Sharifi Mohsen
Arizona Cardiovascular Consultants and Vein Clinic, 3850 E. Baseline Road, Building 1, Suite 102, Mesa, AZ, 85206, USA.
A.T. Still University, Mesa, AZ, USA.
Curr Treat Options Cardiovasc Med. 2016 May;18(5):31. doi: 10.1007/s11936-016-0456-8.
Treatment of pulmonary embolism (PE) is variable amongst different and even the same institutions. With the introduction of different forms of thrombolysis, catheter based interventions, and new oral anticoagulants, the treatment and decision-making process has become more complex. The different forms of classification of PE into massive, submassive, severe, moderate, intermediate high risk, intermediate low risk, and low risk have only added to this complexity. The main two reasons for such classifications have been to aid in assessment of patient prognosis and in the intent to carefully select patients who are high risk and would benefit from thrombolysis. The literature supports the use of thrombolysis in high risk patients albeit at the risk of a higher bleeding rate. It has been suggested that survival can improve in both massive and submassive PE with thrombolysis. Studies have shown a reduced risk of bleeding with reduction of the doses of the thrombolytic and anticoagulant agents while imparting the same beneficial effects seen in full dose thrombolysis. The opinion of this author is that treatment of massive and submassive forms of PE can become standardized, safe, streamlined, and simplified by using a lower dose of systemic thrombolysis for both and an anticoagulation regimen without the necessity for expensive approaches such as invasive catheter placement in the pulmonary circulation.
肺栓塞（PE）的治疗在不同机构甚至同一机构内都存在差异。随着不同形式溶栓治疗、基于导管的介入治疗以及新型口服抗凝药的引入，治疗和决策过程变得更加复杂。将PE分为大面积、次大面积、重度、中度、中高危、中低危和低危等不同类型，只会增加这种复杂性。进行此类分类的主要两个原因是有助于评估患者预后，并旨在仔细挑选高危且能从溶栓治疗中获益的患者。文献支持在高危患者中使用溶栓治疗，尽管存在出血率较高的风险。有人提出，溶栓治疗可改善大面积和次大面积PE患者的生存率。研究表明，降低溶栓剂和抗凝剂的剂量可降低出血风险，同时能产生与全剂量溶栓治疗相同的有益效果。笔者认为，通过对大面积和次大面积PE均采用较低剂量的全身溶栓治疗以及抗凝方案，无需采用诸如在肺循环中进行有创导管置入等昂贵方法，可使PE的治疗变得标准化、安全、简化。
