LD, LAC, and MAF are investigators of the Canadian Venous Thromboembolism Clinical Trials and Outcomes Research (CanVECTOR) Network the Network receives grant funding from the Canadian Institutes of Health Research (Funding Reference: CDT-142654).
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All authors reviewed the full manuscript and contributed to its content and references.įunding: LAC is supported by Heart and Stroke Foundation of Canada National New Investigator and Ontario Clinician Scientist Phase I award. MAF guided the writing of the full manuscript. LD was the lead author of the manuscript, and LAC wrote the sections on choice of anticoagulation for acute pulmonary embolism, treatment of cancer associated pulmonary embolism, and duration of treatment for pulmonary embolism. For this reason they are written predominantly by US authorsĬontributors: LD and LAC did the primary literature search in collaboration with a health information librarian.
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Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. In the remaining patients, future studies are needed to understand the pathophysiology and explore interventions to improve quality of life. Such patients should be screened for chronic thromboembolic pulmonary hypertension, but only a small proportion will have this as the explanation of their symptoms. Despite major advances in the management of pulmonary embolism, up to half of patients report chronic functional limitations. The use of a risk prediction score can help to identify patients with unprovoked venous thromboembolism who can benefit from extended duration therapy. Patients with an ongoing strong risk factor, such as cancer, or unprovoked events are at increased risk of recurrent events and should be considered for extended treatment. Patients with a venous thromboembolism associated with a strong, transient, provoking risk factor can safely discontinue anticoagulation after three months of treatment. After a diagnosis of pulmonary embolism, all patients should be assessed for risk of recurrent venous thromboembolism to guide duration of anticoagulation. The role of low dose systemic or catheter directed thrombolysis in other patient subgroups is uncertain. Recent clinical trials exploring the use of systemic thrombolysis in intermediate to high risk pulmonary embolism suggest that this therapy should be reserved for patients with evidence of hemodynamic compromise. These oral therapeutic options have opened up opportunities for safe outpatient management of pulmonary embolism in selected patients.
Direct oral anticoagulation therapies are safe, effective, and convenient treatments for most patients with acute venous thromboembolism, with a lower risk of bleeding than vitamin K antagonists. The use of either clinical probability adjusted or age adjusted D-dimer interpretation has led to a reduction in diagnostic imaging to exclude pulmonary embolism.
The diagnosis, risk assessment, and management of pulmonary embolism have evolved with a better understanding of efficient use of diagnostic and therapeutic options. Pulmonary embolism is a common and potentially fatal cardiovascular disorder that must be promptly diagnosed and treated.