title: Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association.
abstract: Venous thromboembolism (VTE) is responsible for the hospitalization of >250 000 Americans annually and represents a significant risk for morbidity and mortality. Despite the publication of evidence-based clinical practice guidelines to aid in the management of VTE in its acute and chronic forms, the clinician is frequently confronted with manifestations of VTE for which data are sparse and optimal management is unclear. In particular, the optimal use of advanced therapies for acute VTE, including thrombolysis and catheter-based therapies, remains uncertain. This report addresses the management of massive and submassive pulmonary embolism (PE), iliofemoral deep vein thrombosis (IFDVT),and chronic thromboembolic pulmonary hypertension (CTEPH). The goal is to provide practical advice to enable the busy clinician to optimize the management of patients with these severe manifestations of VTE. Although this document makes recommendations for management, optimal medical decisions must incorporate other factors, including patient wishes, quality of life, and life expectancy based on age and comorbidities. The appropriateness of these recommendations for a specific patient may vary depending on these factors and will be best judged by the bedside clinician.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jaff
authors.forename: M Sean
authors.initials: MS
authors.lastname: McMurtry
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Archer
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.forename: Neil
authors.initials: N
authors.lastname: Goldenberg
authors.forename: Samuel Z
authors.initials: SZ
authors.lastname: Goldhaber
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jenkins
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kline
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Michaels
authors.forename: Patricia
authors.initials: P
authors.lastname: Thistlethwaite
authors.forename: Suresh
authors.initials: S
authors.lastname: Vedantham
authors.forename: R James
authors.initials: RJ
authors.lastname: White
authors.forename: Brenda K
authors.initials: BK
authors.lastname: Zierler
mesh_terms: D000572:American Heart Association; D000925:Anticoagulants / Q000627:therapeutic use*; D002309:Cardiology / Q000592:standards*; D005268:Femoral Vein; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000188:drug therapy*; D007084:Iliac Vein; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000592:standards*; D014481:United States; D020246:Venous Thrombosis / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants