Critical Matters Pulmonary Embolism Update
21 snips
Mar 9, 2023 Dr. Belinda Rivera-Lebron, a pulmonary critical care physician and director of the UPMC Acute Pulmonary Embolus Program, shares her expertise on pulmonary embolism. She highlights PE as a major preventable killer and explains the importance of PE response teams in coordinating care. The conversation covers innovative AI tools for diagnosing PE, the role of anticoagulation therapies, and the nuances of catheter-directed therapies versus systemic thrombolysis. Belinda also discusses the significance of multidisciplinary follow-up and shares personal insights on leadership.
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Use Catheter Techniques To Relieve RV Strain
- Consider catheter-directed therapies (thrombectomy or catheter lysis) for intermediate-high or select high-risk patients to rapidly reverse RV strain.
- Prefer catheter thrombectomy when bleeding risk is high because it often avoids systemic TPA and has low bleeding rates.
Mortality Benefit From Catheter Therapy Is Unproven
- No prospective randomized trial yet demonstrates mortality benefit for catheter therapies; ongoing trials aim to answer this.
- Current retrospective and registry data show improvements in RV metrics and mixed effects on mortality.
Manage Anticoagulation Around Catheter Procedures
- Hold therapeutic unfractionated heparin during catheter-directed TPA but maintain a low sheath infusion to prevent catheter clotting.
- Resume full anticoagulation after catheter removal and transition to a DOAC within ~24 hours when stable.
