In the perioperative setting where systemic anticoagulation poses severe bleeding risks, direct embolism-targeting techniques offer a potentially safer approach for managing acute pulmonary embolism.
May support direct embolism-targeting for perioperative PE; leaves open prospective validation before practice change.
Acute pulmonary embolism (PE) is a relatively rare but potentially fatal complication during the perioperative period. Its diagnosis is particularly challenging in the anesthetized patient, yet early diagnosis and treatment are essential in preventing morbidity and mortality. Preventative measures including anticoagulant treatment are well-established modalities in the management of venous thromboses and PE in the nonsurgical patient. However, a patient undergoing surgery suffering a new PE presents a unique challenge. Conventional treatment is often not an option in the perioperative period, as surgical bleeding may be equally life threatening as a PE. Therefore, techniques that target the embolism directly and avoid systemic anticoagulation seem to promise safer and more efficient treatment of the patient with PE in the perioperative period. Fast detection, correct diagnosis, and appropriate treatment are all essential in improving the outcome of this severe complication.
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Dorothea Hall (2012) studied this question.
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