This review outlines the current status and trends in managing acute pulmonary thromboembolism, highlighting anticoagulation as fundamental and discussing the roles of thrombolysis, catheter interventions, and outpatient management.
Anticoagulation remains central to acute PE care; leaves open optimal selection and timing of advanced therapies.
Untreated acute pulmonary thromboembolism (APTE) is associated with high mortality, which is reduced by prompt treatment. Anticoagulation is fundamental in the treatment of APTE and should be initiated from suspicion. The efficacy and safety of novel anticoagulant drugs, such as oral anti-Xa and anti-IIa inhibitors, are topics in the treatment of APTE and are now under investigation. Thrombolytic therapy is a widely accepted treatment strategy for massive APTE, but its use for submassive APTE is controversial. Catheter intervention, percutaneous cardiopulmonary support and surgical embolectomy are also necessary and effective for some patients with APTE. A retrievable inferior vena cava filter is preferred for transient protection against APTE. Some studies have demonstrated the feasibility of outpatient treatment in patients with APTE after risk stratification.
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Yamada et al. (2011) studied this question.
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