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      Management of Pulmonary Embolism: An Update.

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          Abstract

          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.

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          Author and article information

          Journal
          J. Am. Coll. Cardiol.
          Journal of the American College of Cardiology
          1558-3597
          0735-1097
          Mar 1 2016
          : 67
          : 8
          Affiliations
          [1 ] Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece. Electronic address: stavros.konstantinides@unimedizin-mainz.de.
          [2 ] Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
          [3 ] Hôpital Européen Georges Pompidou, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, and GIRC Thrombose, Paris, France.
          Article
          S0735-1097(16)00011-5
          10.1016/j.jacc.2015.11.061
          26916489
          90e836ba-a6fb-4e96-b7b6-8b32844358ea
          Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
          History

          anticoagulation,cava filters,prognosis,reperfusion,risk assessment,venous thromboembolism

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