Skip to main content
Top
Published in: Journal of Thrombosis and Thrombolysis 1/2017

01-07-2017

Pulmonary embolism response teams

Authors: Maya Serhal, Ihab S. Haddadin, Gustavo A. Heresi, Deborah A. Hornacek, Mehdi H. Shishehbor, John R. Bartholomew

Published in: Journal of Thrombosis and Thrombolysis | Issue 1/2017

Login to get access

Abstract

Pulmonary embolism (PE) is a common thrombotic event that is variable in its presentation. Depending on the patients’ risk for mortality, guidelines provide several treatment strategies including thrombolysis, catheter-directed therapies, pulmonary embolectomy, anticoagulation, and inferior vena cava filters. However, there is considerable disagreement between guidelines regarding the optimal treatment strategy for patients, particularly for those with intermediate-risk PE. In order to provide rapid and individualized care, PE response teams (PERT) have been developed. These teams consist of members from different specialties with a particular interest in PE, varying technical skills, and clinical experience, thereby allowing for a multidisciplinary approach. PERT allows for consensus decision making, and for rapid intervention in patients whose conditions worsen. In this review, we provide an overview of treatment guidelines for PE, and of results from recent clinical trials involving patients with submassive PE. In addition, we discuss an outline of our approach and use of PERT.
Literature
1.
go back to reference Beckman MG, Hooper WC, Critchley SE, Ortel TL (2010) Venous thromboembolism: a public health concern. Am J Prev Med 38:S495–S501CrossRefPubMed Beckman MG, Hooper WC, Critchley SE, Ortel TL (2010) Venous thromboembolism: a public health concern. Am J Prev Med 38:S495–S501CrossRefPubMed
2.
go back to reference Fanikos J, Rao A, Seger AC, Carter D, Piazza G, Goldhaber SZ (2013) Hospital costs of acute pulmonary embolism. Am J Med 126:127–132CrossRefPubMed Fanikos J, Rao A, Seger AC, Carter D, Piazza G, Goldhaber SZ (2013) Hospital costs of acute pulmonary embolism. Am J Med 126:127–132CrossRefPubMed
3.
go back to reference Kearon C, Akl EA, Ornelas J et al (2016) Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 149:315–352CrossRefPubMed Kearon C, Akl EA, Ornelas J et al (2016) Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 149:315–352CrossRefPubMed
4.
go back to reference Jaff MR, McMurtry MS, Archer SL et al (2011) Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 123:1788–1830CrossRefPubMed Jaff MR, McMurtry MS, Archer SL et al (2011) Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 123:1788–1830CrossRefPubMed
5.
go back to reference Konstantinides SV, Torbicki A, Agnelli G et al. (2014) 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 35:3033–3069, 69a-69k Konstantinides SV, Torbicki A, Agnelli G et al. (2014) 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 35:3033–3069, 69a-69k
6.
go back to reference Aujesky D, Obrosky DS, Stone RA et al (2005) Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med 172:1041–1046CrossRefPubMedPubMedCentral Aujesky D, Obrosky DS, Stone RA et al (2005) Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med 172:1041–1046CrossRefPubMedPubMedCentral
7.
go back to reference Venetz C, Jimenez D, Mean M, Aujesky D (2011) A comparison of the original and simplified pulmonary embolism severity index. Thromb Haemost 106:423–428CrossRefPubMed Venetz C, Jimenez D, Mean M, Aujesky D (2011) A comparison of the original and simplified pulmonary embolism severity index. Thromb Haemost 106:423–428CrossRefPubMed
8.
go back to reference Kearon C, Akl EA, Comerota AJ et al (2012) Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:e419S–e494SCrossRefPubMedPubMedCentral Kearon C, Akl EA, Comerota AJ et al (2012) Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:e419S–e494SCrossRefPubMedPubMedCentral
9.
go back to reference Konstantinides S, Geibel A, Heusel G et al (2002) Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med 347:1143–1150CrossRefPubMed Konstantinides S, Geibel A, Heusel G et al (2002) Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med 347:1143–1150CrossRefPubMed
10.
go back to reference Meyer G, Vicaut E, Danays T et al (2014) Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 370:1402–1411CrossRefPubMed Meyer G, Vicaut E, Danays T et al (2014) Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 370:1402–1411CrossRefPubMed
11.
go back to reference Kline JA, Nordenholz KE, Courtney DM et al (2014) Treatment of submassive pulmonary embolism with tenecteplase or placebo: cardiopulmonary outcomes at 3 months: multicenter double-blind, placebo-controlled randomized trial. J Thromb Haemost 12:459–468CrossRefPubMed Kline JA, Nordenholz KE, Courtney DM et al (2014) Treatment of submassive pulmonary embolism with tenecteplase or placebo: cardiopulmonary outcomes at 3 months: multicenter double-blind, placebo-controlled randomized trial. J Thromb Haemost 12:459–468CrossRefPubMed
12.
go back to reference Wang C, Zhai Z, Yang Y et al (2010) Efficacy and safety of low dose recombinant tissue-type plasminogen activator for the treatment of acute pulmonary thromboembolism: a randomized, multicenter, controlled trial. Chest 137:254–262CrossRefPubMed Wang C, Zhai Z, Yang Y et al (2010) Efficacy and safety of low dose recombinant tissue-type plasminogen activator for the treatment of acute pulmonary thromboembolism: a randomized, multicenter, controlled trial. Chest 137:254–262CrossRefPubMed
13.
go back to reference Sharifi M, Bay C, Skrocki L, Rahimi F, Mehdipour M, Investigators M (2013) Moderate pulmonary embolism treated with thrombolysis (from the “MOPETT” trial). Am J Cardiol 111:273–277CrossRefPubMed Sharifi M, Bay C, Skrocki L, Rahimi F, Mehdipour M, Investigators M (2013) Moderate pulmonary embolism treated with thrombolysis (from the “MOPETT” trial). Am J Cardiol 111:273–277CrossRefPubMed
14.
go back to reference Kucher N, Boekstegers P, Muller OJ et al (2014) Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism. Circulation 129:479–486CrossRefPubMed Kucher N, Boekstegers P, Muller OJ et al (2014) Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism. Circulation 129:479–486CrossRefPubMed
15.
go back to reference Piazza G, Hohlfelder B, Jaff MR et al (2015) A prospective, single-arm, multicenter trial of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis for acute massive and submassive pulmonary embolism: the SEATTLE II study. JACC Cardiovasc Interv 8:1382–1392CrossRefPubMed Piazza G, Hohlfelder B, Jaff MR et al (2015) A prospective, single-arm, multicenter trial of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis for acute massive and submassive pulmonary embolism: the SEATTLE II study. JACC Cardiovasc Interv 8:1382–1392CrossRefPubMed
17.
go back to reference PRADAXA® (dabigatran etexilate mesylate) capsules for oral use. Full Prescribing Information. Boehringer Ingelheim Pharmaceuticals, Inc 2015 PRADAXA® (dabigatran etexilate mesylate) capsules for oral use. Full Prescribing Information. Boehringer Ingelheim Pharmaceuticals, Inc 2015
18.
go back to reference XARELTO® (rivaroxaban) tablets, for oral use. Full prescribing information. Janssen Pharmaceutical, Inc 2016 XARELTO® (rivaroxaban) tablets, for oral use. Full prescribing information. Janssen Pharmaceutical, Inc 2016
19.
go back to reference Brekelmans MP, Ageno W, Beenen LF et al. (2016) Recurrent venous thromboembolism in patients with pulmonary embolism and right ventricular dysfunction: a post-hoc analysis of the Hokusai-VTE study. Lancet Haematol 3:e437–e445CrossRefPubMed Brekelmans MP, Ageno W, Beenen LF et al. (2016) Recurrent venous thromboembolism in patients with pulmonary embolism and right ventricular dysfunction: a post-hoc analysis of the Hokusai-VTE study. Lancet Haematol 3:e437–e445CrossRefPubMed
20.
go back to reference SAVAYSA® (edoxaban) tablets for oral use. Full prescribing information. Daiichi Sankyo, Inc 2016 SAVAYSA® (edoxaban) tablets for oral use. Full prescribing information. Daiichi Sankyo, Inc 2016
21.
go back to reference Schulman S, Kakkar AK, Goldhaber SZ et al (2014) Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation 129:764–772CrossRefPubMed Schulman S, Kakkar AK, Goldhaber SZ et al (2014) Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation 129:764–772CrossRefPubMed
22.
go back to reference Einstein-PE Investigators, Buller HR, Prins MH et al (2012) Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med 366:1287–1297CrossRef Einstein-PE Investigators, Buller HR, Prins MH et al (2012) Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med 366:1287–1297CrossRef
23.
go back to reference Einstein Investigators, Bauersachs R, Berkowitz SD et al (2010) Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 363:2499–2510CrossRef Einstein Investigators, Bauersachs R, Berkowitz SD et al (2010) Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 363:2499–2510CrossRef
24.
go back to reference Hokusai VTE Investigators, Buller HR, Decousus H et al (2013) Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med 369:1406–1415CrossRef Hokusai VTE Investigators, Buller HR, Decousus H et al (2013) Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med 369:1406–1415CrossRef
25.
go back to reference Schulman S, Kearon C, Kakkar AK et al (2009) Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med 361:2342–2352CrossRefPubMed Schulman S, Kearon C, Kakkar AK et al (2009) Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med 361:2342–2352CrossRefPubMed
26.
go back to reference Agnelli G, Buller HR, Cohen A et al (2013) Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med 369:799–808CrossRefPubMed Agnelli G, Buller HR, Cohen A et al (2013) Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med 369:799–808CrossRefPubMed
27.
go back to reference Sharifi M, Vajo Z, Freeman W, Bay C, Sharifi M, Schwartz F (2015) Transforming and simplifying the treatment of pulmonary embolism: “safe dose” thrombolysis plus new oral anticoagulants. Lung 193:369–374CrossRefPubMed Sharifi M, Vajo Z, Freeman W, Bay C, Sharifi M, Schwartz F (2015) Transforming and simplifying the treatment of pulmonary embolism: “safe dose” thrombolysis plus new oral anticoagulants. Lung 193:369–374CrossRefPubMed
Metadata
Title
Pulmonary embolism response teams
Authors
Maya Serhal
Ihab S. Haddadin
Gustavo A. Heresi
Deborah A. Hornacek
Mehdi H. Shishehbor
John R. Bartholomew
Publication date
01-07-2017
Publisher
Springer US
Published in
Journal of Thrombosis and Thrombolysis / Issue 1/2017
Print ISSN: 0929-5305
Electronic ISSN: 1573-742X
DOI
https://doi.org/10.1007/s11239-017-1498-9

Other articles of this Issue 1/2017

Journal of Thrombosis and Thrombolysis 1/2017 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.