Treatment of pulmonary embolism in "fragile" patients

Abstract

Pulmonary embolism (PE) is a common and potentially fatal cardiovascular disease that must be promptly diagnosed and treated. The diagnosis, risk assessment, and treatment of PE have evolved with better understanding of the effective use of diagnostic and therapeutic options. Diagnostic testing includes sequential application of clinical decision rules using Wells, Geneva scores, and D-dimer testing. Patients with a high likelihood of having venous thromboembolism (VTE) should undergo ultrasonography if deep vein thrombosis (DVT) is suspected and CT if PE is suspected. Direct oral anticoagulants (DOAC) are a safe, effective, and convenient treatment for most patients with VTE and have a lower risk of bleeding than vitamin K antagonists. Treatment of PE in frail patients, including the elderly (≥75 years) and/or with low body weight (≤50 kg) and/or impaired renal function (GFR ≤ 50 ml/min) remains quite problematic due to the increased risk of hemorrhagic complications compared to the risk of recurrent VTE. Available data indicate that DOAC therapy is not inferior in efficacy and safety to conventional anticoagulant therapy and these drugs can be successfully used in “fragile” patients. The presented review can be used to help in choosing the most rational method of treating pulmonary embolism in “fragile” patients.

Keywords

• venous thromboembolism
• pulmonary embolism
• venous thrombosis
• direct oral anticoagulants
• fragile patient
• low body weight
• kidney disease