Wissam A. Jaber, Pete P. Fong, Giora Weisz, Omar Lattouf, James Jenkins, Kenneth Rosenfield, Tanveer Rab, Stephen Ramee
In an article recently published by the Journal of the American College of Cardiology, a team of experts assessed the current treatment options and procedures for patients with intermediate and high-risk pulmonary embolism (PE) beyond the use of anticoagulation. First and foremost, the researchers recommend multidisciplinary Pulmonary Embolism Response Teams (PERT) with experts and clinicians from varying departments to collaborate on the stages of PE management (such as examination, diagnosis, and procedure). This level of collaborative work will also give way to more comprehensive research and investigation.
If a patient is admitted with a suspected PE, anticoagulation treatment should be initiated unless otherwise opposed. Once the PE is confirmed, there is now the question of risk stratification; is the patient presenting low, intermediate, or high-risk symptoms? If the patient is deemed low-risk, he or she will more often be treated with just anticoagulation, and the PERT may not need to be activated. However, once the PERT is activated, they will review and assess all relevant imaging, testing, and the patient history. The team should then begin to determine the most appropriate course of intervention, a discussion that involved family members. The PERT may consider the following in addition to anticoagulation methods: fibrinolytic therapy, catheter-based therapies, extracorporeal mechanical oxygenation and RV assist devices, surgical embolectomy, and vena cava filters. This particular article summarizes the current trials to assess these options. While there have been promising results throughout the investigation of these interventions, there is not yet enough research to support their use for the management of PE in intermediate and high-risk patients. The authors call for PERT teams nation-wide to continue to share their data and observation so that there may be a stronger course of action taken for PE management beyond the use of anticoagulation.
Journal of the American College of Cardiology. March 2016. DOI:10.1016/j.jacc.2015.12.024