Pulmonary Embolism Management: Unraveling Controversies and Exploring Cutting-Edge Strategies (PG)-Controversies in Current PE Risk Stratification_Moores_ARS

Controversies in Current PE Risk Stratification_Moores_ARS_RD

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Dr. Lisa Moores, Professor of Medicine at the Uniformed Services University of the Health Sciences, emphasizes the need for improved risk stratification in the management of pulmonary embolism (PE), specifically for patients at intermediate-high risk for clinical deterioration. Despite the complexity arising from the lack of a universally accepted definition of clinical deterioration, recent findings indicate that mean arterial pressure (MAP) at admission is a key predictor of early clinical deterioration in these patients. Specifically, a MAP of 81.5 mmHg has been independently linked to an increased risk of deterioration, offering more precise predictive capability than other indicators like right ventricular dysfunction (RVD) on imaging or elevated D-dimer levels.<br /><br />Historically, standard tools such as the Pulmonary Embolism Severity Index (PESI/sPESI), cardiac biomarkers, and RVD measurements have not consistently predicted immediate outcomes effectively. Emerging strategies point to additional predictors such as heart rate normalization, MAP, and right ventricular function indicators that may offer better early risk assessment.<br /><br />To improve patient outcomes, especially in those at risk of clinical deterioration, strategies that involve routine monitoring through serial echocardiograms and consideration of early reperfusion therapy are advised. These measures could include thrombolysis or catheter-directed treatments to preemptively manage the potential for hemodynamic collapse, which may not always be prevented by standard anticoagulation alone.<br /><br />These insights are backed by emerging research in cardiovascular care, underscoring the need for continual advancements in risk stratification methods to better manage patients with intermediate-high risk PE. The involvement of multidisciplinary expertise and research contributions, such as those from colleagues Greg Piazza and David Jimenez, are instrumental in driving these improvements.

Keywords

pulmonary embolism

risk stratification

clinical deterioration

mean arterial pressure

right ventricular dysfunction

Pulmonary Embolism Severity Index

heart rate normalization

reperfusion therapy

hemodynamic collapse

multidisciplinary expertise