title: Critical Review and Update on the Treatment of Acute and Chronic Pulmonary Embolism.
abstract: Pulmonary embolism (PE), can be life-threatening without rapid appropriate therapy and often leads to chronic disease and disability. The ambiguity of symptoms makes PE difficult to diagnose, and available imaging strategies have their limitations. Treatment options for acute PE include fibrinolytics, surgical embolectomy, catheter-directed treatment, or vena cava filter placement as well as traditional parenteral anticoagulants, used alone or as a bridge to a vitamin K antagonist (VKA). The direct oral anticoagulants (DOACs) rivaroxaban and apixaban allow for single drug therapy, eliminating the need for initial parenteral anticoagulation, while dabigatran and edoxaban are initiated after a short course of parenteral therapy. The DOACs serve as a viable alternative to warfarin for chronic management for PE. Pulmonary embolism provoked from transient risk factors often requires a short-term course of anticoagulation (3 months). Unprovoked events, and those that occur in the presence of continuing risk factors such as cancer, or clinical markers such as residual vein thrombosis and elevated d-dimers can predict a higher risk of recurrent events and warrant extended anticoagulation. This review evaluates current recommendations for the treatment of PE, including dosing strategies, duration of therapy, and special populations such as renal impairment, malignancy, and obesity.
authors.affiliation: University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA Antithrombosis Clinic, University of Illinois at Chicago Hospital and Health Sciences System, Chicago, IL, USA nlasack@uic.edu.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Shapiro
authors.affiliation: MCPHS University, Boston, MA, USA Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Snehal H
authors.initials: SH
authors.lastname: Bhatt
mesh_terms: D000208:Acute Disease; D000925:Anticoagulants / Q000627:therapeutic use; D002908:Chronic Disease; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D009765:Obesity / Q000150:complications / Q000188:drug therapy; D062645:Percutaneous Coronary Intervention / Q000379:methods; D011655:Pulmonary Embolism / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D051437:Renal Insufficiency / Q000150:complications / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000379:methods; D016306:Vena Cava Filters
chemical_list: D000925:Anticoagulants
keywords: anticoagulation; fibrinolytics; new oral anticoagulants; pulmonary embolism; venous thromboembolism