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Treatment of submassive and massive pulmonary embolism: a clinical practice survey from the second annual meeting of the Pulmonary Embolism Response Team Consortium

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Abstract

There is a paucity of robust clinical trial data to guide the treatment of acute pulmonary embolism (PE) thus the clinical guidelines rely heavily on expert opinion. Pulmonary Embolism Response Teams (PERT) have been developed to streamline the care of patients with acute PE. We conducted a survey among 100 experts in the field of PE during the second annual meeting of the PERT Consortium. Respondents were queried with respect to their demographic information, clinical practice questions and clinical vignettes. Clinical practice questions were focused questions about the risk stratification and treatment of patients with acute submassive PE, anticoagulation strategies for patients receiving thrombolysis and the use of inferior vena cava filters. Clinical vignettes were designed to assess participants’ preferred choice of treatment for a variety of commonly encountered clinical scenarios. Among physicians affiliated with a PERT, there is overall agreement with regards to the criteria used for risk classification of patients with PE and its application to patients in the provided clinical vignettes. In contrast, there is substantial variability in the treatment strategies of patients presenting with commonly encountered clinical scenarios. The results of this survey highlight the need for more clinical trial data along with accepted algorithms for treatment of acute PE. In the absence of this, PERTs can facilitate multidisciplinary discussions in order to standardize treatment and provide evidence-based therapies to patients with acute PE.

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Abbreviations

CDT:

Catheter-directed thrombolysis

PE:

Pulmonary embolism

LWMH:

Low molecular weight heparin

PERT:

Pulmonary Embolism Response Team

RV:

Right ventricular

UFH:

Unfractionated heparin

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Authors and Affiliations

  1. Division of Cardiology, Sections of Interventional Cardiology and Vascular Medicine, Medical University of South Carolina, 30 Courtenay Drive MSC 592, Charleston, SC, 29401, USA

    Thomas M. Todoran

  2. Penn Cardiovascular Outcomes, Quality and Evaluative Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Jay Giri

  3. Frankel Cardiovascular Center and Institute for Healthcare Policy and Innovation, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA

    Geoffrey D. Barnes

  4. Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Rachel P. Rosovsky

  5. Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Yuchiao Chang

  6. Division of Cardiology, Section of Vascular Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Michael R. Jaff & Kenneth Rosenfield

  7. Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Christopher Kabrhel

Authors
  1. Thomas M. Todoran
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  2. Jay Giri
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  3. Geoffrey D. Barnes
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  4. Rachel P. Rosovsky
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  5. Yuchiao Chang
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  6. Michael R. Jaff
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  7. Kenneth Rosenfield
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  8. Christopher Kabrhel
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on behalf of the PERT Consortium

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Correspondence to Thomas M. Todoran.

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Todoran, T.M., Giri, J., Barnes, G.D. et al. Treatment of submassive and massive pulmonary embolism: a clinical practice survey from the second annual meeting of the Pulmonary Embolism Response Team Consortium. J Thromb Thrombolysis 46, 39–49 (2018). https://doi.org/10.1007/s11239-018-1659-5

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  • DOI: https://doi.org/10.1007/s11239-018-1659-5

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