Submassive Pulmonary Embolism: Current Perspectives and Future Directions
Submassive pulmonary embolism (PE) lies on a spectrum of disease severity between standard and high-risk disease. By definition, patients with submassive PE have a worse outcome than the majority of those with standard-risk PE, who are hemodynamically stable and lack imaging or laboratory features o...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-07-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/15/3383 |
| _version_ | 1797525452364972032 |
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| author | Phillip C. Nguyen Hannah Stevens Karlheinz Peter James D. McFadyen |
| author_facet | Phillip C. Nguyen Hannah Stevens Karlheinz Peter James D. McFadyen |
| author_sort | Phillip C. Nguyen |
| collection | DOAJ |
| description | Submassive pulmonary embolism (PE) lies on a spectrum of disease severity between standard and high-risk disease. By definition, patients with submassive PE have a worse outcome than the majority of those with standard-risk PE, who are hemodynamically stable and lack imaging or laboratory features of cardiac dysfunction. Systemic thrombolytic therapy has been proven to reduce mortality in patients with high-risk disease; however, its use in submassive PE has not demonstrated a clear benefit, with haemodynamic improvements being offset by excess bleeding. Furthermore, meta-analyses have been confusing, with conflicting results on overall survival and net gain. As such, significant interest remains in optimising thrombolysis, with recent efforts in catheter-based delivery as well as upcoming studies on reduced systemic dosing. Recently, long-term cardiorespiratory limitations following submassive PE have been described, termed post-PE syndrome. Studies on the ability of thrombolytic therapy to prevent this condition also present conflicting evidence. In this review, we aim to clarify the current evidence with respect to submassive PE management, and also to highlight shortcomings in current definitions and prognostic factors. Additionally, we discuss novel therapies currently in preclinical and early clinical trials that may improve outcomes in patients with submassive PE. |
| first_indexed | 2024-03-10T09:13:03Z |
| format | Article |
| id | doaj.art-7ec3732ab0da4e81a2ff2f6c6208845b |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T09:13:03Z |
| publishDate | 2021-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-7ec3732ab0da4e81a2ff2f6c6208845b2023-11-22T05:49:58ZengMDPI AGJournal of Clinical Medicine2077-03832021-07-011015338310.3390/jcm10153383Submassive Pulmonary Embolism: Current Perspectives and Future DirectionsPhillip C. Nguyen0Hannah Stevens1Karlheinz Peter2James D. McFadyen3Department of Haematology, Alfred Hospital, Melbourne, VIC 3181, AustraliaDepartment of Haematology, Alfred Hospital, Melbourne, VIC 3181, AustraliaAtherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, AustraliaDepartment of Haematology, Alfred Hospital, Melbourne, VIC 3181, AustraliaSubmassive pulmonary embolism (PE) lies on a spectrum of disease severity between standard and high-risk disease. By definition, patients with submassive PE have a worse outcome than the majority of those with standard-risk PE, who are hemodynamically stable and lack imaging or laboratory features of cardiac dysfunction. Systemic thrombolytic therapy has been proven to reduce mortality in patients with high-risk disease; however, its use in submassive PE has not demonstrated a clear benefit, with haemodynamic improvements being offset by excess bleeding. Furthermore, meta-analyses have been confusing, with conflicting results on overall survival and net gain. As such, significant interest remains in optimising thrombolysis, with recent efforts in catheter-based delivery as well as upcoming studies on reduced systemic dosing. Recently, long-term cardiorespiratory limitations following submassive PE have been described, termed post-PE syndrome. Studies on the ability of thrombolytic therapy to prevent this condition also present conflicting evidence. In this review, we aim to clarify the current evidence with respect to submassive PE management, and also to highlight shortcomings in current definitions and prognostic factors. Additionally, we discuss novel therapies currently in preclinical and early clinical trials that may improve outcomes in patients with submassive PE.https://www.mdpi.com/2077-0383/10/15/3383pulmonary embolismsubmassive |
| spellingShingle | Phillip C. Nguyen Hannah Stevens Karlheinz Peter James D. McFadyen Submassive Pulmonary Embolism: Current Perspectives and Future Directions Journal of Clinical Medicine pulmonary embolism submassive |
| title | Submassive Pulmonary Embolism: Current Perspectives and Future Directions |
| title_full | Submassive Pulmonary Embolism: Current Perspectives and Future Directions |
| title_fullStr | Submassive Pulmonary Embolism: Current Perspectives and Future Directions |
| title_full_unstemmed | Submassive Pulmonary Embolism: Current Perspectives and Future Directions |
| title_short | Submassive Pulmonary Embolism: Current Perspectives and Future Directions |
| title_sort | submassive pulmonary embolism current perspectives and future directions |
| topic | pulmonary embolism submassive |
| url | https://www.mdpi.com/2077-0383/10/15/3383 |
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