How to manage pulmonary embolism

Giancarlo Agnelli Internal and Cardiovascular Medicine– Stroke Unit University of Perugia, Italy

Management of acute pulmonary embolism Clinical suspicion Risk stratification Diagnosis

Treatment

Improvement of clinical outcome

My talk today

Risk stratification in patients with acute PE 1.

Why patients with pulmonary embolism should undergo risk stratification?

2.

How risk stratification should be done (and in whom)?

3.

Implications of risk stratification (diagnosis & treatment)

My talk today

Risk stratification in patients with acute PE 1.

Why patients with pulmonary embolism should undergo risk stratification?

2.

How risk stratification should be done (and in whom)?

3.

Implications of risk stratification (diagnosis & treatment)

The spectrum of clinical presentation of PE

PE-related shock

Mild clinical symptoms

The spectrum of clinical outcome of PE

>30%

Mortality

95%) Implications: Should all patients undergo risk stratification?

Risk stratification in acute PE: RVD at echo 20

*

*

Overall mortality (%)

In-hospital

*

15

* °

10 ° °

5

°

0 no RVD RVD

Ribeiro

Kasper

ICOPER

0

5,7

8,1

14,3

19,0

16,1

Jerjes-

Grif oni

Pieralli

Frémont

Goldhaber

0

3,1

0

1,1

0

17,9

6,2

11,4

3,3

4,4

Sanchez

* stable and unstable ° stable

Vedovati et al., Int Emerg Med 2010

PE-MAP Study

RV LV

CT-RVD and clinical course in HD stable patients 411 HD stable patients 149 patients RV/LV