title: Pharmacological management of pulmonary embolism.
abstract: Pulmonary embolism (PE) is a common and potentially severe manifestation of venous thromboembolism. Its management has relied on anticoagulation by vitamin K antagonists (VKA) for the past fifty years. Recently, new alternative drugs have been developed and dramatically modified both the treatment of acute PE and its secondary prevention. Areas covered: This review discusses the contemporary pharmacological treatment for PE, with a focus on anticoagulation options for non-high risk PE. In particular, the advent of direct oral anticoagulants (rivaroxaban, apixaban, edoxaban and dabigatran) and modalities for long-term prevention will be described. Options for anticoagulation for pregnancy-related PE are presented separately. Expert opinion: Direct oral anticoagulants represent the first-line therapy of non-high risk PE, with better risk-benefit ratios compared with VKA due to lower bleeding risks. In specific groups of patients, however, older generations of anticoagulants such as VKA or heparins still play an important role. Multiple alternatives are available for the secondary prevention of PE, with different efficacies in reducing thrombotic risk and bleeding safety profiles.
authors.affiliation: a Division of Angiology & Hemostasis , Geneva University Hospitals and Faculty of Medicine , Geneva , Switzerland.|b Division of General Internal Medicine , Université de Sherbrooke , Sherbrooke , Canada.
authors.forename: Bobby
authors.initials: B
authors.lastname: Gouin
authors.affiliation: a Division of Angiology & Hemostasis , Geneva University Hospitals and Faculty of Medicine , Geneva , Switzerland.
authors.forename: Helia
authors.initials: H
authors.lastname: Robert-Ebadi
authors.affiliation: a Division of Angiology & Hemostasis , Geneva University Hospitals and Faculty of Medicine , Geneva , Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Righini
authors.affiliation: a Division of Angiology & Hemostasis , Geneva University Hospitals and Faculty of Medicine , Geneva , Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Blondon
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000517:prevention & control; D055502:Secondary Prevention; D054556:Venous Thromboembolism / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants
keywords: pharmacological treatment; pulmonary embolism; review; venous thromboembolism