Kosova Ethan C, Desai Kush R, Schimmel Daniel R
Division of Cardiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 600, Chicago, IL, 60611, USA.
Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.
Curr Cardiol Rep. 2017 Jun;19(6):54. doi: 10.1007/s11886-017-0864-8.
Acute pulmonary embolism (PE) is a common condition associated with high morbidity and mortality. Prior studies have evaluated the role of systemic fibrinolysis and catheter-directed therapy (CDT) in the management of PE. In this review, we examine current data on risk stratification and the appropriate allocation of systemic fibrinolysis and CDT in acute PE patients with elevated risk of adverse outcomes.
Classification of pulmonary embolism is based on risk of adverse events, and relies on clinical parameters, imaging findings, and biomarkers. The synthesis of this data permits appropriate risk stratification of acute PE patients, and is the foundation upon which treatment decisions are made. While systemic thrombolytics remain the frontline therapy for hemodynamically unstable PE patients, studies have suggested that CDT has a significant promise as the primary modality for treating hemodynamically stable patients at increased risk for clinical decompensation and as an alternative therapy for hemodynamically unstable patients who may not tolerate systemic thrombolytics. The appropriate use of CDT in patients with acute PE is dependent on accurate risk stratification. CDT offers the potential to reduce excessive bleeding while maintaining the efficacy of systemic thrombolytics, but will require data from larger randomized trials to support its use prior to widespread adoption as the frontline therapy for PE in patients at elevated risk of adverse outcomes.
急性肺栓塞（PE）是一种常见疾病，具有较高的发病率和死亡率。既往研究评估了全身纤溶治疗和导管定向治疗（CDT）在PE治疗中的作用。在本综述中，我们研究了当前关于风险分层以及在不良结局风险升高的急性PE患者中全身纤溶治疗和CDT合理分配的数据。
肺栓塞的分类基于不良事件风险，并依赖于临床参数、影像学表现和生物标志物。这些数据的综合有助于对急性PE患者进行适当的风险分层，是做出治疗决策的基础。虽然全身溶栓仍然是血流动力学不稳定的PE患者的一线治疗方法，但研究表明，CDT作为治疗临床失代偿风险增加的血流动力学稳定患者的主要方式以及作为可能无法耐受全身溶栓的血流动力学不稳定患者的替代治疗方法具有很大前景。急性PE患者中CDT的合理使用取决于准确的风险分层。CDT有可能减少出血过多，同时保持全身溶栓的疗效，但在广泛用作不良结局风险升高的PE患者的一线治疗之前，需要来自更大规模随机试验的数据来支持其使用。
