Abstract
Acute pulmonary embolism (PE) is a form of venous thromboembolism
(VTE) and has varied clinical manifestations with significant morbidity and mortality.
The general population's overall incidence is on the rise due to the increasing
availability of D-dimer and computed tomographic pulmonary angiography. The
incidence is higher in males than females (58 versus 48 per 100,000, respectively),
increasing with age. In the United States, PE accounts for approximately 100,000
deaths annually. Specific populations, including patients with malignancy, pregnant
females, hospitalized medical and surgical patients, or patients with total joint
replacement, or arthroplasty, are at a higher risk for PE. Patients presenting with
hemodynamic compromise due to PE need to be treated with intravenous thrombolytic
therapy unless contraindicated, followed by anticoagulation. For over six decades,
traditional anticoagulants like unfractionated heparin (UFH) are used for short-term
anticoagulation. For patients who require long-term anticoagulation, low molecular
weight heparin (LMWH) like enoxaparin and a vitamin K antagonist like warfarin are
used to achieve therapeutic anticoagulation. Options for anticoagulation have been
expanding steadily over the last decade with the introduction of the first direct oral
anticoagulant (DOAC). Since their introduction, DOACs have changed the landscape
of anticoagulation. This narrative review aims to summarize for clinicians managing
pulmonary embolism (PE) the main recent advances in patient care, including risk
stratification, current data regarding the use of thrombolytic treatment, and direct oral
anticoagulants.
Keywords: Anticoagulation, Catheter-Directed Therapy, Pulmonary Embolism, Thrombolysis.
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