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Int J Angiol
DOI: 10.1055/s-0044-1782537
Review Article

Anticoagulation in the Management of Acute Pulmonary Embolism—A Review

Raul del Toro Mijares
1   Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
,
Adrian Rojas Murguia 
1   Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
,
Mateo Porres-Aguilar
1   Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
,
Debabrata Mukherjee 
1   Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
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Abstract

Venous thromboembolism (VTE) is a very frequent cardiovascular entity that encompasses deep vein thrombosis and pulmonary embolism (PE). This last entity represents a major cause of cardiovascular morbidity and mortality. The incidence of PE and the rate of PE-related morbidity significantly increase with age, race, and underlying medical conditions, such as malignancy. Given the recent advances in diagnostic strategies and algorithms, patients can be risk assessed and treated promptly to avoid disease progression. Anticoagulation is the mainstay of treatment for acute PE that is not hemodynamically unstable. Direct oral anticoagulants, such as apixaban, rivaroxaban, or edoxaban, are currently the preferred agents for the treatment of patients who present with acute PE or for long-term treatment. Treatment duration should be continued for at least 3 months, and all patients should be assessed for extended duration of therapy based on the precipitating factors that led to the development of the VTE. Novel anticoagulant agents targeting factor XI/XIa are currently being investigated in phases 2 and 3 clinical trials, representing an attractive option in anticoagulation therapies in patients with VTE. For hemodynamically unstable patients, systemic thrombolysis is the treatment of choice, and it may also be of benefit—in reduced dose—for patients with intermediate to high risk who are at risk of hemodynamic collapse.

Keywords

anticoagulation - factor Xa - deep vein thrombosis - pulmonary embolism - thrombolysis - low-molecular-weight heparin - warfarin


Publication History

Article published online:
12 March 2024

© 2024. International College of Angiology. This article is published by Thieme.

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