Risk-adapted treatment, age-adjusted D-dimer cutoffs, and new oral anticoagulants optimize the management of acute pulmonary embolism, while primary systemic fibrinolysis has an unfavorable risk-benefit ratio in intermediate-risk PE.
This review summarizes current evidence for PE management, emphasizing age-adjusted D-dimer cutoffs, the safety of new oral anticoagulants, and the limited role of systemic fibrinolysis in intermediate-risk patients.
Pulmonary embolism (PE) remains a major contributor to global disease burden. Risk-adapted treatment and follow-up contributes to a favorable outcome. Age-adjusted cutoff levels increase D-dimer specificity and may decrease overuse of imaging procedures and overdiagnosis of PE. Primary systemic fibrinolysis has an unfavorable risk-benefit ratio in intermediate-risk PE; catheter-directed techniques are an option for patients with hemodynamic decompensation and high bleeding risk. New oral anticoagulant agents are effective and safe alternatives to standard anticoagulation regimens. Recent trial data do not support insertion of cava filters in patients who can receive anticoagulant treatments. Remaining areas of uncertainty include the therapeutic implications of subsegmental PE, the optimal diagnostic approach to the pregnant patient with suspected PE, and the efficacy and safety of new oral anticoagulant agents in patients with cancer. Campaigns to increase awareness combined with strategies to implement guideline recommendations will be crucial steps towards further optimizing management of acute PE.
Konstantinides et al. (Mon,) conducted a review in Pulmonary embolism. Management strategies (D-dimer, fibrinolysis, NOACs, cava filters) was evaluated. Risk-adapted treatment, age-adjusted D-dimer cutoffs, and new oral anticoagulants optimize the management of acute pulmonary embolism, while primary systemic fibrinolysis has an unfavorable risk-benefit ratio in intermediate-risk PE.