the deep veins in both legs should be performed to exclude proximal DVT, and that clinical surveillance may be supplemented by serial ultrasound scanning.

• #1 Pulmonary Embolism – Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/pulmonary-embolism-treatment/

  Pulmonary Embolism – Treatment […] Up to 10% of symptomatic PE result in death within 1 hour of symptom onset. Early diagnosis and treatment reduce morbidity and mortality for the rest. […] Administer O2 to keep SaO2 > 90%, including high-flow O2, or mechanical ventilation if indicated (i.e. cardiac arrest). […] High pre-test probability (PTP) (Wells Score ≥ 6) – promptly initiate anticoagulation, unless bleeding risk is high. […] Intermediate PTP (Wells Score 2 – 5.5) – treatment can be withheld if diagnostic imaging within 4 hours. […] Low PTP (Wells Score ≤ 1.5) – treatment can be withheld if diagnostic imaging within 24 hours. […] Stratify to inpatient vs outpatient management using Pulmonary Embolism Severity Index (PESI) or simplified PESI (sPESI). […] Consider outpatient management for very low- or low-risk patients: PESI = Class I or II OR sPESI = 0.

• #1 Management of patients with high-risk pulmonary embolism: a narrative review | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-018-0286-8

  Large hospitals having an intensive care unit should preemptively establish diagnostic and therapeutic protocols and rehearse multidisciplinary management for patients with high-risk PE. Coordination with a skilled team comprising intensivists, cardiologists, cardiac surgeons, radiologists, and other specialists is crucial to maximize success. […] Acute RV failure with resulting low systemic output is the leading cause of death in patients with high-risk PE. Therefore, supportive treatment is of vital importance in patients with PE who develop shock. […] Hypoxia is usually reversed with administration of oxygen. […] Experimental evidence suggests that extracorporeal membrane oxygenation (ECMO) support can be an effective procedure in patients with PE-induced circulatory collapse. […] Anticoagulant treatment plays a pivotal role in the management of patients with PE.

• #1 Pulmonary embolism – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/diagnosis-treatment/drc-20354653

  Because you may be at risk of another deep vein thrombosis or pulmonary embolism, it’s important to continue treatment, such as remaining on anticoagulants and being monitored as often as suggested by your health care provider. Also, keep regular visits with your provider to prevent or treat complications.

• #1 DOACs: Oral Anticoagulant Treatment of Choice for Pulmonary Embolism? – Endovascular Today

  https://evtoday.com/articles/2019-july-supplement/doacs-oral-anticoagulant-treatment-of-choice-for-pulmonary-embolism

  With multiple anticoagulant options now available, including the DOACs that do not require an initial parenteral agent, inpatient versus outpatient management of PE has become a part of the initial assessment. […] Duration of anticoagulation should be individualized for each patient and should include the initial and periodic assessment of risk factors for recurrent VTE (transient or persistent) as well as age, sex, obesity, and organ function (liver and kidney). […] Importantly, anticoagulation duration should be assessed at least annually, considering risk for VTE recurrence is 7% within the first year and 40% within 5 years. […] All anticoagulants including the DOACs are associated with bleeding, which in rare situations can be life-threatening. Currently, there are two FDA-approved DOAC-specific reversal agents: idarucizumab for dabigatran and andexanet for rivaroxaban and apixaban.

• #1 Deep Venous Thrombosis and Pulmonary Embolism: Current Therapy | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0301/p295.html

  For patients with recurrent VTE while taking a low-molecular-weight heparin, the dose should be increased by 25% to 33% (weak recommendations based on moderate to poor quality evidence per the ACCP grading system). […] Because of the high risk of bleeding, thrombolysis is restricted to specific circumstances. Expert consensus guidelines support thrombolytic therapy in patients with persistent hypotension or shock secondary to acute PE. […] The risk of VTE recurrence is greatest in the first year after the event and remains elevated indefinitely compared with the general population. […] Long-term anticoagulation reduces the risk of recurrent VTE but results in more bleeding events. Considering this trade-off, it is critical that the duration of anticoagulation therapy be individualized based on the patient’s risk of recurrence vs. risk of bleeding.

• #1 Pulmonary Embolism and CTEPH

  https://www.uofmhealth.org/conditions-treatments/pulmonary-embolism-and-cteph

  This procedure involves a vein filter implanted via a thin wire into the vena cava, the main vein leading from the legs to the right side of the heart. […] In patients with more chronic and well organized clot, Balloon Pulmonary Angioplasty (BPA) is performed to relieve obstruction using special catheter-based balloons delivered over a thin wire in the lung arteries. […] Pulmonary endarterectomy (PEA) is the treatment of choice for appropriate CTEPH patients to relieve pulmonary artery blockages. […] Not all CTEPH patients are eligible for this surgery. Balloon pulmonary angioplasty (BPA) and medications are also available for CTEPH patients who are not candidates for PEA surgery or who continue to have pulmonary hypertension after surgery. […] Pulmonary rehabilitation helps patients regain strength and endurance following treatment for a pulmonary embolism.

• #1 Pulmonary embolism – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/symptoms-causes/syc-20354647

  A pulmonary embolism can be life-threatening. However, prompt treatment greatly reduces the risk of death. […] Preventing clots in the deep veins in your legs will help prevent pulmonary embolisms. For this reason, most hospitals are aggressive about taking measures to prevent blood clots, including: […] Blood thinners (anticoagulants). These medicines are often given to people at risk of clots before and after surgery. […] Compression stockings. Compression stockings steadily squeeze the legs, helping veins and leg muscles move blood more efficiently. […] Physical activity. Moving as soon as possible after surgery can help prevent pulmonary embolism and hasten recovery overall. […] Pneumatic compression. This treatment uses thigh-high or calf-high cuffs that automatically inflate with air and deflate every few minutes. This massages and squeezes the veins in your legs and improves blood flow.

• #1 Pulmonary Embolisms: Causes, Symptoms & Treatment | Tampa General Hospital

  https://www.tgh.org/institutes-and-services/conditions/pulmonary-embolism

  A patient may be asked to make changes to their current lifestyle or certain habits. For example, wearing compression socks can help improve blood flow and prevent blood from pooling in the legs. Quitting smoking, maintaining a healthy weight and eating a balanced diet are other changes that may be recommended. […] In emergency situations, a surgeon may remove a large blood clot from the lung using a catheter inserted into the affected blood vessel. This procedure is called a pulmonary embolectomy and has a high success rate. […] Another surgical option called inferior vena cava filter implantation involves an umbrella-shaped device implanted in the deep veins of the lower extremities to prevent clots from traveling to the lungs. Patients who cant take blood thinners or continue to clot despite the use of anticoagulants are often candidates for this procedure. In general, this procedure has a high success rate of preventing clots from moving into the lungs. Implant retrieval procedures are generally highly successful as well.

• #1 Management of PE

  https://www.acc.org/Latest-in-Cardiology/Articles/2020/01/27/07/42/Management-of-PE

  The incidence of venous thromboembolism (VTE), including pulmonary embolism (PE) and deep venous thromboembolism (DVT), in the United States is unclear because there is no national surveillance system. However, PE is considered to be the third most common cause of cardiovascular death, with 60,000-100,000 deaths per year. Treatment varies depending on the severity of the disease and the center’s expertise and resources. A consensus document was recently issued by the Pulmonary Embolism Response Team (PERT) Consortium, which endorses a PERT approach to high- and intermediate-risk cases by a multidisciplinary team. This team includes, but is not limited to, cardiac surgery, cardiology, hematology, critical care, vascular medicine, vascular surgery, and radiology specialists who discuss complex cases and expedite treatment decisions.

• #1 Percutaneous interventions for pulmonary embolism | EuroIntervention

  https://eurointervention.pcronline.com/article/percutaneous-interventions-for-pulmonary-embolism

  Risk assessment is crucial to determining the appropriate management for patients with PE. For high-risk cases (i.e., massive PE) accompanied by haemodynamic instability, an immediate referral for reperfusion treatment via an emergency management algorithm is necessary. This includes systemic thrombolysis, surgical embolectomy, or percutaneous catheter-directed treatments, with or without mechanical haemodynamic support. […] Thrombolytic therapy either systemic (most common) or directed by a catheter into the pulmonary arteries can restore pulmonary circulation, relieve RV afterload, and improve systemic oxygenation and overall haemodynamics. High-risk patients with haemodynamic compromise account for about 5% of the total PE cases and represent the subgroup at the highest risk for early mortality (about 50%), making them the ones who stand to benefit most from thrombolytic therapy.

• #1 Management of PE

  https://www.acc.org/Latest-in-Cardiology/Articles/2020/01/27/07/42/Management-of-PE

  In patients with high-risk PE and cardiogenic shock, cardiac arrest, or impending hemodynamic collapse, further mechanical support should be considered. Venoarterial extracorporeal membrane oxygenation (VA ECMO) is effective when used in combination with any of the above treatments with good survival rates and low complication risks. […] In patients with PE who cannot tolerate anticoagulation, current guidelines recommend the use of inferior vena cava filters. The addition of inferior vena cava filters to anticoagulation has not been demonstrated to be beneficial in prospective trials but may be considered in patients with large, mobile, or proximal DVT. […] PE is a common clinical problem with varied manifestations ranging from benign to fatal. Given the complexities of diagnostic, stabilization, and treatment modalities, a rapidly assembled and collaborative multi-disciplinary approach is helpful. Further development of treatment options and randomized clinical trials are needed to delineate optimal approaches for these patients. The consensus document published by the PERT consortium provides a foundation for the decision-making required for these patients.

• #1 Interventional therapies for pulmonary embolism | Nature Reviews Cardiology

  https://www.nature.com/articles/s41569-023-00876-0

  Patients with low-risk or intermediate-low-risk PE benefit from anticoagulation alone, whereas treatment of patients with intermediate-high-risk or high-risk PE poses difficulties; systemic thrombolysis is the first-line recommendation for patients with high-risk PE but is associated with severe adverse events, especially bleeding. […] In patients with intermediate-high-risk PE and those with high-risk PE and contraindications to thrombolysis, interventional therapies, such as catheter-directed thrombolysis (CDT), ultrasound-assisted CDT (USCDT), pharmacomechanical CDT and aspiration thrombectomy, are possible options. […] Despite showing promising results in reducing right ventricular dysfunction and relief of haemodynamic compromise in small studies and registries, these interventional therapies have not been rigorously investigated in adequately powered randomized controlled trials.

• #1 Future Perspectives on Pulmonary Embolism Treatment | ICR Journal

  https://www.icrjournal.com/articles/limitations-and-future-perspectives-pulmonary-embolism-so-far-so-good?language_content_entity=en

  As for intermediate- to high-risk PE, in the haemodynamically setting, the role of the PE response team is fundamental in identifying clinical nuance that may inform the choice of CDT or conservative treatment for individual patients. […] PE bail-out intervention on top of systemic thrombolysis is associated with a higher bleeding rate and although the lysis itself may be ineffective, the consistency of the thrombus changes, becoming more friable. […] From a technical point of view, the timing of PE (and deep vein thrombosis) is not always easy to define in intermediate- to high-risk patients. Thrombus composition is crucial for safety and efficacy. […] In addition to expected new evidence from the upcoming trials, the increasing complexity of medicine warrants decision-making guidance from multidisciplinary teams. To this end, some institutions have created PE response teams consisting of emergency medicine physicians, interventional radiologists, cardiologists and pulmonologists.

• #1 Pulmonary Embolism (PE) – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/pulmonary-embolism/pulmonary-embolism-pe

  Pulmonary embolism treatment is with anticoagulants and, sometimes, clot dissolution with systemic or catheter-directed thrombolysis or by removal of the clot via catheter suction thrombectomy or surgical resection. […] Rapid reduction of clot burden via thrombolytic therapy or embolectomy is indicated for patients with hypotension that does not resolve after fluid resuscitation, and for selected patients with impaired RV function or escalating oxygen requirements. […] Anticoagulation is the mainstay of therapy for PE. […] Placement of a removable percutaneous inferior vena cava filter (IVCF) should be considered for patients with contraindications to anticoagulation or for those with recurrent PE despite anticoagulation. […] Patients at low risk should receive anticoagulation alone.

• #1 Treatment for Patients With Acute Pulmonary Embolism Diagnosed in Primary Care | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1100/letter-acute-pulmonary-embolism.html

  Evidence shows that patients with acute pulmonary embolism (PE) can be treated as outpatients effectively and safely. Guidelines recommend outpatient treatment for patients who meet low-risk criteria; however, eligibility criteria vary. The American College of Chest Physicians recommends outpatient care for adults who meet the following criteria: (1) clinically stable with good cardiopulmonary reserve; (2) no contraindications such as recent bleeding, severe renal or liver disease, or severe thrombocytopenia (i.e., 50,000 per mm3); (3) expected to be compliant with treatment; and (4) the patient feels well enough to be treated at home. The patient must also have access to treatment and follow-up care. […] This study is the first to demonstrate that outpatient treatment of patients in the primary care setting with acute PE can be feasible and safe. One-third of these patients were treated with a direct oral anticoagulant, and 20.5% (n = 134) went home from the clinic. Of the 50.5% (n = 330) of total patients treated without hospitalization, 1.8% (n = 6) required hospitalization within seven days for symptoms related to PE, and 0.3% (n = 1) experienced a 30-day outcome (nonfatal worsening PE).

• #2 Pulmonary Embolism: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17400-pulmonary-embolism

  A pulmonary embolism (PE) is a medical emergency. You need a prompt diagnosis and treatment. […] Without quick treatment, a pulmonary embolism can cause heart or lung damage and even death. About 33% of people with a pulmonary embolism die before they get a diagnosis and treatment. […] Quick treatment greatly reduces the chance of death. […] Healthcare providers usually treat a PE in a hospital, where they can monitor your condition closely. […] The main treatment for a pulmonary embolism is an anticoagulant (blood thinner). […] Depending on the severity of your clot and its effect on your other organs such as your heart, you may also undergo thrombolytic therapy, surgery or interventional procedures to improve blood flow in your pulmonary arteries. […] In most cases, treatment consists of anticoagulant medications (blood thinners). Anticoagulants decrease your blood’s ability to clot. This prevents future blood clots.

• #2 Pulmonary Embolism (PE) Medication: Anticoagulants, Thrombolytics, Direct Thrombin Inhibitors and Factor Xa Inhibitors

  https://emedicine.medscape.com/article/300901-medication

  Immediate therapeutic anticoagulation is initiated for patients with suspected deep venous thrombosis (DVT) or pulmonary embolism (PE). Anticoagulation therapy with heparin reduces mortality rates from 30% to less than 10%. Anticoagulation is essential, but anticoagulation alone does not guarantee a successful outcome. DVT and PE may recur or extend despite full and effective heparin anticoagulation. […] Chronic anticoagulation is critical to prevent relapse of DVT or PE following initial heparinization. Heparin works by activating antithrombin III to slow or prevent the progression of DVT and to reduce the size and frequency of PE. Heparin does not dissolve existing clot. […] Thrombolysis is indicated for hemodynamically unstable patients with pulmonary embolism. Thrombolysis dramatically improves acute cor pulmonale. Thrombolytic therapy has replaced surgical embolectomy as the treatment for hemodynamically unstable patients with massive pulmonary embolism.

• #2 Acute Management of Pulmonary Embolism

  https://www.acc.org/Latest-in-Cardiology/Articles/2017/10/23/12/12/Acute-Management-of-Pulmonary-Embolism

  Anticoagulation therapy is the primary treatment option for most patients with acute PE. The utilization of factor Xa antagonists and direct thrombin inhibitors, collectively termed Novel Oral Anticoagulants (NOACs) are likely to increase as they become incorporated into societal guidelines as first line therapy. Adoption of these newer agents may mitigate the major limitation of VKA therapy, frequently found in studies of VTE/PE to have sub-therapeutic INRs in a significant number of patients. Low molecular weight heparin is superior to unfractionated heparin in both treatment and thrombo-prophylaxis in cancer patients. This is reflected in the recommendations made by the American College of Chest Physicians who recommend the use of low molecular weight heparin on the basis of the strength of evidence available. The importance of prompt initiation of anticoagulation cannot be over emphasized; objective assessment of bleeding risk, set in the context of the risk of choosing not to use anticoagulation, should prevent overly conservative practices founded upon theoretical concerns over bleeding.

• #2 Deep Venous Thrombosis and Pulmonary Embolism: Current Therapy | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0301/p295.html

  Once VTE is diagnosed and the patient is stabilized if needed, anticoagulation should be initiated unless contraindicated. […] In the initial phase of anticoagulation, a decision must be made between using the vitamin K antagonist warfarin or a direct-acting oral anticoagulant. […] Guidelines recommend low-molecular-weight over unfractionated heparin, which is supported by multiple therapeutic trials showing greater effectiveness and safety and lower mortality. […] The ACCP recommends the use of direct-acting anticoagulants over warfarin for VTE treatment in patients without cancer (weak recommendation based on moderate quality evidence, per the ACCP grading system). […] For patients with recurrent VTE who are already taking an oral anticoagulant, low-molecular-weight heparin is recommended over other oral anticoagulants.

• #2 Cutting-Edge Techniques and Drugs for the Treatment of Pulmonary Embolism: Current Knowledge and Future Perspectives

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11012374/

  The introduction of DOACs radically changed PE treatment, offering a safe and effective alternative to traditional anticoagulation agents such as heparin and VKA. DOACs have a rapid onset of action, predictable pharmacokinetics, and a lower risk of major bleeding. They have been shown to be non-inferior or superior to traditional anticoagulation therapy in large randomized controlled trials (RCTs) and are now recommended as first-line therapy for most patients with acute PE. […] Fibrinolysis is currently suggested in high-risk PE, while its use in intermediate-risk is still object of debate. […] Currently, the most debated topics in VTE management are represented by (i) the optimal treatment of patients with high- or intermediate-high-risk PE, (ii) PE management in subjects at a high risk of bleeding, (iii) the assessment and management of the bleeding risk in certain populations, and (iv) the management of VTE in specific, complement-mediated diseases.

• #2 DOACs: Oral Anticoagulant Treatment of Choice for Pulmonary Embolism? – Endovascular Today

  https://evtoday.com/articles/2019-july-supplement/doacs-oral-anticoagulant-treatment-of-choice-for-pulmonary-embolism

  It is well established that early therapeutic anticoagulation improves mortality and decreases acute PE recurrence risk. However, selecting the anticoagulant can be challenging, and the decision depends on factors related to the patient (severity of PE, comorbidities [adequate organ function], bleeding risks, need for invasive procedures, adherence behaviors, preferences, concomitant medications, and weight), anticoagulant (properties of DOACs and potential drug-drug interactions), and clinical judgment. […] There are currently four FDA-approved DOACs for the treatment of VTE. According to the most recent CHEST guidelines, anticoagulation therapy with one of these four DOACs is suggested over VKAs as long-term therapy in patients with DVT of the leg or PE and no evidence of cancer. […] Currently, there are no head-to-head trials comparing the DOACs. However, because each DOAC has different doses and dosing regimens, it is important for prescribing clinicians to know and understand their nuances.

• #2 Pulmonary embolism: Symptoms, causes, risk factors, and treatment – Harvard Health

  https://www.health.harvard.edu/diseases-and-conditions/pulmonary-embolism-symptoms-causes-risk-factors-and-treatment

  The main treatment for DVT and PE is an anticoagulant drug. Although often called blood thinners, anticoagulants do not actually thin the blood. They block certain proteins that cause unwanted blood clots while the body’s natural process dissolves the clot. […] The choice of initial drug treatment depends on the severity of symptoms and risk of complications. For smaller pulmonary emboli, doctors usually prescribe a direct-acting oral anticoagulant (DOAC). The four DOACs currently FDA-approved to treat pulmonary emboli are: apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa, Lixiana), rivaroxaban (Xarelto). […] People with a large pulmonary embolism such as a saddle embolism will need to be hospitalized. They may be treated with intravenous (IV) heparin, or with injections of a different kind of heparin under the skin. Some patients will need an IV clot-dissolving drug (known as thrombolysis) or a procedure to remove the large clot.

• #2 Pulmonary Embolism – Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/pulmonary-embolism-treatment/

  If thrombolysis is contraindicated, surgical embolectomy may be considered. […] Patients should receive therapy for 3-6 months, and may be extended if: Concurrent systemic chemotherapy, Metastatic disease, Progressive/relapsed disease, Other prothrombotic risk factors. […] LMWH or UFH are safe during pregnancy. LMWH is the drug of choice unless: Patient has heparin induced thrombocytopenia (HIT) /history of HIT, Severe renal dysfunction. […] Anticoagulation should be continued for a minimum of 3 months. Often continued until at least 6 weeks postpartum due to increased risk of VTE in pregnancy. […] Warfarin is contraindicated in pregnancy, okay during breastfeeding. […] DOACs should be avoided in pregnancy and breastfeeding. […] Patients with massive PE, or those receiving thrombolytic treatment are generally placed in the ICU. Patients deemed to be low-risk and are able to adhere to treatment are generally treated as outpatients and are discharged.

• #2 Deep Venous Thrombosis and Pulmonary Embolism: Current Therapy | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0301/p295.html

  If there are no contraindications, current guidelines recommend anticoagulation for a minimum of three months for PE and proximal DVT. […] Extended anticoagulation is recommended for patients with an unprovoked VTE and low risk of bleeding. […] Indefinite anticoagulation is recommended for patients with a second VTE and low or moderate risk of bleeding.

• #2 Cutting-Edge Techniques and Drugs for the Treatment of Pulmonary Embolism: Current Knowledge and Future Perspectives

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11012374/

  With this narrative review, we aim to assess the state of the art of newer techniques and drugs that could radically improve PE management in the near future: (i) mechanical thrombectomy and pulmonary embolectomy are promising techniques reserved to patients with massive PE and contraindications or failure to systemic thrombolysis; (ii) catheter-directed thrombolysis is a minimally invasive approach that can be suggested for the treatment of massive or submassive PE, but the lack of large, randomized controlled trials represents a limitation to widespread use; (iii) novel pharmacological approaches, by agents inhibiting thrombin-activatable fibrinolysis inhibitor, factor Xia, and the complement cascade, are currently under investigation to improve PE-related outcomes in specific settings. […] Anticoagulation remains the mainstay of PE treatment at any level of severity: the aim of this treatment is to prevent further clot formation and promote the natural dissolution of the thrombus. Heparins (both unfractionated and low-molecular-weight), vitamin K antagonists (VKAs), and direct oral anticoagulants (DOACs) have been extensively studied, and their role has been clarified in several clinical settings.

• #2 DOACs: Oral Anticoagulant Treatment of Choice for Pulmonary Embolism? – Endovascular Today

  https://evtoday.com/articles/2019-july-supplement/doacs-oral-anticoagulant-treatment-of-choice-for-pulmonary-embolism

  With multiple anticoagulant options now available, including the DOACs that do not require an initial parenteral agent, inpatient versus outpatient management of PE has become a part of the initial assessment. […] Duration of anticoagulation should be individualized for each patient and should include the initial and periodic assessment of risk factors for recurrent VTE (transient or persistent) as well as age, sex, obesity, and organ function (liver and kidney). […] Importantly, anticoagulation duration should be assessed at least annually, considering risk for VTE recurrence is 7% within the first year and 40% within 5 years. […] All anticoagulants including the DOACs are associated with bleeding, which in rare situations can be life-threatening. Currently, there are two FDA-approved DOAC-specific reversal agents: idarucizumab for dabigatran and andexanet for rivaroxaban and apixaban.

• #2 Pulmonary Embolism: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17400-pulmonary-embolism

  If a PE is life-threatening, or if other treatments aren’t working, your provider may recommend using surgery or a catheter to remove the blood clot from your pulmonary artery. Thrombolytic therapy is another option. […] Thrombolytic medications (clot busters), including tissue plasminogen activator (TPA), dissolve the clot. […] Bleeding is a possible side effect of medications for pulmonary embolism treatment. […] You should feel better within a week of treatment. But a pulmonary embolism can take months or years to go away completely. […] You’ll need to take a blood thinner for three to six months or longer. Don’t stop taking it unless your provider instructs you to. […] Follow their recommendations to reduce the risk of another PE.

• #2 Advanced Management Options for Massive and Submassive Pulmonary Embolism | USC Journal

  https://www.uscjournal.com/articles/advanced-management-options-massive-and-submassive-pulmonary-embolism?language_content_entity=en

  Pulmonary embolism (PE) is an important cause of morbidity and mortality and presents with significant diagnostic and therapeutic challenges. […] Therapeutic anticoagulation is indicated in all patients in the absence of contraindications. Thrombolysis should be strongly considered in selected high- and intermediate-risk patients, either by systemic infusion or percutaneous catheter-directed therapy. […] Prompt initiation of therapeutic anticoagulation is indicated for all patients with PE unless there is a strong contraindication (e.g., active or recent severe bleeding, major surgery, or trauma). […] Use of systemic thrombolysis has been shown to decrease mortality and recurrent PE in high-risk patients who present with hemodynamic instability. […] The current guidelines recommend systemic thrombolysis in patients with high-risk PE with hemodynamic compromise in the absence of contraindications. However, guidelines do not recommend routine use of systemic thrombolysis in all patients with intermediate-risk PE.

• #2 Acute Management of Pulmonary Embolism

  https://www.acc.org/Latest-in-Cardiology/Articles/2017/10/23/12/12/Acute-Management-of-Pulmonary-Embolism

  The most dreaded acute complication of PE is death; it is estimated that over 100,000 deaths in hospitalized patients in the United States are attributable to acute PE each year. The severity of PE is stratified into massive (PE causing hemodynamic compromise), submassive (PE causing right ventricular dysfunction demonstrable by echocardiography, computed tomography or elevated cardiac biomarkers) and non-massive or low-risk (PE without evidence of RV dysfunction or hemodynamic compromise). In patients with massive PE, systemic thrombolytic therapy has been shown to reduce mortality, decrease the risk of developing CTEPH and improve quality of life. A recent meta-analysis suggests that systemic thrombolytic therapy also reduces mortality in patients with submassive PE. This, however, appears to be at the expense of significant major bleeding complications including intracranial hemorrhage. These bleeding-related adverse events as well as treatment failure seen with systemic thrombolysis have resulted in the exploration of catheter-based thrombus removal as an alternative therapeutic option for these patients. In contemporary practice, catheter-based endovascular therapy for acute PE can be considered in patients where there is a clear contraindication to full dose thrombolytic therapy or when risk stratification in a patient with stable hemodynamics indicates an increased likelihood of morbidity and mortality.

• #2 Pulmonary Embolism Medications: Anticoagulants and Thrombolytics

  https://www.healthline.com/health/pulmonary-embolism-medication

  While anticoagulants are primarily used for decreasing blood clot size and occurrence in PE, thrombolytics may be needed in emergency situations. These work by dissolving the blood clot in your lungs. […] Due to their action and risk for side effects, thrombolytics are exclusively used for PE in emergency situations. […] Alteplase (Activase) is the most common thrombolytic medication used to treat PE. While it carries a low risk of allergic reactions compared with other thrombolytics, the medication is associated with the risk of bleeding. […] If a doctor doesn’t believe you are a candidate for anticoagulants, or if your condition doesn’t respond to these blood thinning agents, they may recommend a vena cava filter placement. […] Alternatively, if you have a large blood clot or are experiencing a related medical emergency due to PE, a doctor may perform a thrombectomy or embolectomy to remove it.

• #2 List of 15 Pulmonary Embolism Medications Compared

  https://www.drugs.com/condition/pulmonary-embolism.html

  Medications for Pulmonary Embolism […] The medications listed below are related to or used in the treatment of this condition. […] Eliquis to treat Pulmonary Embolism […] Xarelto to treat Pulmonary Embolism […] apixaban to treat Pulmonary Embolism […] rivaroxaban to treat Pulmonary Embolism […] Pradaxa to treat Pulmonary Embolism […] Arixtra to treat Pulmonary Embolism […] Activase to treat Pulmonary Embolism […] alteplase to treat Pulmonary Embolism […] dabigatran to treat Pulmonary Embolism […] fondaparinux to treat Pulmonary Embolism

• #2 Pulmonary Embolism – Zero To Finals

  https://zerotofinals.com/medicine/respiratory/pe/

  Pulmonary embolism can be asymptomatic (discovered incidentally), present with subtle signs and symptoms, or even cause sudden death. […] Anticoagulation is the mainstay of management. In most patients, NICE (2020) recommend treatment-dose apixaban or rivaroxaban as first-line. Low molecular weight heparin (LMWH) is the main alternative. This should be started immediately in patients where PE is suspected and there is a delay in getting a scan to confirm the diagnosis. […] Massive PE with haemodynamic compromise is treated with a continuous infusion of unfractionated heparin and considering thrombolysis. Thrombolysis involves injecting a fibrinolytic (breaks down fibrin) medication that rapidly dissolves clots. There is a significant risk of bleeding with thrombolysis, making it dangerous. It is only used in patients with a massive PE where the benefits outweigh the risks. Some examples of thrombolytic agents are streptokinase, alteplase and tenecteplase.

• #2 Percutaneous interventions for pulmonary embolism | EuroIntervention

  https://eurointervention.pcronline.com/article/percutaneous-interventions-for-pulmonary-embolism

  To mitigate the risks associated with PE, it is critical to focus on prevention, early diagnosis, proper risk stratification, and optimal treatment. […] Anticoagulation is the mainstay of acute treatment for PE across all risk categories, but the management of PE is rapidly evolving with the development of new interventions and drugs that have shown promising results in selected patients. This expansion of available options offers new opportunities for both the treatment and prevention of PE. […] Systemic thrombolysis is currently indicated for high-risk PE patients, and as a rescue strategy for intermediate- or low-risk patients who experience haemodynamic deterioration despite anticoagulation. This therapy can rapidly improve pulmonary perfusion and right ventricular (RV) function and is associated with a decreased risk of PE recurrence and mortality. […] However, systemic thrombolysis is accompanied by substantial increases in the risk of major bleeding and intracranial haemorrhage. Furthermore, it cannot be used in patients with absolute contraindications, such as active bleeding, recent stroke or surgery, or central nervous system neoplasm. Additionally, systemic thrombolysis is not always successful, supporting the need for alternative treatment options.

• #2 Percutaneous interventions for pulmonary embolism | EuroIntervention

  https://eurointervention.pcronline.com/article/percutaneous-interventions-for-pulmonary-embolism

  Surgical embolectomy is a potential treatment option for high-risk PE patients who cannot receive systemic thrombolysis due to contraindications or for whom this therapy previously failed. […] Surgical embolectomy is recommended for cases with a high proximal thrombus burden, thrombus in transit, paradoxical embolism, or haemodynamic instability, as it can improve RV function similarly to thrombolysis, with comparable 30-day mortality and 5-year survival rates. […] In recent years, percutaneous catheter-based approaches have gained attention as an alternative to anticoagulation, systemic thrombolysis, and surgical embolectomy, due to their lower risk and potential benefits. […] These approaches provide a minimally invasive treatment option for high-risk PE patients who have a contraindication to systemic thrombolysis or in whom this therapy has failed. Factors such as overall patient condition, operator experience, local availability, and thrombus burden and location should be considered when selecting the appropriate approach.

• #2 Acute Management of Pulmonary Embolism

  https://www.acc.org/Latest-in-Cardiology/Articles/2017/10/23/12/12/Acute-Management-of-Pulmonary-Embolism

  For patients without an absolute contraindication to systemic thrombolysis, ultrasound-assisted catheter-directed thrombolysis (UA-CDT) can be considered. Low energy ultrasound disaggregates fibrin within acute thrombi, this is exploited by the EKOS device, which combines emission of low energy ultrasound and infusion of a thrombolytic agent via a multi side-hole containing catheter. This strategy has been evaluated in the ULTIMA trial, which demonstrated superiority to anticoagulation alone in improving hemodynamics without a significant increase in bleeding complications. […] Given the available evidence for UA-CDT in the treatment of acute PE, the use of an ultrasound assisted CDT strategy should be explored on a highly individualized basis. The common femoral vein should be accessed with a 6F single lumen sheath for unilateral therapy or two 6F sheaths or single 10F dual lumen sheath for bilateral therapy. Standard right heart catheterization with simultaneous mixed venous and systemic oxygen saturation should be obtained. A 0.035 inch guide wire along with a standard diagnostic angiographic catheter should be used to cross the diseased segment.

• #2 Interventional therapies for pulmonary embolism | Nature Reviews Cardiology

  https://www.nature.com/articles/s41569-023-00876-0

  CDT, USCDT and pharmacomechanical CDT reduce the dose of thrombolytics used, whereas aspiration thrombectomy eliminates the use of thrombolytics. […] Large, adequately powered, randomized controlled trials investigating low-dose thrombolysis, CDT, USCDT and large-bore thrombectomy are ongoing and more are planned.

• #2 Interventional therapies for pulmonary embolism | Nature Reviews Cardiology

  https://www.nature.com/articles/s41569-023-00876-0

  Patients with low-risk or intermediate-low-risk PE benefit from anticoagulation alone, whereas treatment of patients with intermediate-high-risk or high-risk PE poses difficulties; systemic thrombolysis is the first-line recommendation for patients with high-risk PE but is associated with severe adverse events, especially bleeding. […] In patients with intermediate-high-risk PE and those with high-risk PE and contraindications to thrombolysis, interventional therapies, such as catheter-directed thrombolysis (CDT), ultrasound-assisted CDT (USCDT), pharmacomechanical CDT and aspiration thrombectomy, are possible options. […] Despite showing promising results in reducing right ventricular dysfunction and relief of haemodynamic compromise in small studies and registries, these interventional therapies have not been rigorously investigated in adequately powered randomized controlled trials.

• #2 Percutaneous interventions for pulmonary embolism | EuroIntervention

  https://eurointervention.pcronline.com/article/percutaneous-interventions-for-pulmonary-embolism

  In response to the limitations of systemic thrombolysis, several percutaneous catheter-directed treatments have emerged as alternatives. These treatments aim to prevent the migration of thrombotic emboli from the deep venous system to the pulmonary circulation by utilising a filter or directly targeting the embolus in the pulmonary circulation through a venous catheter. […] These techniques have a high procedural success rate of approximately 87% and are associated with reduced mortality and a lower risk of major bleeding compared to systemic thrombolysis in patients with intermediate- or high-risk PE. […] The main focus of this article is to provide a comprehensive overview of percutaneous management options for PE, with a specific emphasis on catheter-directed treatments and their effect on patient outcomes. […] Furthermore, we aimed to identify gaps in current knowledge and areas for future research in the field, including the potential expansion of these techniques to patients at intermediate risk, which could lead to a broader application of these interventions.

• #2 Pulmonary Embolism and CTEPH

  https://www.uofmhealth.org/conditions-treatments/pulmonary-embolism-and-cteph

  At the University of Michigan Health, pulmonary embolism patients are treated with a specialized multidisciplinary team-based approach. […] Our ability to work in a multidisciplinary fashion differentiates our program and allows patients access to various specialists and therapies. […] Acute PE often needs immediate treatment with clot busters and blood thinning medications. […] Patients with a pulmonary embolism can be treated with blood thinners, also known as anticoagulants. These medications can be given intravenously or by mouth. Blood thinners help our body to break down existing blood clots and prevent new clots from forming. […] Catheter-directed thrombolysis is a minimally invasive treatment to dissolve vascular blood clots and improve blood flow to prevent damage to tissues and organs. […] Catheter-based thrombus removal, or thrombectomy, involves a novel thin tube, or catheter, used to remove large blood clots from an artery.

• #2 Pulmonary Embolism | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/pulmonary-embolism.html

  Pulmonary embolectomy. Rarely used, this is surgery done to remove a PE. It is generally done only in severe cases when your PE is very large, you can’t get anticoagulation or thrombolytic therapy due to other medical problems or you haven’t responded well to those treatments, or your condition is unstable. […] Percutaneous thrombectomy. A long, thin, hollow tube (catheter) can be threaded through the blood vessel to the site of the embolism guided by X-ray. Once the catheter is in place, it’s used to break up the embolism, pull it out, or dissolve it using thrombolytic medicine. […] An important aspect of treating a PE is treatment to prevent more embolisms.

• #2 Management of PE

  https://www.acc.org/Latest-in-Cardiology/Articles/2020/01/27/07/42/Management-of-PE

  Anticoagulation should be initiated as soon as the diagnosis of PE is suspected. Unfractionated heparin may be preferred in patients who are candidates for further advanced therapies such as thrombolysis, catheter-directed thrombolytics or embolectomy, or surgical embolectomy because it provides more flexibility for procedures. Direct oral anticoagulants are first-line therapy for low-risk patients and intermediate- and high-risk patients once they have achieved hemodynamic stability. Systemic thrombolytic therapy should be considered in massive PE due to observed reduction in mortality and recurrence. […] Surgical embolectomy is recommended in patients with high-risk or intermediate-high-risk PE with absolute contraindications to thrombolytic therapy, failed thrombolytic therapy, or cardiogenic shock that may cause death prior to thrombolytic therapy.

• #2 Pulmonary Embolism (PE) – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/pulmonary-embolism/pulmonary-embolism-pe

  Surgical embolectomy is reserved for patients with PE who are hypotensive despite supportive measures or on the verge of cardiac or respiratory arrest. […] Extracorporeal membrane oxygenation (ECMO) is sometimes used in catastrophic acute pulmonary embolism when thrombolysis is contraindicated or failed.

• #2 Advanced Management Options for Massive and Submassive Pulmonary Embolism | USC Journal

  https://www.uscjournal.com/articles/advanced-management-options-massive-and-submassive-pulmonary-embolism?language_content_entity=en

  Surgical embolectomy is an open surgical procedure in which clots are removed from the right atrium or ventricle or main/proximal pulmonary arteries. It is indicated in patients with massive PE (and possibly in select patients with submassive PE) who have a contraindication to thrombolysis or when thrombolysis or catheter-based mechanical clot disruption has failed. […] In patients with acute PE who cannot safely receive anticoagulation, placement of an inferior vena cava (IVC) filter is indicated (even in the absence of lower extremity clot).

• #2 Future Perspectives on Pulmonary Embolism Treatment | ICR Journal

  https://www.icrjournal.com/articles/limitations-and-future-perspectives-pulmonary-embolism-so-far-so-good?language_content_entity=en

  Pulmonary embolism (PE) represents the third most common cardiovascular emergency and, despite continuous diagnostic therapeutic progress, has high mortality and morbidity rates. Risk stratification is of paramount importance, allowing diagnostic and therapeutic processes to be guided more accurately. High-risk PE is characterised by haemodynamic instability, is associated with a high mortality rate (around 30-60%) and requires prompt and aggressive treatment. Systemic thrombolysis represents the treatment of choice for high-risk PE, but there are relative or absolute contraindications to its use. Almost 40% of PE patients have absolute or relative contraindications to systemic thrombolysis. In this case, according to 2019 ESC guidelines, catheter-directed therapy (CDT) may be a reasonable solution. CDT should be considered for PE patients in whom systemic thrombolysis is contraindicated or has failed.

• #2 Pulmonary Embolism | Deep Vein Thrombosis | MedlinePlus

  https://medlineplus.gov/pulmonaryembolism.html

  Procedures: Catheter-assisted thrombus removal uses a flexible tube to reach a blood clot in your lung. Your health care provider can insert a tool in the tube to break up the clot or to deliver medicine through the tube. Usually you will get medicine to put you to sleep for this procedure. […] A vena cava filter may be used in some people who cannot take blood thinners. Your health care provider inserts a filter inside a large vein called the vena cava. The filter catches blood clots before they travel to the lungs, which prevents pulmonary embolism. But the filter does not stop new blood clots from forming.

• #2 Management of patients with high-risk pulmonary embolism: a narrative review | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-018-0286-8

  Thrombolytic treatment of acute PE restores pulmonary perfusion more rapidly than anticoagulation with UFH alone. […] Catheter-directed treatment (CDT) can be performed as an alternative to thrombolysis when a patient has absolute contraindications to thrombolysis, as adjunctive therapy when thrombolysis has failed to improve hemodynamics, or as an alternative to surgery if immediate access to cardiopulmonary bypass is unavailable. […] Traditionally, surgical embolectomy has been reserved for patients with PE who may need cardiopulmonary resuscitation. It is also performed in patients with contraindications or inadequate responses to thrombolysis and in those with patent foramen ovale and intracardiac thrombi. […] In general, inferior vena cava (IVC) filters are indicated in patients with acute PE who have absolute contraindications to anticoagulant drugs and in patients with objectively confirmed recurrent PE despite adequate anticoagulation treatment.

• #2 Pulmonary Embollism (PE) Treatment & Surgery

  https://www.webmd.com/lung/treatment-for-a-pulmonary-embolism

  In life-threatening situations, doctors might use what are called thrombolytic drugs. These quickly break up clots that cause severe symptoms. But they can lead to sudden bleeding and are only used after careful consideration. […] In carefully selected cases, this is another emergency treatment your doctor might use. Theyll insert a thin, flexible tube into a vein in your thigh or arm. Theyll continue on to your lung, where theyll remove the clot or use medicine to dissolve it. […] If you cant take blood thinners, your doctor might use this option to treat your PE: The inferior vena cava is a large vein that carries blood from the lower body to the heart. Your doctor can put a filter in it to stop clots before they get to your lungs. It wont stop clots from forming — just from getting to the lungs. This procedure may be needed when blood thinners can’t be used because of a recent surgery, a stroke caused by bleeding, or significant bleeding in another area of the body.

• #2 Acute Management of Pulmonary Embolism

  https://www.acc.org/Latest-in-Cardiology/Articles/2017/10/23/12/12/Acute-Management-of-Pulmonary-Embolism

  There are no comparative studies or societal recommendations to suggest the type, dose and duration of anticoagulation therapy or antiplatelet therapy following catheter based endovascular therapies with or without angioplasty and stenting. Current recommendations suggest therapy based on VTE stratification: 1) VTE associated with reversible risk factor or „provoked” DVT (at least 3 months); 2) unprovoked or recurrent VTE (6 to 12 months); and 3) VTE in the setting of cancer (indefinitely with LMWH). […] VTE is increasingly recognized as a cause of significant morbidity and mortality in the United States. An interventional approach to managing both acute LE-iliofemoral DVT and massive and submassive PE has great promise. There remains a paucity of robust long-term evidence, particularly addressing safety outcomes in therapies utilizing drugs and delivery systems that can result in bleeding complications. A highly individualized approach encompassing patient selection, type of therapy, operator and hospital level of experience should be followed to maximize the benefits of an interventional strategy as well as minimize the risk of harm.

• #2 Pulmonary Embolism – Zero To Finals

  https://zerotofinals.com/medicine/respiratory/pe/

  The options for long-term anticoagulation in VTE are a DOAC, warfarin or LMWH. Direct-acting oral anticoagulants (DOACs) are oral anticoagulants that do not require monitoring. Options are apixaban, rivaroxaban, edoxaban and dabigatran. They are suitable for most patients. Exceptions include severe renal impairment (creatinine clearance less than 15 ml/min), antiphospholipid syndrome and pregnancy. […] Warfarin is a vitamin K antagonist. The target INR for warfarin is between 2 and 3 when treating DVTs and PEs. It is the first-line in patients with antiphospholipid syndrome (who also require initial concurrent treatment with LMWH). […] Low molecular weight heparin (LMWH) is the first-line anticoagulant in pregnancy.

• #2 DOACs: Oral Anticoagulant Treatment of Choice for Pulmonary Embolism? – Endovascular Today

  https://evtoday.com/articles/2019-july-supplement/doacs-oral-anticoagulant-treatment-of-choice-for-pulmonary-embolism

  The choice of DOAC must be made in the context of the specific patient, and DOACs are either contraindicated or have not yet been extensively evaluated in certain patient populations. […] The treatment of patients with active malignancy and VTE can be challenging. Present evidence indicates that, at least in the short term, edoxaban and rivaroxaban seem as effective as standard anticoagulation with dalteparin. […] No DOACs have been evaluated during pregnancy. There is evidence that they are present in breast milk. For this reason, they are best avoided during pregnancy and breastfeeding. […] Patients with liver impairment should not receive DOACs because the international normalized ratio may be prolonged due to liver synthetic defect during the course of treatment. […] VTE is a common disorder and is associated with significant morbidity and mortality. DOACs have emerged as the treatment of choice for many patients given their convenience, predictable pharmacokinetics and pharmacodynamics, and their similar effectiveness in reducing VTE compared to VKAs, with significantly less major bleeding.

• #2 Management of patients with high-risk pulmonary embolism: a narrative review | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-018-0286-8

  Large hospitals having an intensive care unit should preemptively establish diagnostic and therapeutic protocols and rehearse multidisciplinary management for patients with high-risk PE. Coordination with a skilled team comprising intensivists, cardiologists, cardiac surgeons, radiologists, and other specialists is crucial to maximize success. […] Acute RV failure with resulting low systemic output is the leading cause of death in patients with high-risk PE. Therefore, supportive treatment is of vital importance in patients with PE who develop shock. […] Hypoxia is usually reversed with administration of oxygen. […] Experimental evidence suggests that extracorporeal membrane oxygenation (ECMO) support can be an effective procedure in patients with PE-induced circulatory collapse. […] Anticoagulant treatment plays a pivotal role in the management of patients with PE.

• #2 Pulmonary Embolism Treatment, Diagnosis, Causes & Symptoms

  https://www.emedicinehealth.com/pulmonary_embolism/article_em.htm

  What Are Pulmonary Embolism Treatment Options? […] The following treatments are the most frequently used for pulmonary embolisms. […] Oxygen can be given in several ways. One is through tubing that is inserted at the tip of the nostrils, called a nasal cannula. […] Blood-thinning medication may be given, especially in patients with severe symptoms. This is given through an IV, injected into the skin directly, or taken by mouth. […] „Clot buster” medications (also called thrombolytics) are given to those who are critically ill. The purpose is to break up the clot that is blocking the blood vessel in the lung. […] In some life-threatening cases, the patient is taken to a radiologic surgery by an interventional radiologist and a catheter is placed into the pulmonary artery similar to the angiogram described above. This special catheter can break up and suck the clot out relieving the obstruction immediately.

• #2 Management of PE

  https://www.acc.org/Latest-in-Cardiology/Articles/2020/01/27/07/42/Management-of-PE

  In patients with high-risk PE and cardiogenic shock, cardiac arrest, or impending hemodynamic collapse, further mechanical support should be considered. Venoarterial extracorporeal membrane oxygenation (VA ECMO) is effective when used in combination with any of the above treatments with good survival rates and low complication risks. […] In patients with PE who cannot tolerate anticoagulation, current guidelines recommend the use of inferior vena cava filters. The addition of inferior vena cava filters to anticoagulation has not been demonstrated to be beneficial in prospective trials but may be considered in patients with large, mobile, or proximal DVT. […] PE is a common clinical problem with varied manifestations ranging from benign to fatal. Given the complexities of diagnostic, stabilization, and treatment modalities, a rapidly assembled and collaborative multi-disciplinary approach is helpful. Further development of treatment options and randomized clinical trials are needed to delineate optimal approaches for these patients. The consensus document published by the PERT consortium provides a foundation for the decision-making required for these patients.

• #2 Acute Pulmonary Embolism Treatment Options | Temple Health

  https://www.templehealth.org/services/conditions/acute-pulmonary-embolism/treatment-options

  There are several ways to treat an acute pulmonary embolism, including lifestyle changes, medications and surgery. Your doctor will work with you to determine which approach will yield the best results for you. […] Blood thinners, such as Heparin, are prescribed to prevent new clots from forming while your body works to break up existing clots. These medications can work quickly and are often taken for several days with an oral anticoagulant, such as warfarin. […] In addition, clot dissolvers, such as Streptokinase, are prescribed to quickly dissolve the existing clots. Because these medications can cause sudden and severe bleeding, they usually are reserved for life-threatening situations. […] When lifestyle changes and medications do not reduce the frequency or severity of your symptoms, you may require surgery.

• #2 Deep Vein Thrombosis and Pulmonary Embolism | Yellow Book | CDC

  https://wwwnc.cdc.gov/travel/yellowbook/2024/air-land-sea/deep-vein-thrombosis-and-pulmonary-embolism

  The BTS 2022 Clinical Statement on air travel for passengers with respiratory disease states that air travel should be delayed for 2 weeks after a diagnosis of DVT or PE. […] Graduated compression stockings (GCS) appear to reduce asymptomatic DVT in travelers and are generally well tolerated. Decisions regarding use of pharmacologic prophylaxis for long-distance travelers at high risk should be made on an individual basis. When the potential benefits of pharmacologic prophylaxis outweigh the possible adverse effects, anticoagulants rather than antiplatelet drugs (e.g., aspirin) are recommended. […] For long-distance travelers (6 hours travel) at increased risk of VTE, the ACCP recommends frequent ambulation, calf muscle exercise, sitting in an aisle seat, and using properly fitted below-the-knee GCS that provide 15-30 mmHg of pressure at the ankle during travel (grade 2C: weak recommendations, low or very low-quality evidence). For long-distance travelers not at increased risk of VTE, use of GCS is not recommended. ACCP advises against the use of aspirin or anticoagulants to prevent VTE in long-distance travelers.

• #2 Pulmonary Embolism: Recovery, Treatment, and Life Changes

  https://www.webmd.com/lung/pulmonary-embolism-recovery

  Drugs called anticoagulants are the first tools doctors reach for if you’ve had a pulmonary embolism. They’re known as blood thinners because they make it harder for your blood to clot. They don’t break up a clot, but they keep it from getting bigger as your body dissolves it. […] You can expect to take blood thinners for at least 3 months and possibly much longer. Some people need to take them for life. […] One way to do that is with special socks known as compression stockings. These socks get tighter as they go down toward your ankle, which helps your leg muscles move blood up your leg. Your doctor will give you a prescription for compression stockings that says how much pressure they need to apply.

• #2 Management of PE

  https://www.acc.org/Latest-in-Cardiology/Articles/2020/01/27/07/42/Management-of-PE

  The incidence of venous thromboembolism (VTE), including pulmonary embolism (PE) and deep venous thromboembolism (DVT), in the United States is unclear because there is no national surveillance system. However, PE is considered to be the third most common cause of cardiovascular death, with 60,000-100,000 deaths per year. Treatment varies depending on the severity of the disease and the center’s expertise and resources. A consensus document was recently issued by the Pulmonary Embolism Response Team (PERT) Consortium, which endorses a PERT approach to high- and intermediate-risk cases by a multidisciplinary team. This team includes, but is not limited to, cardiac surgery, cardiology, hematology, critical care, vascular medicine, vascular surgery, and radiology specialists who discuss complex cases and expedite treatment decisions.

• #2 Pulmonary Embolism Response Team Conditions & Treatments | Temple Health

  https://www.templehealth.org/services/lung/patient-care/programs/pulmonary-embolism-response-team/conditions-treatments

  For these reasons, it’s important for patients to be examined and treated by a team of experts, who can carefully evaluate each patient to determine and deliver the most effective treatment. […] If a patient has a very high risk of bleeding, surgical removal of clots may be necessary. This is done by our highly skilled cardiovascular surgical specialists, who strive to use minimally invasive methods whenever possible, reducing scarring, blood loss and recovery time. […] One of the only lung centers in the region with a dedicated Pulmonary Embolism Response Team, the Temple Lung Center can: […] Being a founding member of the national Pulmonary Embolism Response Team Consortium, Temples PERT is on the leading edge of this new paradigm of care for pulmonary embolism.

• #2 Percutaneous interventions for pulmonary embolism | EuroIntervention

  https://eurointervention.pcronline.com/article/percutaneous-interventions-for-pulmonary-embolism

  Risk assessment is crucial to determining the appropriate management for patients with PE. For high-risk cases (i.e., massive PE) accompanied by haemodynamic instability, an immediate referral for reperfusion treatment via an emergency management algorithm is necessary. This includes systemic thrombolysis, surgical embolectomy, or percutaneous catheter-directed treatments, with or without mechanical haemodynamic support. […] Thrombolytic therapy either systemic (most common) or directed by a catheter into the pulmonary arteries can restore pulmonary circulation, relieve RV afterload, and improve systemic oxygenation and overall haemodynamics. High-risk patients with haemodynamic compromise account for about 5% of the total PE cases and represent the subgroup at the highest risk for early mortality (about 50%), making them the ones who stand to benefit most from thrombolytic therapy.

• #2 Treatment for Patients With Acute Pulmonary Embolism Diagnosed in Primary Care | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1100/letter-acute-pulmonary-embolism.html

  Evidence shows that patients with acute pulmonary embolism (PE) can be treated as outpatients effectively and safely. Guidelines recommend outpatient treatment for patients who meet low-risk criteria; however, eligibility criteria vary. The American College of Chest Physicians recommends outpatient care for adults who meet the following criteria: (1) clinically stable with good cardiopulmonary reserve; (2) no contraindications such as recent bleeding, severe renal or liver disease, or severe thrombocytopenia (i.e., 50,000 per mm3); (3) expected to be compliant with treatment; and (4) the patient feels well enough to be treated at home. The patient must also have access to treatment and follow-up care. […] This study is the first to demonstrate that outpatient treatment of patients in the primary care setting with acute PE can be feasible and safe. One-third of these patients were treated with a direct oral anticoagulant, and 20.5% (n = 134) went home from the clinic. Of the 50.5% (n = 330) of total patients treated without hospitalization, 1.8% (n = 6) required hospitalization within seven days for symptoms related to PE, and 0.3% (n = 1) experienced a 30-day outcome (nonfatal worsening PE).

• #3 Acute pulmonary embolism in adults: Treatment overview and prognosis – UpToDate

  https://www.uptodate.com/contents/acute-pulmonary-embolism-in-adults-treatment-overview-and-prognosis

  Acute pulmonary embolism (PE) is a common and sometimes fatal disease with variable clinical presentation. It is critical that therapy be administered in a timely fashion to avoid fatalities. […] The treatment, prognosis, and follow-up of patients with acute PE are reviewed here. […] Empiric anticoagulation or thrombolysis. […] Anticoagulation. […] Thrombolytic therapy. […] Contraindications to thrombolysis for deep venous thrombosis or acute pulmonary embolism.

• #3 Acute Pulmonary Embolism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560551/

  Management of PE includes supportive measures, anticoagulation as the mainstay of treatment, and reperfusion strategies for severe cases. […] Anticoagulation is the mainstay of treating acute PE. Low-molecular-weight heparin (LMWH; fondaparinux) or unfractionated heparin (UFH) can be used for anticoagulation in acute PE. […] For patients with a high clinical suspicion of PE who are hemodynamically unstable, emergent CTPA, portable perfusion scanning, or bedside transthoracic echocardiography should be performed whenever possible. Primary reperfusion treatment, usually thrombolysis, is the treatment of choice for patients with hemodynamically unstable acute PE. […] Thrombolysis has shown an effective reduction in pulmonary artery pressure and resistance in patients with PE compared to UFH alone; a decrease in right ventricular dilation on echocardiography assesses these improvements.

• #3 Pulmonary embolism: Symptoms, causes, risk factors, and treatment – Harvard Health

  https://www.health.harvard.edu/diseases-and-conditions/pulmonary-embolism-symptoms-causes-risk-factors-and-treatment

  The main treatment for DVT and PE is an anticoagulant drug. Although often called blood thinners, anticoagulants do not actually thin the blood. They block certain proteins that cause unwanted blood clots while the body’s natural process dissolves the clot. […] The choice of initial drug treatment depends on the severity of symptoms and risk of complications. For smaller pulmonary emboli, doctors usually prescribe a direct-acting oral anticoagulant (DOAC). The four DOACs currently FDA-approved to treat pulmonary emboli are: apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa, Lixiana), rivaroxaban (Xarelto). […] People with a large pulmonary embolism such as a saddle embolism will need to be hospitalized. They may be treated with intravenous (IV) heparin, or with injections of a different kind of heparin under the skin. Some patients will need an IV clot-dissolving drug (known as thrombolysis) or a procedure to remove the large clot.

• #3 Percutaneous interventions for pulmonary embolism | EuroIntervention

  https://eurointervention.pcronline.com/article/percutaneous-interventions-for-pulmonary-embolism

  Risk assessment is crucial to determining the appropriate management for patients with PE. For high-risk cases (i.e., massive PE) accompanied by haemodynamic instability, an immediate referral for reperfusion treatment via an emergency management algorithm is necessary. This includes systemic thrombolysis, surgical embolectomy, or percutaneous catheter-directed treatments, with or without mechanical haemodynamic support. […] Thrombolytic therapy either systemic (most common) or directed by a catheter into the pulmonary arteries can restore pulmonary circulation, relieve RV afterload, and improve systemic oxygenation and overall haemodynamics. High-risk patients with haemodynamic compromise account for about 5% of the total PE cases and represent the subgroup at the highest risk for early mortality (about 50%), making them the ones who stand to benefit most from thrombolytic therapy.

• #3 Cutting-Edge Techniques and Drugs for the Treatment of Pulmonary Embolism: Current Knowledge and Future Perspectives

  https://www.mdpi.com/2077-0383/13/7/1952

  European (ESC) and American (AHA) guidelines suggest considering CDT use in patients with high- or intermediate–high risk PE associated with hemodynamic and respiratory deterioration despite anticoagulation, but also in subjects with high-risk PE with contraindications to systemic rtPA or in whom systemic fibrinolysis has failed. […] The existing data regarding CDT are not sufficient to establish these options as first-line treatments for patients with intermediate-risk PE. An important gap in the evidence is the lack of demonstration of the clinical benefits in terms of positive impact on prognosis and quality of life using a valid, composite clinical outcome. […] PE treatments are rapidly evolving. MT and CDT are actual techniques that are already improving the management of high- and intermediate–high-risk PE. Newer pharmacological treatments, such as FXIa and TAFIa inhibitors, are currently under investigation to improve PE management in specific clinical settings, while complement-modulating drugs currently represent a therapeutic mainstay in immunothrombosis, in which PE represents a very difficult-to-treat complication.

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