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The Modern Algorithm For Management Of Massive And Submassive Pulmonary Embolism
Date:11/21/2013

NEW YORK, Nov. 21, 2013 /PRNewswire-iReach/ -- Acute pulmonary embolism (PE) is a potentially life-threatening condition, reporting an overall mortality rate of 15% in the first three months after diagnosis. The literature describes a three-tier risk stratification scale (massive, submassive and minor) based on the hemodynamic status and presence of signs/symptoms.  Tod C. Engelhardt, MD, Louisiana Heart, Lung and Vascular Institute, East Jefferson General Hospital (Metairie, LA) reported at the 40th Annual VEITHsymposium in New York stating, "Massive PE patients present with critical conditions, such as severe right ventricular (RV) dysfunction, systemic arterial hypotension or cardiogenic shock, and require immediate intervention. Submassive PE patients, while systemically normotensive, exhibit RV dysfunction and are typically managed conservatively. These patients represent a serious unmet need for advanced therapy to restore the hemodynamic impairment, given that RV dysfunction if unresolved promptly predicts poor outcome, including death."

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Engelhardt reports that intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rtPA) allows reversal of hemodynamic compromise and gas exchange derangement, and is considered a life-saving therapy for massive PE patients. For submassive PE patients, the recently completed PEITHO trial demonstrated a reduction of a combined endpoint of 7-day cardiopulmonary collapse and mortality with treatment by IV Tenecteplase compared to placebo. However, widespread adoption of IV thrombolysis is hampered by increased risk of major bleeding, including intracranial hemorrhage reported at 3% historically and at 2% specifically in PEITHO.
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