Pulmonary Embolism: Contemporary Medical Management and Future Perspectives

• Published in: Annals of Vascular Diseases Vol. 11; no. 3; pp. 265 - 276
• Main Authors: Barco, Stefano, Konstantinides, Stavros V.
• Format: Journal Article
• Language: English
• Published: Japan The Editorial Committee of Annals of Vascular Diseases 25.09.2018; Japanese College of Angiology / The Japanese Society for Vascular Surgery / Japanese Society of Phlebology
• Subjects: direct oral anticoagulants; pulmonary embolism; Review; right ventricular dysfunction; risk stratification; thrombolysis; venous thromboembolism; thrombolysis; direct oral anticoagulants; right ventricular dysfunction; risk stratification; pulmonary embolism; venous thromboembolism
• ISSN: 1881-641X; 1881-6428; 1881-6428
• DOI: 10.3400/avd.ra.18-00054

Pulmonary embolism (PE) contributes substantially to the global disease burden. A key determinant of early adverse outcomes is the presence (and severity) of right ventricular dysfunction. Consequently, risk-adapted management strategies continue to evolve, tailoring acute treatment to the patients’ clinical presentation, hemodynamic status, imaging and biochemical markers, and comorbidity. For subjects with hemodynamic instability or ‘high-risk’ PE, immediate systemic reperfusion treatment with intravenous thrombolysis is indicated; emerging approaches such as catheter-directed pharmacomechanical reperfusion might help to minimize the bleeding risk. Currently, direct, non-vitamin K-dependent oral anticoagulants are the mainstay of treatment for acute PE. They have been shown to simplify initial and extended anticoagulation regimens while reducing the bleeding risk compared to vitamin K antagonists. (This is a review article based on the invited lecture of the 37th Annual Meeting of Japanese Society of Phlebology.)