From the Guidelines
The treatment for chronic pulmonary embolism primarily involves life-long anticoagulation and consideration of pulmonary endarterectomy surgery for eligible candidates with chronic thromboembolic pulmonary hypertension (CTEPH). According to the 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension 1, life-long anticoagulation is recommended in all patients with CTEPH. The assessment of operability and decisions regarding other treatment strategies should be made by a multidisciplinary team of experts 1. Key treatment options include:
- Life-long anticoagulation
- Surgical pulmonary endarterectomy (PEA) in deep hypothermia circulatory arrest for patients with CTEPH 1
- Riociguat for symptomatic patients who have been classified as having persistent/recurrent CTEPH after surgical treatment or inoperable CTEPH by a CTEPH team including at least one experienced PEA surgeon 1
- Off-label use of drugs approved for PAH may be considered in symptomatic patients who have been classified as having inoperable CTEPH by a CTEPH team including at least one experienced PEA surgeon 1
- Interventional balloon pulmonary angioplasty (BPA) may be considered in patients who are technically non-operable or carry an unfavourable risk:benefit ratio for PEA 1. These treatments aim to prevent clot extension, reduce pulmonary vascular resistance, improve right ventricular function, and enhance quality of life by addressing the underlying pathophysiology of chronic pulmonary embolism.
From the FDA Drug Label
1.3 Treatment of Pulmonary Embolism
XARELTO is indicated for the treatment of pulmonary embolism (PE).
1.4 Reduction in the Risk of Recurrence of Deep Vein Thrombosis and/or Pulmonary Embolism
XARELTO is indicated for the reduction in the risk of recurrence of DVT and/or PE in adult patients at continued risk for recurrent DVT and/or PE after completion of initial treatment lasting at least 6 months.
- The treatment for chronic pulmonary embolism is rivaroxaban (XARELTO), as indicated in the drug label 2.
- Apixaban is also indicated for the treatment of pulmonary embolism (PE), as stated in the drug label 3.
- The main goal of treatment is to reduce the risk of recurrence of DVT and/or PE in adult patients at continued risk.
- Rivaroxaban (XARELTO) and apixaban can be used for the treatment of pulmonary embolism.
From the Research
Treatment for Chronic Pulmonary Embolism
The treatment for chronic pulmonary embolism involves anticoagulation therapy to prevent further clot formation and reduce the risk of recurrence.
- Anticoagulation is strongly recommended by current practice guidelines, with indefinite anticoagulation preferred for patients with chronic thromboembolic pulmonary hypertension (CTEPH) 4.
- The choice of anticoagulant agent depends on the individual patient's risk factors and medical history, with direct oral anticoagulants (DOACs) such as apixaban, edoxaban, and rivaroxaban being effective alternatives to traditional vitamin K antagonists (VKAs) 5.
- For patients with active cancer, DOACs are preferred over VKAs, while low-molecular-weight heparin is recommended for the first 6 months 6.
Anticoagulation Therapy
Anticoagulation therapy is the mainstay of treatment for chronic pulmonary embolism, with the goal of preventing further clot formation and reducing the risk of recurrence.
- The duration of anticoagulation therapy depends on the individual patient's risk factors, with extended duration of anticoagulation preferred for patients with idiopathic PE or persistent risk factors 6.
- The decision to extend anticoagulation therapy should consider both the individual risk of PE recurrence and the individual risk of bleeding 5.
- DOACs have a favorable safety profile and are preferred over VKAs for long-term anticoagulation 5, 7.
Surgical Intervention
In some cases, surgical intervention may be necessary to treat chronic pulmonary embolism.