Unraveling the Gordian Knot: Stratifying Risk and Individualizing Care for Each Patient
Once an acute pulmonary embolism (PE) has been diagnosed, risk stratification is important to tailor treatments for an individual patient. Risk stratification allows physicians to identify low-risk patients to promote early discharge on novel oral anticoagulant therapy and high-risk patients who may benefit from escalation of care beyond simple anticoagulation alone. Determining who these higher-risk patients are requires an efficient strategy utilizing available resources to allow escalation of care with a cohesive approach aimed at optimizing outcomes. The most important immediate step in risk stratification is to assess the right ventricle’s ability to overcome the afterload caused by the pulmonary thrombus obstruction, which is evaluated using a variety of clinical, imaging, and/or laboratory data. Regardless of which assessment tools are used, the ultimate goal is to categorize patients into one of the following categories shortly after diagnosis: (1) high-risk or massive PE, (2) intermediate-risk or submassive PE, or (3) low-risk/minor PE.1 Treatments can range from anticoagulation alone, catheter-directed thrombolysis, full-dose systemic thrombolysis, reduced-dose systemic thrombolysis, catheter embolectomy, surgical embolectomy, and/or mechanical circulatory support such as extracorporeal membrane oxygenation.
McDaniel MC, Courtney M, Bowers TR. Unraveling the Gordian knot: Stratifying risk and individualizing care for each patient. PERT Consortium, supplement to Endovascular Today, Vol. 18, Suppl, July 2019