24 Interventions for acute pulmonary embolism to prevent right heart failure and circulatory collapse. (9th April 2018)

• Record Type: Journal Article
• Authors: Yan, Bryan P
• Is Part Of: Heart Asia. Volume 10(2018)Supplement 1
• Page Start: A8
• Page End: A8
• Publication Date: 2018-04-09
• DOI: 10.1136/heartasia-2018-apahff.24
• Languages: English
• ISSNs: 2398-5968

Abstract

Abstract : Pulmonary embolism (PE) is a common and life-threatening disease. Circulatory collapse is usually preceded by right heart dysfunction and dilatation due to acute increase in right ventricular afterload from pulmonary artery obstruction. The rationale for early intervention is to restore pulmonary perfusion and minimise the risk of right ventricular collapse. For patients with intermediate-high and high-risk PE, endovascular intervention has emerged as potential alternative to systemic thrombolysis or surgical embolectomy. Recent studies have shown that endovascular therapies, including catheter-directed thrombolysis and/or mechanical thrombectomy and ultrasound-assisted thrombolysis, lead to early reversal of right ventricular dysfunction and dilatation compared to anticoagulation therapy alone with low risk of major bleeding. However, there is a lack of large prospective trials on long-term clinical outcomes to standardise endovascular regime and to identify subgroups that may benefit from intervention. The choice between interventional treatment modalities for intermediate-high and high-risk PE should depend on local expertise, patient characteristics and time to therapy.