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Treatment options and strategies for acute severe pulmonary embolism

Authors

  • C. R. Hamilton-Craig,

    Corresponding author
    1. 1 Department of Cardiology, 2Pulmonary Hypertension and Lung Transplantation Unit and 4Centre for Cardiovascular Imaging, The Prince Charles Hospital, Brisbane, Queensland, Australia and 3Department of CardioThoracic Surgery, Papworth Hospital, UK
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  • 1 K. McNeil,

    1. 1 Department of Cardiology, 2Pulmonary Hypertension and Lung Transplantation Unit and 4Centre for Cardiovascular Imaging, The Prince Charles Hospital, Brisbane, Queensland, Australia and 3Department of CardioThoracic Surgery, Papworth Hospital, UK
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  • 2 J. Dunning,

    1. 1 Department of Cardiology, 2Pulmonary Hypertension and Lung Transplantation Unit and 4Centre for Cardiovascular Imaging, The Prince Charles Hospital, Brisbane, Queensland, Australia and 3Department of CardioThoracic Surgery, Papworth Hospital, UK
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  • 3 D. L. Walters,

    1. 1 Department of Cardiology, 2Pulmonary Hypertension and Lung Transplantation Unit and 4Centre for Cardiovascular Imaging, The Prince Charles Hospital, Brisbane, Queensland, Australia and 3Department of CardioThoracic Surgery, Papworth Hospital, UK
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  • 1 R. Slaughter,

    1. 1 Department of Cardiology, 2Pulmonary Hypertension and Lung Transplantation Unit and 4Centre for Cardiovascular Imaging, The Prince Charles Hospital, Brisbane, Queensland, Australia and 3Department of CardioThoracic Surgery, Papworth Hospital, UK
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  • and 4 F. Kermeen 2

    1. 1 Department of Cardiology, 2Pulmonary Hypertension and Lung Transplantation Unit and 4Centre for Cardiovascular Imaging, The Prince Charles Hospital, Brisbane, Queensland, Australia and 3Department of CardioThoracic Surgery, Papworth Hospital, UK
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  • Funding: None

    Potential conflicts of interest: None

Christian R. Hamilton-Craig, Rode Road, Chermside, Qld 4032, Australia.
Email: christian_hamilton-craig@health.qld.gov.au

Abstract

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.

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