Department of Pharmacy Practice, Texas A&M Rangel College of Pharmacy, 1010 W Ave B, Kingsville, TX 78363, USA.
Medicina (Kaunas). 2021 Jan 26;57(2):110. doi: 10.3390/medicina57020110.
Traditionally, the management of patients with pulmonary embolism has been accomplished with anticoagulant treatment with parenteral heparins and oral vitamin K antagonists. Although the administration of heparins and oral vitamin K antagonists still plays a role in pulmonary embolism management, the use of these therapies are limited due to other options now available. This is due to their toxicity profile, clearance limitations, and many interactions with other medications and nutrients. The emergence of direct oral anticoagulation therapies has led to more options now being available to manage pulmonary embolism in inpatient and outpatient settings conveniently. These oral therapeutic options have opened up opportunities for safe and effective pulmonary embolism management, as more evidence and research is now available about reversal agents and monitoring parameters. The evolution of the pharmacological management of pulmonary embolism has provided us with better understanding regarding the selection of anticoagulants. There is also a better understanding and employment of anticoagulants in pulmonary embolism in special populations, such as patients with liver failure, renal failure, malignancy, and COVID-19.
传统上，肺栓塞患者的管理是通过使用抗凝治疗来实现的，包括静脉注射肝素和口服维生素 K 拮抗剂。尽管肝素和口服维生素 K 拮抗剂在肺栓塞管理中仍然发挥作用，但由于现在有其他选择，这些治疗方法的应用受到限制。这是由于它们的毒性特征、清除限制以及与许多其他药物和营养素的相互作用。直接口服抗凝治疗的出现为在住院和门诊环境中方便地管理肺栓塞提供了更多的选择。这些口服治疗选择为安全有效的肺栓塞管理开辟了机会，因为现在有更多关于逆转剂和监测参数的证据和研究。肺栓塞药物治疗的发展为我们提供了更好的抗凝药物选择的理解。对于特殊人群（如肝功能衰竭、肾功能衰竭、恶性肿瘤和 COVID-19 患者）的肺栓塞，也有了更好的抗凝药物理解和应用。
