title: Management of intermediate-risk pulmonary embolism: uncertainties and challenges.
abstract: Current guidelines on the treatment of acute pulmonary embolism (PE) recommend stratification of hemodynamically stable patients in 'low risk' and 'intermediate risk'. Validated risk scores, cardiac biomarkers, and imaging of the right ventricle all help in distinguishing both patient categories. The relevance of this risk stratification lies in the determination of the most optimal treatment for the individual patient. In this clinical review, we will discuss how patients with 'intermediate-risk' PE can be identified as well as recent advances in their therapeutic management. Based on a clinical case, we will highlight the indications for reperfusion therapy and the current experience with non-vitamin K-dependent oral anticoagulant (NOACs) in this specific patient's category.
authors.affiliation: Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany.
authors.forename: Frederikus Albertus
authors.initials: FA
authors.lastname: Klok
authors.affiliation: Hôpital Européen Georges Pompidou, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMRS 970, CIC 1418, Paris, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Meyer
authors.affiliation: Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany.
authors.forename: Stavros
authors.initials: S
authors.lastname: Konstantinides
mesh_terms: D000792:Angiography; D015415:Biomarkers; D000066491:Clinical Decision-Making; D003131:Combined Modality Therapy; D019468:Disease Management; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: fibrinolysis; intermediate risk; outpatient treatment; pulmonary embolism; treatment