Investigation and management of pulmonary embolism 2: specific clinical conditions

2021 ◽  
pp. 1-6
Author(s):  
Stephanie Stolberg ◽  
Dalia Mudawi ◽  
Katrina Dean ◽  
Andrew Cheng ◽  
Richard Barraclough
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Presentation ◽  
Recurrent Disease ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Outpatient Management ◽  
Treatment And Prevention ◽  
Thromboembolic Pulmonary Hypertension ◽  
Deadly Disease ◽  
Multifactorial Approach ◽  
Clinical Conditions

Pulmonary embolism remains a common and potentially deadly disease, despite advances in diagnostic imaging, treatment and prevention. Managing pulmonary embolism requires a multifactorial approach involving risk stratification, determining appropriate diagnostics and selecting individualised therapy. The first part of this article reviewed the pathophysiology, risk factors, clinical presentation, diagnostic evaluation and therapeutic management and early outpatient management of pulmonary embolism. This second part summarises pulmonary embolism in the setting of pregnancy, COVID-19, recurrent disease and chronic thromboembolic pulmonary hypertension.

Investigation and management of pulmonary embolism 1: a probability-based approach

2021 ◽  
pp. 1-16
Author(s):  
Stephanie Stolberg ◽  
Dalia Mudawi ◽  
Katrina Dean ◽  
Andrew Cheng ◽  
Richard Barraclough
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Clinical Presentation ◽  
Recurrent Disease ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Outpatient Management ◽  
Treatment And Prevention ◽  
Thromboembolic Pulmonary Hypertension ◽  
Deadly Disease ◽  
Multifactorial Approach

Pulmonary embolism remains a common and potentially deadly disease, despite advances in diagnostic imaging, treatment and prevention. Managing pulmonary embolism requires a multifactorial approach involving risk stratification, determining appropriate diagnostics and selecting individualised therapy. This article reviews the pathophysiology, risk factors, clinical presentation, diagnostic evaluation and therapeutic management and early outpatient management of pulmonary embolism. The second part summarises pulmonary embolism in the setting of pregnancy, COVID-19, recurrent disease and chronic thromboembolic pulmonary hypertension.

Acute Pulmonary Embolism

2019 ◽  
Author(s):  
Brett J Carroll ◽  
Eric A Secemsky
Keyword(s):  
Pulmonary Embolism ◽  
Diagnostic Imaging ◽  
Risk Stratification ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Integrated Approach ◽  
Initial Management ◽  
Right Ventricular Strain ◽  
Thromboembolic Pulmonary Hypertension ◽  
Short And Long Term

Pulmonary embolism (PE) is a frequently encountered clinical condition with both short- and long-term adverse consequences. An integrated approach to diagnosis is important to maximize early diagnosis but also to minimize the unnecessary utilization of diagnostic imaging. Comprehensive risk stratification with clinical features and assessment of right ventricular strain by diagnostic imaging and cardiac biomarker results are essential to guide initial management decisions. There is a growing treatment arsenal for acute PE, including increased anticoagulation and advanced therapeutic options such as catheter-based therapy.  Despite such advances, mortality remains high, particularly among those who present critically ill with PE, and long-term physical and psychological effects can persist in many patients for years after the initial diagnosis. This review contains 7 figures, 6 tables, and 69 references. Key Words: anticoagulation, catheter-directed therapy, chronic thromboembolic pulmonary hypertension pulmonary embolism, computed tomography, echocardiography, fibrinolysis, risk stratification, venous thromboembolism

Risk Factors and Epidemiology of Pulmonary Embolism

2020 ◽  
Author(s):  
Aaron B Waxman ◽  
Aaron W Aday
Keyword(s):  
United States ◽  
Risk Factors ◽  
Pulmonary Embolism ◽  
Recurrent Events ◽  
Hormone Replacement ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
The United States ◽  
Vein Thrombosis ◽  
Thromboembolic Pulmonary Hypertension ◽  
Deep Vein

More than 200,000 individuals are hospitalized with an acute pulmonary embolism in the United States annually. Despite advances in diagnosis and treatment, pulmonary embolism accounts for nearly 1% of all cardiovascular-related deaths each year in the United States alone. Those who survive an acute episode remain at a risk of recurrent events as well as ongoing dyspnea, reduced quality of life, and chronic thromboembolic pulmonary hypertension. Recognized risk factors for pulmonary embolism include advanced age, obesity, smoking, malignancy, immobilization from any cause, pregnancy and the postpartum period, oral contraceptives, and hormone replacement therapy. Numerous heritable and acquired thrombophilias increase the risk of pulmonary embolism. Additionally, inflammation and autoimmune disorders are increasingly recognized as potent risk factors for pulmonary embolism. This review contains 3 figures, 6 tables, 54 references. Key Words: anticoagulation, deep vein thrombosis, epidemiology, genetics, inflammation, malignancy, pulmonary embolism, thrombosis, venous thromboembolism

Active search for chronic thromboembolic pulmonary hypertension does not appear indicated after acute pulmonary embolism

2010 ◽  
Vol 125 (5) ◽  
pp. e202-e205 ◽  
Author(s):  
Sulaiman Surie ◽  
Nadine S. Gibson ◽  
Victor E.A. Gerdes ◽  
Berto J. Bouma ◽  
Berthe L.F. van Eck – Smit ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
Acute Pulmonary Embolism ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Active Search ◽  
Thromboembolic Pulmonary Hypertension

scholarly journals Impact of residual pulmonary obstruction on the long-term outcome of patients with pulmonary embolism

2017 ◽  
Vol 49 (5) ◽  
pp. 1601980 ◽  
Author(s):  
Raffaele Pesavento ◽  
Lucia Filippi ◽  
Antonio Palla ◽  
Adriana Visonà ◽  
Carlo Bova ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
Venous Thromboembolism ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
First Episode ◽  
Long Term Outcome ◽  
Recurrent Venous Thromboembolism ◽  
Thromboembolic Pulmonary Hypertension ◽  
The Impact ◽  
Lung Scanning

The impact of residual pulmonary obstruction on the outcome of patients with pulmonary embolism is uncertain.We recruited 647 consecutive symptomatic patients with a first episode of pulmonary embolism, with or without concomitant deep venous thrombosis. They received conventional anticoagulation, were assessed for residual pulmonary obstruction through perfusion lung scanning after 6 months and then were followed up for up to 3 years. Recurrent venous thromboembolism and chronic thromboembolic pulmonary hypertension were assessed according to widely accepted criteria.Residual pulmonary obstruction was detected in 324 patients (50.1%, 95% CI 46.2–54.0%). Patients with residual pulmonary obstruction were more likely to be older and to have an unprovoked episode. After a 3-year follow-up, recurrent venous thromboembolism and/or chronic thromboembolic pulmonary hypertension developed in 34 out of the 324 patients (10.5%) with residual pulmonary obstruction and in 15 out of the 323 patients (4.6%) without residual pulmonary obstruction, leading to an adjusted hazard ratio of 2.26 (95% CI 1.23–4.16).Residual pulmonary obstruction, as detected with perfusion lung scanning at 6 months after a first episode of pulmonary embolism, is an independent predictor of recurrent venous thromboembolism and/or chronic thromboembolic pulmonary hypertension.

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