Pulmonary Embolism: From Acute PE to Chronic Complications

Contents
Contributors
Pulmonary Embolism
Epidemiology of Pulmonary Embolism
	Introduction
	Incidence and Prevalence of PE
		Age, Gender, and Ethnicity
	PE-Related Mortality
	Impact of VTE Risk Factors on PE Epidemiology
	Conclusion
	References
PE Diagnosis
	Approach to Patients with Suspected Pulmonary Embolism
		Clinical Prediction Rules
		D-Dimer
		Clinical Use of Prediction Scores and Drawbacks
	Imaging Studies
		Chest Radiograph (CXR)
		Electrocardiogram
		Echocardiography
		Computed Tomography Pulmonary Angiography (CTA)
		Pulmonary Angiography
		Ventilation-Perfusion (V/Q) Scan
		Ultrasonography
		Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiogram (MRA)
	Conclusion
	References
Risk Stratification of Acute PE
	Introduction
	Classification of Acute PE
	Risk Stratification of Acute PE
		Clinical Scoring Systems
		Biomarkers
			Troponin
			B-Type Natriuretic Peptide
		Right Ventricular Imaging
			Echocardiogram
			Computed Tomographic Angiography (CTA)
		Integrated Risk Stratification
	Summary
	References
Bleeding Risk Considerations Prior to Initiation and Duration of Anticoagulation Therapy for the Treatment of Venous Thromboembolism
	Introduction
	Incidence of Bleeding
	Incidence of Major Bleeding During Initial Anticoagulation with Heparin, LMWH, or Fondaparinux
	Incidence of Major Bleeding During the First Three Months of Treatment with a Vitamin K Antagonist
	Incidence of Major Bleeding with the Direct Oral Anticoagulants
	Considerations Prior to Initiation of Anticoagulation Therapy
	Bleeding Risk Considerations Prior to Initiation of Anticoagulant Therapy
	Incidence of Major Bleeding Associated with Thrombolytic Therapy
	Summary
	References
Treatment for Pulmonary Embolism: Anticoagulation Selection and Duration
	Introduction
	Historical Perspective
	Overview of Anticoagulants
		Parenteral Agents
			Heparinoids and Fondaparinux
			Direct Thrombin Inhibitors (DTIs)
		Oral Anticoagulants
			Vitamin K Antagonists
			Direct-Acting Oral Anticoagulants (Apixaban, Edoxaban, Rivaroxaban, and Dabigatran)
	Treatment Paradigms
		LMWH Trials
		Fondaparinux Trials
		DTI Trials
			Argatroban
			Bivalirudin
		DOAC Trials
	Extended Therapy
	Special Populations
		Pregnancy and Lactation
		Cancer
		Antiphospholipid Syndrome (APLS)
		Heparin-Induced Thrombocytopenia (HIT)
		Renal Impairment
		Hepatic Impairment
		Obesity
		Pediatrics
	Anticoagulation Reversal
	Future Directions
	Conclusion
	References
Indications for Systemic Thrombolysis Over Anticoagulation
	Introduction and Overview
	Thrombolytic Agents
		Alteplase
		Streptokinase
		Urokinase
		Other Agents
		Adverse Reactions
		Summary
	Contraindications to Thrombolytics
	Indications for Thrombolysis Based on Risk Stratification of Pulmonary Embolism
		Classification and Risk Stratification
		Use of Thrombolytic Therapy in High-Risk Pulmonary Embolism
		Use of Thrombolytic Therapy in Intermediate-Risk Pulmonary Embolism
		Use of Thrombolytic Therapy in Low-Risk Pulmonary Embolism
	Other Considerations
		Low-Dose Thrombolysis
		Catheter-Directed Thrombolysis
		Cardiopulmonary Arrest
	Impact of Thrombolysis on Long-Term Outcomes
		Mortality
		Hemodynamics and RV Function
		Venous Thromboembolism Recurrence
		Bleeding
	Summary
	References
Endovascular Techniques in the Treatment of Acute PE
	Introduction to Catheter-Directed Therapy
	Role and Rationale for Catheter-Directed Therapy
	Evidence for Catheter-Directed Therapy
	Contraindications to Catheter-Directed Therapy
	Preparation for Catheter-Directed Therapy
	Procedure Walkthrough
	Periprocedural IVC Filter Placement
	Follow-Up Care
	References
Role of Surgical Embolectomy and ECMO in PE
	The History of Surgical Therapy for Acute Pulmonary Emboli
	SPE and Outcomes in the Modern Era
	Indications for Surgical Pulmonary Embolectomy
	Surgical Procedure
	SPE as First-Line Therapy
	VA-ECMO in PE
	Conclusion
	References
Inferior Vena Cava Filters in Venous Thromboembolism
	Introduction and Background
	Types of IVC Filters
	Indications for Filter Placement
	Evidence-Based Literature Review
	Complications of IVC Filters
	Future Directions
	References
Multidisciplinary PE Response Team Development and Implementation
	Background
	PERT
	Review of Published PERT Data
	PERT Consortium
	References
Post-PE Management
	Introduction
	The Outpatient Clinic Setting – Follow-Up After Acute PE
	Symptoms
	History: The Initial Event
	Risk Factors for VTE
	Assessment of Bleeding Risk
	Medication Review
	Physical Examination and Laboratory Testing
		Physical Examination
		Laboratory Testing
	Anticoagulation Post-Pulmonary Embolism
		Drug Interactions
		Renal and Hepatic Insufficiency
		Obesity and Anticoagulants
		Anticoagulant Absorption and Bariatric Surgery
		Cancer and Anticoagulants
	Duration of Anticoagulation: Persisting Risk of VTE and Thrombophilia Testing
		Duration of Anticoagulation
		Thrombophilia Testing
		Screening for Malignancy
	Other Aspects of Post-Pulmonary Embolism Management
		Oxygen Requirement Post-PE
		Inferior Vena Caval (IVC) Filters
		Post-Thrombotic Syndrome (PTS)
		Post-PE Rehabilitation
	Management of Recurrent VTE
	Post-PE Dyspnea
	Post-PE Diagnostic Imaging
	Long-Term Survival and VTE Recurrence: What to Tell the Patient
	Conclusions
	References
Epidemiology and Diagnosis of Chronic Thromboembolic Pulmonary Hypertension
	Background
	Epidemiology of CTEPH
	Risk Factors for CTEPH
	Screening for CTEPH
	Diagnosis of CTEPH
		Symptoms and Exam
		EKG
		Chest X-Ray
		Pulmonary Functions Tests
		Echocardiography
		Ventilation/Perfusion Scintigraphy (VQ)
		Single Photon Emission Computed Tomography (SPECT-VQ)
		Computed Tomography Pulmonary Angiography (CTPA)
		Dual-Energy CT
		Digital Subtraction Angiography
		Magnetic Resonance Angiography (MRA)
		Right Heart Catheterization
		Cardiopulmonary Exercise Testing
	Mimickers of CTEPH
	Conclusions
	References
Medical, Endovascular, and Surgical Treatment of CTEPH
	Introduction
	Surgical Treatment
	Balloon Pulmonary Angioplasty
	Medical Therapy
	Conclusion
	References
Index