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Review
. 2024 Sep 20;13(18):5583.
doi: 10.3390/jcm13185583.

Risk Stratification and Management of Intermediate- and High-Risk Pulmonary Embolism

Sanaullah Mojaddedi  1   2 , Javairia Jamil  3 , Daniel Bishev  1   2 , Kobina Essilfie-Quaye  1   2 , Islam Y Elgendy  4
Affiliations
Review

Risk Stratification and Management of Intermediate- and High-Risk Pulmonary Embolism

Sanaullah Mojaddedi et al. J Clin Med. .

Abstract

Acute pulmonary embolism (PE) is a leading cause of mortality. Not only is PE associated with short-term mortality, but up to ~20% of patients might suffer from long-term consequences such as post-PE syndrome and chronic thromboembolic pulmonary hypertension. Current risk stratification tools poorly predict those who are at risk for short-term deterioration and those who develop long-term consequences. Traditionally, systemic thrombolysis has been considered the first-line therapy for patients with high-risk PE without contraindications; however, it comes with the risk of major bleeding (notably intracranial hemorrhage). The use of catheter-directed interventions (embolectomy or thrombolysis) has been increasing owing to their low bleeding risk; however, randomized trial data supporting their efficacy in improving clinical outcomes are limited. In this review, we highlight the evidence supporting the available advanced therapies for high- and intermediate-risk PE and summarize the ongoing trials which are evaluating these therapies.

Keywords: catheter-directed embolectomy; catheter-directed thrombolysis; pulmonary embolism; systemic thrombolysis; venous thromboembolism.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Pathophysiology of shock in acute pulmonary embolism. RV: right ventricle, LV: left ventricle, O2: oxygen.
See this image and copyright information in PMC

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