Clinical controversies in the management of acute pulmonary embolism: evaluation of four important but controversial aspects of acute pulmonary embolism management that are still subject of debate and research.

IF 2.9 3区 医学 Q2 RESPIRATORY SYSTEM Expert Review of Respiratory Medicine Pub Date : 2023-03-01 Epub Date: 2023-03-20 DOI:10.1080/17476348.2023.2190888
Dieuwke Luijten, Frederikus A Klok, Thijs E van Mens, Menno V Huisman
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引用次数: 1

Abstract

Introduction: Acute pulmonary embolism (PE) is a disease with a broad spectrum of clinical presentations. While some patients can be treated at home or may even be left untreated, other patients require an aggressive approach with reperfusion treatment.

Areas covered: (1) Advanced reperfusion treatment in hemodynamically stable acute PE patients considered to be at high risk of decompensation and death, (2) the treatment of subsegmental pulmonary embolism, (3) outpatient treatment for hemodynamically stable PE patients with signs of right ventricle (RV) dysfunction, and (4) the optimal approach to identify and treatpost-PE syndrome.

Expert opinion: Outside clinical trials, hemodynamically stable acute PE patients should not be treated with primary reperfusion therapy. Thrombolysis and/or catheter-directed therapy are only to be considered as rescue treatment. Subsegmental PE can be left untreated in selected low-risk patients, after proximal deep vein thrombosis has been ruled out. Patients with an sPESI or Hestia score of 0 criteria can be treated at home, independent of the presence of RV overload. Finally, health-care providers should be aware of post-PE syndrome and diagnose chronic thromboembolic pulmonary disease (CTEPD) as early as possible. Persistently symptomatic patients without CTEPD benefit from exercise training and cardiopulmonary rehabilitation.

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急性肺栓塞治疗中的临床争议:评估急性肺栓塞管理的四个重要但有争议的方面,这些方面仍然是争论和研究的主题。
引言:急性肺栓塞(PE)是一种临床表现广泛的疾病。虽然一些患者可以在家接受治疗,甚至可能不接受治疗,但其他患者需要积极的再灌注治疗。涵盖的领域:(1)被认为具有失代偿和死亡高风险的血液动力学稳定的急性PE患者的高级再灌注治疗,(2)亚节段肺栓塞的治疗,(3)有右心室(RV)功能障碍迹象的血液动力学稳定PE患者的门诊治疗,以及(4)识别和治疗PE后综合征的最佳方法。专家意见:在临床试验之外,血液动力学稳定的急性PE患者不应接受一次再灌注治疗。溶栓和/或导管导向治疗只能被视为抢救性治疗。在排除了近端深静脉血栓形成后,选定的低风险患者可以不治疗亚段PE。sPESI或Hestia评分为0标准的患者可以在家接受治疗,与RV超负荷无关。最后,医疗保健提供者应该意识到PE后综合征,并尽早诊断慢性血栓栓塞性肺病(CTEPD)。没有CTEPD的持续症状患者受益于运动训练和心肺康复。
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CiteScore
6.80
自引率
2.60%
发文量
90
期刊介绍: Coverage will include the following key areas: - Prospects for new and emerging therapeutics - Epidemiology of disease - Preventive strategies - All aspects of COPD, from patient self-management to systemic effects of the disease and comorbidities - Improved diagnostic methods, including imaging techniques, biomarkers and physiological tests. - Advances in the treatment of respiratory infections and drug resistance issues - Occupational and environmental factors - Progress in smoking intervention and cessation methods - Disease and treatment issues for defined populations, such as children and the elderly - Respiratory intensive and critical care - Updates on the status and advances of specific disease areas, including asthma, HIV/AIDS-related disease, cystic fibrosis, COPD and sleep-disordered breathing morbidity
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