Tromeur Cécile, Van Der Pol Liselotte M, Couturaud Francis, Klok Frederikus A, Huisman Menno V
a Department of Thrombosis and Hemostasis , Leiden University Medical Center , Leiden , the Netherlands.
b Groupe d'Etude de la Thrombose de Bretagne Occidentale , Equipe d'Accueil 3878, Department of Internal Medicine and Chest Diseases, Hôpital de la cavale Blanche, CHRU Brest , Brest , France.
Expert Rev Respir Med. 2017 Aug;11(8):641-648. doi: 10.1080/17476348.2017.1338952. Epub 2017 Jun 8.
Acute pulmonary embolism (PE) is a potentially fatal manifestation of venous thromboembolism. Prompt anticoagulant treatment is crucial for PE patients, which can decrease morbidity and mortality. Risk assessment is the cornerstone of the therapeutic management of PE. It guides physicians to the most appropriate treatment and selects patients for early discharge or home treatment. Areas covered: Here, we review the current treatments of acute PE according to contemporary risk stratification strategies, highlighting each step of PE therapeutic management. Expert commentary: Currently, direct oral anticoagulants (DOACs) represent the first-line therapy of patients presenting with non-high risk PE with a better risk-benefit ratios than vitamin K antagonists (VKAs) due to lower risk of major bleeding. Only high-risk patients with PE who present in shock should be treated with systematic thrombolysis, while surgical thrombectomy or catheter direct thrombolysis (CDT) should only be considered when thrombolysis is contraindicated because of too high bleeding risk.
急性肺栓塞（PE）是静脉血栓栓塞的一种潜在致命表现。及时的抗凝治疗对PE患者至关重要，可降低发病率和死亡率。风险评估是PE治疗管理的基石。它指导医生选择最合适的治疗方法，并挑选适合早期出院或居家治疗的患者。涵盖领域：在此，我们根据当代风险分层策略回顾急性PE的当前治疗方法，突出PE治疗管理的每一步。专家评论：目前，直接口服抗凝剂（DOACs）是无高风险PE患者的一线治疗药物，由于大出血风险较低，其风险效益比优于维生素K拮抗剂（VKAs）。只有出现休克的高风险PE患者应接受系统性溶栓治疗，而当因出血风险过高而禁忌溶栓时，才应考虑手术取栓或导管直接溶栓（CDT）。
