Nguyen Phillip C, Stevens Hannah, Peter Karlheinz, McFadyen James D
Department of Haematology, Alfred Hospital, Melbourne, VIC 3181, Australia.
Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia.
J Clin Med. 2021 Jul 30;10(15):3383. doi: 10.3390/jcm10153383.
Submassive pulmonary embolism (PE) lies on a spectrum of disease severity between standard and high-risk disease. By definition, patients with submassive PE have a worse outcome than the majority of those with standard-risk PE, who are hemodynamically stable and lack imaging or laboratory features of cardiac dysfunction. Systemic thrombolytic therapy has been proven to reduce mortality in patients with high-risk disease; however, its use in submassive PE has not demonstrated a clear benefit, with haemodynamic improvements being offset by excess bleeding. Furthermore, meta-analyses have been confusing, with conflicting results on overall survival and net gain. As such, significant interest remains in optimising thrombolysis, with recent efforts in catheter-based delivery as well as upcoming studies on reduced systemic dosing. Recently, long-term cardiorespiratory limitations following submassive PE have been described, termed post-PE syndrome. Studies on the ability of thrombolytic therapy to prevent this condition also present conflicting evidence. In this review, we aim to clarify the current evidence with respect to submassive PE management, and also to highlight shortcomings in current definitions and prognostic factors. Additionally, we discuss novel therapies currently in preclinical and early clinical trials that may improve outcomes in patients with submassive PE.
次大面积肺栓塞（PE）处于标准风险和高风险疾病之间的疾病严重程度范围内。根据定义，次大面积PE患者的预后比大多数标准风险PE患者更差，标准风险PE患者血流动力学稳定，且缺乏心脏功能障碍的影像学或实验室特征。全身溶栓治疗已被证明可降低高风险疾病患者的死亡率；然而，其在次大面积PE中的应用尚未显示出明显益处，血流动力学改善被出血过多所抵消。此外，荟萃分析结果相互矛盾，在总体生存率和净获益方面存在冲突。因此，人们仍然对优化溶栓治疗有着浓厚兴趣，近期在基于导管的给药方面做出了努力，同时也有关于降低全身给药剂量的后续研究。最近，有人描述了次大面积PE后长期存在的心肺功能受限情况，称为PE后综合征。关于溶栓治疗预防这种情况能力的研究也提供了相互矛盾的证据。在本综述中，我们旨在阐明关于次大面积PE管理的当前证据，并突出当前定义和预后因素中的不足之处。此外，我们还讨论了目前处于临床前和早期临床试验阶段的新型疗法，这些疗法可能改善次大面积PE患者的预后。
