title: Treatment options and strategies for acute severe pulmonary embolism.
abstract: Pulmonary thromboembolism (PE) is the third most frequent cause of cardiovascular death after ischaemic heart disease and stroke. In fatal PE, 2/3 of patients die within first hour of presentation. There is a clinical impetus to rapidly recognize, risk-stratify and appropriately treat patients with acute severe PE. Current recommendations present conflicting classification systems, and there is often some confusion in the clinical evaluation and management of patients with acute severe PE. This review presents a series of real clinical cases, which illustrate the available treatment options, ranging from conservative therapy to thrombolysis through to percutaneous catheter fragmentation and open surgical embolectomy. We evaluate the evidence for the various strategies and propose an algorithm for clinicians with a focus on early risk stratification and timely referral. This is particularly relevant to regional and remote centres, as well as secondary and tertiary institutions.
authors.affiliation: Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia. christian_hamilton-craig@health.qld.gov.au
authors.forename: C R
authors.initials: CR
authors.lastname: Hamilton-Craig
authors.forename: K
authors.initials: K
authors.lastname: McNeil
authors.forename: J
authors.initials: J
authors.lastname: Dunning
authors.forename: D L
authors.initials: DL
authors.lastname: Walters
authors.forename: R
authors.initials: R
authors.lastname: Slaughter
authors.forename: F
authors.initials: F
authors.lastname: Kermeen
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator