Debate: Pharmacological or invasive therapy in acute pulmonary embolism. The clinician perspective
QUESTION: In the current management of acute pulmonary thromboembolism (PTE) to what extent is thrombolytic therapy used? and what about invasive therapy? ANSWER: During the early management of PTE, we’re going after the clinical stabilization of the patient and the alleviation of symptom...
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| Format: | Article |
| Language: | English |
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Permanyer
2022-08-01
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| Series: | REC: Interventional Cardiology (English Ed.) |
| Online Access: | https://recintervcardiol.org/en/index.php?option=com_content&view=article&id=894 |
| _version_ | 1811311575565336576 |
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| author | David Jiménez |
| author_facet | David Jiménez |
| author_sort | David Jiménez |
| collection | DOAJ |
| description | QUESTION: In the current management of acute pulmonary thromboembolism (PTE) to what extent is thrombolytic therapy used? and what about invasive therapy? ANSWER: During the early management of PTE, we’re going after the clinical stabilization of the patient and the alleviation of symptoms, the resolution of vascular obstruction, and the prevention of thrombotic recurrences. The priority of these goals depends on the severity of the patient. Most times (over 90%) these goals can be achieved using conventional anticoagulant treatment to stop the progression of the thrombus while the patient’s endogenous fibrinolytic system resolves the vascular obstruction developing collateral circulation. In a minority of the patients (5% to 10%)—often those with hemodynamic instability (high-risk PTE)—aggressive therapies (of reperfusion) can be used to resuscitate the patient or accelerate the lysis of the blood clot. When reperfusion therapy is advised for a patient with symptomatic acute PTE, the clinical practice guidelines recommend the use of full-dose systemic fibrinolysis as long as it has not been contraindicated.1 Some of the reasons behind this recommendation are: a) Numerous clinical trials (with over 2000 patients included) have assessed the efficacy and safety profile of systemic fibrinolysis (compared to anticoagulation) demonstrating a statistically significant drop of the mortality rate. On... |
| first_indexed | 2024-04-13T10:20:10Z |
| format | Article |
| id | doaj.art-e7690697b19745c2af4c97fbb17709b5 |
| institution | Directory Open Access Journal |
| issn | 2604-7322 |
| language | English |
| last_indexed | 2024-04-13T10:20:10Z |
| publishDate | 2022-08-01 |
| publisher | Permanyer |
| record_format | Article |
| series | REC: Interventional Cardiology (English Ed.) |
| spelling | doaj.art-e7690697b19745c2af4c97fbb17709b52022-12-22T02:50:32ZengPermanyerREC: Interventional Cardiology (English Ed.)2604-73222022-08-014323823910.24875/RECICE.M22000282Debate: Pharmacological or invasive therapy in acute pulmonary embolism. The clinician perspectiveDavid Jiménez0Servicio de Neumología, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain. Departamento de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), SpainQUESTION: In the current management of acute pulmonary thromboembolism (PTE) to what extent is thrombolytic therapy used? and what about invasive therapy? ANSWER: During the early management of PTE, we’re going after the clinical stabilization of the patient and the alleviation of symptoms, the resolution of vascular obstruction, and the prevention of thrombotic recurrences. The priority of these goals depends on the severity of the patient. Most times (over 90%) these goals can be achieved using conventional anticoagulant treatment to stop the progression of the thrombus while the patient’s endogenous fibrinolytic system resolves the vascular obstruction developing collateral circulation. In a minority of the patients (5% to 10%)—often those with hemodynamic instability (high-risk PTE)—aggressive therapies (of reperfusion) can be used to resuscitate the patient or accelerate the lysis of the blood clot. When reperfusion therapy is advised for a patient with symptomatic acute PTE, the clinical practice guidelines recommend the use of full-dose systemic fibrinolysis as long as it has not been contraindicated.1 Some of the reasons behind this recommendation are: a) Numerous clinical trials (with over 2000 patients included) have assessed the efficacy and safety profile of systemic fibrinolysis (compared to anticoagulation) demonstrating a statistically significant drop of the mortality rate. On...https://recintervcardiol.org/en/index.php?option=com_content&view=article&id=894 |
| spellingShingle | David Jiménez Debate: Pharmacological or invasive therapy in acute pulmonary embolism. The clinician perspective REC: Interventional Cardiology (English Ed.) |
| title | Debate: Pharmacological or invasive therapy in acute pulmonary embolism. The clinician perspective |
| title_full | Debate: Pharmacological or invasive therapy in acute pulmonary embolism. The clinician perspective |
| title_fullStr | Debate: Pharmacological or invasive therapy in acute pulmonary embolism. The clinician perspective |
| title_full_unstemmed | Debate: Pharmacological or invasive therapy in acute pulmonary embolism. The clinician perspective |
| title_short | Debate: Pharmacological or invasive therapy in acute pulmonary embolism. The clinician perspective |
| title_sort | debate pharmacological or invasive therapy in acute pulmonary embolism the clinician perspective |
| url | https://recintervcardiol.org/en/index.php?option=com_content&view=article&id=894 |
| work_keys_str_mv | AT davidjimenez debatepharmacologicalorinvasivetherapyinacutepulmonaryembolismtheclinicianperspective |