WJCD  Vol.8 No.2 , February 2018
Diagnosis and Treatment Options for Pulmonary Embolism (PE) in the Acute Care Setting
ABSTRACT
Thromboembolic diseases continue to be one of the most prevalent medical problems today and can lead to life-threatening conditions, such as pulmonary embolism (PE). Currently, PE diagnosis and treatment are a challenge because of acute onset right ventricular strain with right-sided heart failure, sudden death, pulmonary infarction, and cardiogenic shock, which limit the time for therapeutic success. The aim of this study was to evaluate our perception, knowledge, and concerns regarding PE, discuss the importance of promptly diagnosing PE to provide appropriate treatment options for this life-threatening condition, list the most common clinical manifestations present when PE is suspected, and review the clinical approach to patients with suspected PE in an inpatient setting. In addition, this study reviews the risk stratification of patients with PE and treatment options beyond anticoagulation, compares new treatment options for patients presenting with acute symptomatic PE, and compares aspiration catheters (10 F Pronto .035” and 14 F XL extraction catheter (Vascular Solutions, Minneapolis, MN)) and ultrasound-assisted catheter-directed thrombolysis (USAT) versus systemic thrombolysis.This literature review was limited by the quality and number of studies available regarding new treatment options for patients presenting with acute symptomatic PE. Thus, more studies are needed to prove the validity of newer treatment options being trialed, such as aspiration catheters (10 F Pronto .035” and 14 F XL extraction catheter) and USAT, with the hope that further studies will guide patient management and increase our understanding of next generation aspiration catheters, which may provide novel insights on treating acute symptomatic PE.
Cite this paper
Campa, S. and Gantioque, R. (2018) Diagnosis and Treatment Options for Pulmonary Embolism (PE) in the Acute Care Setting. World Journal of Cardiovascular Diseases, 8, 152-161. doi: 10.4236/wjcd.2018.82015.
References
[1]   Goldman, L. and Schafer, A.I. (2015) Goldman-Cecil Medicine. Elsevier Saunders, Philadelphia, PA.

[2]   Grossman, S. and Porth, M.C. (2014) Porth’s Pathophysiology: Concepts of Altered Health States. Lippincott Williams & Wilkins, Philadelphia, PA.

[3]   Belohlavek, J., Dytrych, V. and Linhart, A. (2013) Pulmonary Embolism, Part I: Epidemiology, Risk Factors and Risk Stratification, Pathophysiology, Clinical Presentation, Diagnosis and Nonthrombotic Pulmonary Embolism. Experimental and Clinical Cardiology, 18, 129-138.

[4]   Zakai, N.A., McClure, L.A., Judd, S.E., Safford, M.M., Folsom, A.R., Lutsey, P.L. and Cushman, M. (2014) Racial and Regional Differences in Venous Thromboembolism in the United States in 3 Cohorts. Circulation, 129, 1502-1509.
https://doi.org/10.1161/CIRCULATIONAHA.113.006472

[5]   Bińkowska, M. (2014) Menopausal Hormone Therapy and Venous Thromboembolism. Menopause Review, 13, 267-272.
https://doi.org/10.5114/pm.2014.46468

[6]   Minet, C., Potton, L., Bonadona, A., Hamidfar-Roy, R., Somohano, C.A., Lugosi, M., Cartier, J.-C., Ferretti, G., Schwebel, C. and Timsit, J.-F. (2015) Venous Thromboembolism in the ICU: Main Characteristics, Diagnosis and Thromboprophylaxis. Critical Care, 19, 287.
https://doi.org/10.1186/s13054-015-1003-9

[7]   Garcia-Sanz, M., Pena-Alvarez, C., Lopez-Landeiro, P., Bermo-Dominguez, A., Fonturbel, T. and Barcala, F.J.G. (2014) Symptoms, Location and Prognosis of Pulmonary Embolism. Revista Portuguesa de Pneumologia, 20, 194-199.
https://doi.org/10.1016/j.rppneu.2013.09.006

[8]   Brown, A., Dingle, H.E., Brywczynski, J., McKinney, J.J. and Slovis, C.M. (2017) The 5 Deadly Causes of Chest Pain: Recognizing the Potentially Lethal Causes Other than Myocardial Infarction. A Journal of Emergency Medical Services, 42, 55-63.

[9]   Barkley, T.W. and Myers, C.M. (2015) Practice Considerations for Adult-Gerontology Acute Care Nurse Practitioners. Barkley & Associates, West Hollywood, CA.

[10]   Modi, S., Deisler, R., Gozel, K., Reicks, P., Irwin, E., Brunsvold, M., Banton, K. and Beilman, G.J. (2016) Wells Criteria for DVT Is a Reliable Clinical Tool To Assess the Risk of Deep Venous Thrombosis in Trauma Patients. World Journal of Emergency Surgery, 11, 24.
https://doi.org/10.1186/s13017-016-0078-1

[11]   Raja, A.S., Greenberg, J.O., Qaseem, A., et al. (2015) Evaluation of Patients with Suspected Acute Pulmonary Embolism: Best Practice Advice from the Clinical Guidelines Committee of the American College of Physicians. Annals of Internal Medicine, 163, 701-711.
https://doi.org/10.7326/M14-1772

[12]   Le Gal, G. and Righini, M. (2015) Controversies in the Diagnosis of Venous Thromboembolism. Journal of Thrombosis and Haemostasis, 13, S259-S265.

[13]   Ferris, N. and Goergen, S. (2017) Gadolinium Contrast Medium (MRI Contrast Agents). Inside Radiology, General Radiology.
https://www.insideradiology.com.au/gadolinium-contrast-medium/

[14]   Zarghouni, M., Charles, H.W., Maldonado, T.S. and Deipolyi, A.R. (2016) Catheter-Directed Interventions for Pulmonary Embolism. Cardiovascular Diagnosis and Therapy, 6, 651-661.
https://doi.org/10.21037/cdt.2016.11.15

[15]   Tapson, V.F. (2008) Acute Pulmonary Embolism. The New England Journal of Medicine, 358, 1037-1052.
https://doi.org/10.1056/NEJMra072753

[16]   Heberlein, W.E., Meek, M.E., Saleh, O., Meek, J.C., Lensing, S.Y. and Culp, W.C. (2013) New Generation Aspiration Catheter: Feasibility in the Treatment of Pulmonary Embolism. World Journal of Radiology, 5, 430-435.
https://doi.org/10.4329/wjr.v5.i11.430

[17]   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.
http://onlinelibrary.wiley.com/doi/10.1111/j.1445-5994.2008.01671.x/abstract
https://doi.org/10.1111/j.1445-5994.2008.01671.x


[18]   Haxaire, C., Tromeur, C., Couturaud, F. and Leroyer, C. (2015) A Qualitative Study to Appraise Patients and Family Members Perceptions, Knowledge, and Attitudes towards Venous Thromboembolism Risk. PLoS ONE, 10, e0142070.
https://doi.org/10.1371/journal.pone.0142070

[19]   Flinterman, L.E., Vlieg, A.V., Cannegieter, S.C. and Rosendaal, F.R. (2012) Long-Term Survival in a Large Cohort of Patients with Venous Thrombosis: Incidence and Predictors. PLoS Medicine, 9, e1001155.
http://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.1001155
https://doi.org/10.1371/journal.pmed.1001155


 
 
Top