From the Guidelines
Acute pulmonary embolism (PE) is a life-threatening medical condition that requires immediate attention, characterized by a blood clot blocking one or more pulmonary arteries, disrupting normal blood flow and oxygen exchange, and potentially causing damage to lung tissue and reducing oxygen levels in the blood. The condition is typically caused by a blood clot originating in the deep veins of the legs, which breaks off and travels to the lungs. Symptoms of acute PE include sudden shortness of breath, chest pain that worsens with breathing, rapid heartbeat, coughing (sometimes with blood), and lightheadedness [ 1 ]. Risk factors for developing acute PE include prolonged immobility, recent surgery, cancer, pregnancy, hormonal contraceptives, and inherited clotting disorders.
Diagnosis and Treatment
Diagnosis of acute PE typically involves blood tests (D-dimer), imaging studies like CT pulmonary angiography, and sometimes ventilation-perfusion scans [ 1 ]. Treatment usually begins with anticoagulants such as heparin (initially) followed by oral anticoagulants like warfarin, rivaroxaban, or apixaban for at least 3-6 months. Severe cases may require thrombolytic therapy to dissolve clots or surgical intervention. The 2019 ESC guidelines recommend anticoagulation with UFH, including a weight-adjusted bolus injection, be initiated without delay in patients with high-risk PE, and systemic thrombolytic therapy is recommended for high-risk PE [ 1 ]. Preventive measures include early mobilization after surgery, compression stockings, and prophylactic anticoagulation for high-risk patients.
Clinical Severity and Outcome
Acute PE can lead to haemodynamic instability, which is a critical determinant of clinical severity and outcome [ 1 ]. High-risk PE is defined by haemodynamic instability and encompasses forms of clinical presentation such as cardiac arrest, obstructive shock, and persistent hypotension. The definition of haemodynamic instability is crucial in identifying patients with high-risk PE, who require immediate medical attention and aggressive treatment [ 1 ]. The clinical symptoms and signs of overt RV failure and haemodynamic instability indicate a high risk of early (in-hospital or 30-day) mortality.
From the Research
Definition and Overview of Acute Pulmonary Embolism
- Acute pulmonary embolism is a life-threatening condition that can lead to both acute and long-term morbidity and mortality 2.
- It is characterized by a blockage of one of the pulmonary arteries in the lungs, which can be caused by a blood clot that has traveled from another part of the body 3.
Clinical Presentation and Diagnosis
- Acute pulmonary embolism can present with a broad clinical spectrum, ranging from an asymptomatic course to sudden cardiac death 3.
- Patients with acute pulmonary embolism are at risk for significant complications, including the development of chronic pulmonary embolism and chronic thromboembolic pulmonary hypertension 2.
- Diagnosis is typically made using validated diagnostic algorithms, including multidetector CT or echocardiography 3.
Treatment Options
- Treatment options for acute pulmonary embolism range from anticoagulation alone to surgical embolectomy and hemodynamic support with extracorporeal membrane oxygenation 2.
- Anticoagulants such as warfarin, unfractionated heparin, and low-molecular-weight heparins are commonly used to treat pulmonary embolism 4.
- Newer oral anticoagulants such as rivaroxaban, dabigatran, and apixaban have also been approved for the treatment of venous thromboembolism, including pulmonary embolism 4.
- Enoxaparin monotherapy has also been shown to be a feasible treatment option for symptomatic pulmonary embolism 5.
Management and Follow-up
- The care for patients with acute pulmonary embolism does not end at hospital discharge, and it is essential to ensure adequate follow-up and identify patients with persistent symptoms and impaired quality of life 2.
- The Pulmonary Embolism Response Team Consortium has provided a comprehensive review of the diagnosis, treatment, and follow-up of acute pulmonary embolism, including both clinical data and consensus opinion to provide guidance for clinicians caring for these patients 6.