Title: Is it time to wake up the interventionalist for this PE?<br/>
Author: Robert Flint<br/>
<a href='mailto:rflint@som.umaryland.edu'>[Click to email author]</a><hr/>
Link: <a href='https://umem.org/educational_pearls/4554/'>https://umem.org/educational_pearls/4554/</a><hr/><p>Deciding  which pulmonary embolism patient needs thrombolytics/catheter based intervention is a shared decision among emergency physicians, intensivists, interventionalists, hospitalists, and the patient/family.  This  article provides evidence to help guide this decision.  Keep in mind “The use of either CDL or catheter-based embolectomy in patients with intermediate-risk PE has, thus far, been correlated only with more rapid improvement of RV dysfunction than anticoagulation alone, not short- or long-term clinical or functional outcomes.”</p>
<p>"1. Massive (AHA) or high risk (ESC): Hypotension, defined as a systolic blood pressure <90 mm?Hg, a drop of >40 mm?Hg for at least 15 minutes (this latter criterion may be difficult to ascertain in some clinical circumstances), or need for vasopressor support, identifies these patients. They account for ?5% of hospitalized patients with PE and have an average mortality of ?30% within 1 month.</p>
<p>2.Submassive (AHA) or intermediate risk (ESC): RV strain without hypotension (see above) primarily identifies these patients. RV strain includes RV dysfunction on computed tomography pulmonary angiography or echocardiography (RV/left ventricular [LV] ratio >0.9)<a href="https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000707#core-R6">6</a>,<a href="https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000707#core-R7">7</a> or RV injury and pressure overload detected by an increase in cardiac biomarkers such as troponins or brain natriuretic hormone.</p>
<p>3.Low risk (ESC and AHA): These patients do not meet criteria for submassive (AHA) or intermediate-risk (ESC) PE"</p>
<p><img src="https://umem.org/files/uploads/content/pearls/e774fig05-66992a9789b51.jpg" alt="" /></p>
<fieldset><legend>References</legend><p><strong>Interventional Therapies for Acute Pulmonary Embolism: Current Status and Principles for the Development of Novel Evidence: A Scientific Statement From the American Heart Association</strong></p>
<p><a href="https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000707#con1"><strong>Jay Giri, MD, MPH, FAHA, Chair</strong></a><strong>,</strong> <a href="https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000707#con2"><strong>Akhilesh K. Sista, MD, FAHA, Vice Chair</strong></a><strong>,</strong> <a href="https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000707#con3"><strong>Ido Weinberg, MD, MSc</strong></a><strong>,</strong> <a href="https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000707#con4"><strong>Clive Kearon, MB, PhD</strong></a><strong>,</strong> <a href="https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000707#con5"><strong>Dharam J. Kumbhani, MD, FAHA</strong></a><strong>,</strong> <a href="https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000707#con6"><strong>Nimesh D. Desai, MD, PhD</strong></a><strong>,</strong> <a href="https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000707#con7"><strong>Gregory Piazza, MD, MS, FAHA</strong></a><strong>,</strong> <a href="https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000707#con8"><strong>Mark T. Gladwin, MD, FAHA</strong></a><strong>,</strong> <a href="https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000707#con9"><strong>Saurav Chatterjee, MD</strong></a><strong>,</strong> <a href="https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000707#con10"><strong>Taisei Kobayashi, MD</strong></a><strong>,</strong> <a href="https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000707#con11"><strong>Christopher Kabrhel, MD, MPH</strong></a><strong>, and</strong> <a href="https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000707#con12"><strong>Geoffrey D. Barnes, MD, MSc, FAHA</strong></a><a href="https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000707#tab-contributors"><strong>AUTHOR INFO & AFFILIATIONS</strong></a></p>
<p><strong>Circulation</strong></p>
<p><a href="https://www.ahajournals.org/toc/circ/140/20"><strong>Volume 140, Number 20</strong></a></p>
<p><a href="https://doi.org/10.1161/CIR.0000000000000707"><strong>https://doi.org/10.1161/CIR.0000000000000707</strong></a></p>
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