Critical Care Management of Acute Venous Thromboembolism: Integrating Pharmacotherapy, Thrombectomy, and Temporary Mechanical Support

Abstract

Venous thromboembolism (VTE), which includes pulmonary embolism and deep vein thrombosis, carries significant morbidity and mortality risks, and is conventionally managed with anticoagulation. In recent years, notable progress has been made in the therapeutic options available for the acute treatment of VTE. The heterogeneity within pulmonary embolism, spanning a wide spectrum of risks, underscores the critical need for precise risk stratification, particularly in identifying individuals prone to right heart failure and increased mortality. This review navigates the transformative developments in VTE approaches, focusing on the diagnosis and management of acute VTE in the critical care setting. It encompasses developing critical care approaches to intermediate- and high-risk pulmonary embolism, the treatment of right heart failure, and the integration of mechanical circulatory support, providing comprehensive insights into risk stratification, emerging interventions, and evolving treatment strategies. It is important to note that some of the novel therapies are still under clinical trials and, despite promising reports, are not yet considered standard of care.