Pulmonary Embolism and Pregnancy-Challenges in Diagnostic and Therapeutic Decisions in High-Risk Patients

Lukas Hobohm; Ioannis T Farmakis; Thomas Münzel; Stavros Konstantinides; Karsten Keller

doi:10.3389/fcvm.2022.856594

Pulmonary Embolism and Pregnancy-Challenges in Diagnostic and Therapeutic Decisions in High-Risk Patients

Front Cardiovasc Med. 2022 Mar 8:9:856594. doi: 10.3389/fcvm.2022.856594. eCollection 2022.

Authors

Lukas Hobohm^{1

2}, Ioannis T Farmakis², Thomas Münzel^{1

3}, Stavros Konstantinides^{2

4}, Karsten Keller^{1

5}

Affiliations

¹ Department of Cardiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
² Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
³ German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany.
⁴ Department of Cardiology, Democritus University of Thrace, Komotini, Greece.
⁵ Medical Clinic VII, University Hospital Heidelberg, Heidelberg, Germany.

Abstract

Diagnosis of acute PE in pregnant women with haemodynamic instability is following the general integrated risk-adapted diagnostic algorithm and starts with bedside echocardiography to assess RV function. If RV dysfunction is identified, a prompt and immediate reperfusion without further imaging should be initiated. Although pregnancy is listed as a relative contraindication of systemic thrombolysis, in pregnant women with acute PE and haemodynamic instability thrombolysis must be considered. In those cases, other treatment strategies as surgical embolectomy or catheter-directed low-dose thromboylysis or percutaneous thrombectomy should be taken into consideration as well. A multidisciplinary team with experience of PE management in pregnancy should be consulted to reach consensus on the best treatment approach.

Keywords: outcome; pregnancy; pulmonary embolism; thrombolysis; venous thromboembolism.

Publication types

Review