PG 2025: Pulmonary Literature Review and Interactive Complex Case Presentations (PG)-STEIGER MOC Questions

STEIGER MOC Questions

Pdf Summary

This educational activity, presented by Dr. David Steiger in the 2025 Pulmonary Literature Review course, focuses on advances in pulmonary hypertension and thromboembolic disease. The learning objectives include improving understanding of risk prediction in acute pulmonary embolism (PE), reviewing evidence for advanced therapies in acute PE emphasizing early intervention, and assessing the efficacy and safety of sotatercept in high-risk pulmonary arterial hypertension (PAH) patients.<br /><br />A key pre-course test question addressed risk stratification in acute PE patients at intermediate mortality risk. It highlighted that mortality in this group varies widely (1.8%-17%), making precise prediction challenging. Established risk scores like BOVA, plasma lactate, and FAST improve prognostication but cannot fully define risk alone. The recently developed Composite Pulmonary Embolism Shock Score (CPES Score), which does not require right heart catheterization, incorporates clinical and imaging factors to identify normotensive shock patients and predict adverse outcomes, including decompensation and mortality, making it a valuable tool in clinical decision-making.<br /><br />The post-course assessment question focused on cancer-associated venous thromboembolism (VTE). Contrary to outdated beliefs, VTE risk is significantly increased in cancer patients. Direct oral anticoagulants (DOACs) are non-inferior to low molecular weight heparin (LMWH) for initial VTE treatment, with higher compliance due to oral administration. Notably, recent data showed that after six months of full-dose apixaban therapy, switching to a reduced dose (2.5 mg twice daily) maintains efficacy in preventing recurrent VTE while lowering major and clinically relevant bleeding risks. This finding supports extended anticoagulation with reduced-dose apixaban as a safe, effective option to enhance patient outcomes in cancer-associated VTE.<br /><br />Overall, the activity integrates updated risk stratification strategies and therapeutic advances in managing pulmonary embolism and thrombosis, particularly emphasizing personalized approaches to improve prognosis and safety.

Keywords

pulmonary hypertension

thromboembolic disease

acute pulmonary embolism

risk prediction

Composite Pulmonary Embolism Shock Score

cancer-associated venous thromboembolism

direct oral anticoagulants

low molecular weight heparin

apixaban dose reduction

personalized therapy