Nagraj Sanjana, Li Weijia, Zamora Cristian, Barakakis Paraschos Archontakis, Kokkinidis Damianos G
Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA.
Department of Medicine, Northeast Internal Medicine Associates, LaGrange, IN 46761, USA.
Future Cardiol. 2022 Mar;18(3):191-206. doi: 10.2217/fca-2021-0109. Epub 2022 Feb 8.
As the third most common cardiovascular disease, pulmonary embolism (PE) has an uptrending incidence and mortality, resulting in significant healthcare expenditure. Risk stratification of acute PE guides management. Although anticoagulation remains the cornerstone management, systemic fibrinolysis and targeted therapeutic approaches, catheter-directed thrombolysis and catheter-based embolectomy are available for high-risk patients. Life-threatening bleeding complications associated with systemic fibrinolysis have restricted its widespread implementation. Catheter-based techniques for intermediate high-risk categories were devised to reduce bleeding complications and improve outcomes. Catheter-directed thrombolysis helps minimize bleeding by way of direct drug delivery. Catheter-based embolectomy mechanically retrieves thrombi without using fibrinolytics. This focused review of medical and interventional management of acute PE provides a highlight of ongoing trials expected to add value to current practice.
作为第三常见的心血管疾病，肺栓塞（PE）的发病率和死亡率呈上升趋势，导致大量医疗支出。急性肺栓塞的风险分层指导治疗管理。尽管抗凝治疗仍然是治疗的基石，但对于高危患者，可采用全身溶栓和靶向治疗方法，即导管定向溶栓和基于导管的栓子切除术。与全身溶栓相关的危及生命的出血并发症限制了其广泛应用。为减少出血并发症并改善治疗效果，针对中高危类别设计了基于导管的技术。导管定向溶栓通过直接给药有助于将出血降至最低。基于导管的栓子切除术通过机械方式清除血栓，无需使用溶栓剂。这篇对急性肺栓塞的药物和介入治疗管理的重点综述突出了正在进行的试验，这些试验有望为当前的治疗实践增添价值。
