Acute pulmonary embolism: Part II - Risk stratification, treatment, and prevention

Acute PE is increasingly appreciated as a major cardiopulmonary illness and public health issue. As the public becomes familiar with signs and symptoms of PE and DVT, more patients will be transported to emergency departments for urgent evaluation and treatment. Great progress has been made in the rapid detection and exclusion of PE, especially with the advent of D-dimer testing and chest CT scans. Rapid risk stratification facilitates selection of patients who warrant aggressive intervention with thrombolysis or embolectomy. For patients with idiopathic venous thromboembolism, there seems to be a lifelong tendency for recurrent thrombosis unless anticoagulation is continued. New frontiers in molecular genetics will provide a better appreciation of the interaction between inherited and environmental risk factors for PE. Novel mutations for thrombophilia will emerge in patients who presently have normal laboratory evaluations. Point of care blood testing will provide accurate screening of patients with suspected PE to triage those most appropriate for noninvasive imaging. When PE is confirmed, cardiac biomarkers will assist in rapid risk stratification so that the intensity of treatment matches the predicted risk profile of the patient. The definition of idiopathic PE will undergo refinement, and indefinite duration anticoagulation will become commonplace. Novel anticoagulant regimens will be safer and more convenient. Efforts to prevent PE will be pervasive, and computerized order entry and surveillance will ensure that hospitalized patients received appropriate prophylaxis.