Barco Stefano, Konstantinides Stavros V
Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.
Ann Vasc Dis. 2018 Sep 25;11(3):265-276. doi: 10.3400/avd.ra.18-00054.
Pulmonary embolism (PE) contributes substantially to the global disease burden. A key determinant of early adverse outcomes is the presence (and severity) of right ventricular dysfunction. Consequently, risk-adapted management strategies continue to evolve, tailoring acute treatment to the patients' clinical presentation, hemodynamic status, imaging and biochemical markers, and comorbidity. For subjects with hemodynamic instability or 'high-risk' PE, immediate systemic reperfusion treatment with intravenous thrombolysis is indicated; emerging approaches such as catheter-directed pharmacomechanical reperfusion might help to minimize the bleeding risk. Currently, direct, non-vitamin K-dependent oral anticoagulants are the mainstay of treatment for acute PE. They have been shown to simplify initial and extended anticoagulation regimens while reducing the bleeding risk compared to vitamin K antagonists. (This is a review article based on the invited lecture of the 37th Annual Meeting of Japanese Society of Phlebology.).
肺栓塞（PE）在全球疾病负担中占很大比例。早期不良结局的一个关键决定因素是右心室功能障碍的存在（及其严重程度）。因此，风险适应性管理策略不断发展，根据患者的临床表现、血流动力学状态、影像学和生化标志物以及合并症来调整急性治疗方案。对于血流动力学不稳定或“高危”PE患者，建议立即进行静脉溶栓的全身再灌注治疗；诸如导管定向药物机械再灌注等新兴方法可能有助于将出血风险降至最低。目前，直接口服非维生素K拮抗剂是急性PE治疗的主要手段。与维生素K拮抗剂相比，它们已被证明能简化初始和长期抗凝方案，同时降低出血风险。（这是一篇基于日本静脉病学会第37届年会特邀演讲的综述文章。）
