Key result
DOACs advance acute PE treatment but require essential risk stratification and mandatory follow-up.
Provides an overview of the diagnosis, risk stratification, and management of acute pulmonary embolism, highlighting the role of DOACs and pulmonary embolism response teams.
Affirms DOAC role in acute PE with required stratification; leaves open need for prospective validation.
Pulmonary embolism, despite being common, often remains elusive as a diagnosis, and clinical suspicion needs to remain high when seeing a patient with cardiopulmonary symptoms. Once suspected, diagnosis is usually straightforward; however, optimal treatment can be difficult. Risk stratification with clinical scores, biomarkers and imaging helps to refine the best treatment strategy, but the position of thrombolysis in intermediate risk (submassive) pulmonary embolism remains a grey area. Pulmonary embolism response teams are on the increase to provide advice in such cases. Direct oral anticoagulants have been a major advance in treatment this decade, but are not appropriate for all patients. Follow-up of patients with pulmonary embolism should be mandatory to determine duration of anticoagulation and to assess for serious long-term complications.
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Luke Howard (2019) conducted a review in Acute pulmonary embolism. Direct oral anticoagulants represent a major advance in the treatment of acute pulmonary embolism, though risk stratification and mandatory follow-up remain essential for optimal management.
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