Anticoagulation is the primary treatment for pulmonary embolism, with thrombolytics, caval interruption, and embolectomy reserved for specific high-risk or refractory scenarios.
Reinforces anticoagulation as first-line for PE in practice; extends synthesized evidence for selective advanced therapies in refractory cases.
Most clinically important pulmonary emboli are associated with thrombosis of the proximal deep veins of the leg. Anticoagulant therapy is highly successful in reducing death and recurrence from pulmonary embolism and is the treatment of choice in the majority of these patients. Thrombolytic therapy is usually reserved for selected patients with clinically serious or massive pulmonary embolism. Vena caval interruption is limited to patients who have an absolute contraindication to anticoagulant therapy or who develop recurrent pulmonary embolism despite adequate anticoagulant therapy. Pulmonary embolectomy has a high mortality and should therefore be restricted to the most desperate cases.
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J. Hirsh (1987) studied this question.
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