Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.
Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
J Am Coll Cardiol. 2016 Mar 1;67(8):976-990. doi: 10.1016/j.jacc.2015.11.061.
Pulmonary embolism (PE) remains a major contributor to global disease burden. Risk-adapted treatment and follow-up contributes to a favorable outcome. Age-adjusted cutoff levels increase D-dimer specificity and may decrease overuse of imaging procedures and overdiagnosis of PE. Primary systemic fibrinolysis has an unfavorable risk-benefit ratio in intermediate-risk PE; catheter-directed techniques are an option for patients with hemodynamic decompensation and high bleeding risk. New oral anticoagulant agents are effective and safe alternatives to standard anticoagulation regimens. Recent trial data do not support insertion of cava filters in patients who can receive anticoagulant treatments. Remaining areas of uncertainty include the therapeutic implications of subsegmental PE, the optimal diagnostic approach to the pregnant patient with suspected PE, and the efficacy and safety of new oral anticoagulant agents in patients with cancer. Campaigns to increase awareness combined with strategies to implement guideline recommendations will be crucial steps towards further optimizing management of acute PE.
肺栓塞（PE）仍然是全球疾病负担的主要原因。风险适应治疗和随访有助于获得良好的结果。年龄调整的截断值可提高 D-二聚体的特异性，并可能减少成像程序的过度使用和 PE 的过度诊断。在中等风险的 PE 中，原发性全身纤溶疗法的风险效益比不理想；对于血流动力学失代偿和高出血风险的患者，导管引导技术是一种选择。新型口服抗凝剂是标准抗凝治疗方案的有效且安全的替代方法。最近的试验数据不支持在可以接受抗凝治疗的患者中插入腔静脉滤器。仍然存在不确定的领域包括亚段 PE 的治疗意义、疑似 PE 孕妇的最佳诊断方法，以及新型口服抗凝剂在癌症患者中的疗效和安全性。提高认识的运动加上实施指南建议的策略将是进一步优化急性 PE 管理的关键步骤。
