Management of intermediate-risk pulmonary embolism: uncertainties and challenges

Eur J Haematol. 2015 Dec;95(6):489-97. doi: 10.1111/ejh.12612. Epub 2015 Jul 15.

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.

Keywords: fibrinolysis; intermediate risk; outpatient treatment; pulmonary embolism; treatment.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Angiography
  • Biomarkers
  • Clinical Decision-Making
  • Combined Modality Therapy
  • Disease Management
  • Hemodynamics
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Pulmonary Embolism / diagnosis*
  • Pulmonary Embolism / etiology
  • Pulmonary Embolism / metabolism
  • Pulmonary Embolism / therapy*
  • Risk Assessment
  • Tomography, X-Ray Computed
  • Treatment Outcome

Substances

  • Biomarkers