Systemic fibrinolysis remains the first-line therapy for acute high-risk pulmonary embolism, while catheter-directed techniques may offer a better safety profile.
Systemic fibrinolysis remains first-line for high-risk PE, though catheter-directed therapies may offer a better safety profile.
Hemodynamic instability and right ventricular (RV) dysfunction are the key determinants of short-term prognosis in patients with acute pulmonary embolism (PE). High-risk PE encompasses a wide spectrum of clinical situations from sustained hypotension to cardiac arrest. Early recognition and treatment tailored to each individual are crucial. Systemic fibrinolysis is the first-line pulmonary reperfusion therapy to rapidly reverse RV overload and hemodynamic collapse, at the cost of a significant rate of bleeding. Catheter-directed pharmacological and mechanical techniques ensure swift recovery of echocardiographic parameters and may possess a better safety profile than systemic thrombolysis. Further clinical studies are mandatory to clarify which pulmonary reperfusion strategy may improve early clinical outcomes and fill existing gaps in the evidence.
Chopard et al. (Wed,) conducted a review in Acute High-Risk Pulmonary Embolism. Pulmonary reperfusion therapy (systemic fibrinolysis and catheter-directed techniques) was evaluated. Systemic fibrinolysis remains the first-line therapy for acute high-risk pulmonary embolism, while catheter-directed techniques may offer a better safety profile.
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