Treatment options and strategies for acute severe pulmonary embolism
Article first published online: 3 SEP 2008
© 2008 The Authors Journal compilation © 2008 Royal Australasian College of Physicians
Internal Medicine Journal
Volume 38, Issue 8, pages 657–667, August 2008
How to Cite
Hamilton-Craig, C. R., McNeil, K., Dunning, J., Walters, D. L., Slaughter, R. and Kermeen, F. (2008), Treatment options and strategies for acute severe pulmonary embolism. Internal Medicine Journal, 38: 657–667. doi: 10.1111/j.1445-5994.2008.01671.x
Potential conflicts of interest: None
- Issue published online: 3 SEP 2008
- Article first published online: 3 SEP 2008
- Received 24 July 2007; accepted 18 January 2008.
- pulmonary embolism;
- pulmonary hypertension
Pulmonary thromboembolism (PE) is the third most frequent cause of cardiovascular death after ischaemic heart disease and stroke. In fatal PE, 2/3 of patients die within first hour of presentation. There is a clinical impetus to rapidly recognize, risk-stratify and appropriately treat patients with acute severe PE. Current recommendations present conflicting classification systems, and there is often some confusion in the clinical evaluation and management of patients with acute severe PE. This review presents a series of real clinical cases, which illustrate the available treatment options, ranging from conservative therapy to thrombolysis through to percutaneous catheter fragmentation and open surgical embolectomy. We evaluate the evidence for the various strategies and propose an algorithm for clinicians with a focus on early risk stratification and timely referral. This is particularly relevant to regional and remote centres, as well as secondary and tertiary institutions.