Extract
Contemporary classification of acute pulmonary embolism (PE) severity is based on the risk of early death, which is influenced by demographic factors, comorbidity, and the functional status of the right ventricle (RV) under acute pressure overload [1]. Shock or persistent arterial hypotension, indicating overt RV failure at presentation, has long been identified as a key determinant of poor prognosis [2] and represents the only widely accepted indication for (systemic) thrombolytic therapy to date [3]. In contrast, for normotensive patients who present with imaging findings that indicate RV dysfunction and biochemical evidence of myocardial injury, anticoagulation remains the primary treatment option [3, 4]. This recommendation is supported by the Pulmonary Embolism Thrombolysis (PEITHO) trial, which showed that patients fulfilling these latter criteria were unlikely to derive a net clinical benefit from routine use of systemic thrombolysis in view of the high risk for major bleeding [5].
Abstract
Defining a “higher-risk” population among intermediate-risk patients with pulmonary embolism included in PEITHO http://ow.ly/JM7u30hcSgN
Footnotes
Support statement: This work was supported by: the Federal Ministry of Education and Research (BMBF; 01KG0802, 01EO1003 and 01EO1503) in Germany; the Programme Hospitalier de Recherche Clinique (PHRC; AOM 03063, AOM 08231 and AOM 10171) in France; and a grant from the market authorisation holder of tenecteplase, Boehringer Ingelheim, to the trial sponsor, Assistance Publique Hôpitaux de Paris. The authors are responsible for the contents of this publication. Funding information for this article has been deposited with Crossref Funder Registry.
Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com
- Received August 30, 2017.
- Accepted October 31, 2017.
- Copyright ©ERS 2018