Pulmonary Embolism and Its Complications: Causes, Diagnosis and Treatment

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: 16 June 2024 | Viewed by 17953

Special Issue Editor


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Guest Editor
Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
Interests: vascular medicine; pulmonary embolism; deep vein thrombosis; Raynaud's disease; aortic dissection; aortic aneurysm; limb edema; peripheral artery disease; carotid artery disease

Special Issue Information

Dear Colleagues,

Acute pulmonary embolism (PE) is caused by the abrupt occlusion of pulmonary arteries from thrombus formed in the venous system. PE is one of the most frequent acute cardiovascular syndromes and its incidence continues to rise worldwide. Along with symptoms of dyspnea and chest pain, if there is significant thrombus burden, right ventricular strain can result with the potential for cardio-pulmonary collapse. Besides the risk of death, venous thromboembolism (VTE) recurrence, the occurrence of the post-PE syndrome, and PE-related quality of life/functional status are further outcomes that matter to patients with PE. 

This Special Issue of the Journal of Clinical Medicine aims to report the latest research on pulmonary embolism and its complications. We aim to attract original research articles, reviews, and communications on the latest updates in pulmonary embolism and its complications, to improve clinical outcomes and ensure optimal short- and long-term management.

Dr. Brett J. Carroll
Guest Editor

Manuscript Submission Information

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Keywords

  • pulmonary embolism
  • cardio-vascular disease
  • venous thromboembolism
  • thrombosis
  • deep vein thrombosis

Published Papers (6 papers)

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Research

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8 pages, 395 KiB  
Article
The Obesity Mortality Paradox in Patients with Pulmonary Embolism: Insights from a Tertiary Care Center
by Fahad Alkhalfan, Syed Bukhari, Akiva Rosenzveig, Rohitha Moudgal, Syed Zamrak Khan, Mohamed Ghoweba, Pulkit Chaudhury, Scott J. Cameron and Leben Tefera
J. Clin. Med. 2024, 13(8), 2375; https://doi.org/10.3390/jcm13082375 - 19 Apr 2024
Viewed by 417
Abstract
Background: While obesity is associated with an increased risk of venous thromboembolism (VTE), there is some data to suggest that higher BMI is also associated with decreased all-cause mortality in patients with a pulmonary embolism (PE). Methods: Using PE Response Team (PERT) activation [...] Read more.
Background: While obesity is associated with an increased risk of venous thromboembolism (VTE), there is some data to suggest that higher BMI is also associated with decreased all-cause mortality in patients with a pulmonary embolism (PE). Methods: Using PE Response Team (PERT) activation data from a large tertiary hospital between 27 October 2020 and 28 August 2023, we constructed a multivariate Cox proportional hazards model to assess the association between obesity as a dichotomous variable (defined as BMI ≥ 30 vs. BMI 18.5–29.9), BMI as a continuous variable, and 30-day PE-related mortality. Results: A total of 248 patients were included in this analysis (150 with obesity and 98 who were in the normal/overweight category). Obesity was associated with a lower risk of 30-day PE-related mortality (adjusted HR 0.29, p = 0.036, 95% CI 0.09–0.92). A higher BMI was paradoxically associated with a lower risk of PE-related mortality (HR = 0.91 per 1 kg/m2 increase, p = 0.049, 95% CI 0.83–0.999). Conclusions: In our contemporary cohort of patients with a PERT activation, obesity was associated with a lower risk of PE-related mortality. Full article
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Review

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14 pages, 1324 KiB  
Review
The Role of IVC Filters in the Management of Acute Pulmonary Embolism
by Samer Asmar, George Michael, Vincent Gallo and Mitchell D. Weinberg
J. Clin. Med. 2024, 13(5), 1494; https://doi.org/10.3390/jcm13051494 - 5 Mar 2024
Viewed by 2417
Abstract
Venous thromboembolism (VTE), comprising deep venous thrombosis (DVT) and pulmonary embolism (PE), is a prevalent cardiovascular condition, ranking third globally after myocardial infarction and stroke. The risk of VTE rises with age, posing a growing concern in aging populations. Acute PE, with its [...] Read more.
Venous thromboembolism (VTE), comprising deep venous thrombosis (DVT) and pulmonary embolism (PE), is a prevalent cardiovascular condition, ranking third globally after myocardial infarction and stroke. The risk of VTE rises with age, posing a growing concern in aging populations. Acute PE, with its high morbidity and mortality, emphasizes the need for early diagnosis and intervention. This review explores prognostic factors for acute PE, categorizing it into low-risk, intermediate-risk, and high-risk based on hemodynamic stability and right ventricular strain. Timely classification is crucial for triage and treatment decisions. In the contemporary landscape, low-risk PE patients are often treated with Direct Oral Anticoagulants (DOACS) and rapidly discharged for outpatient follow-up. Intermediate- and high-risk patients may require advanced therapies, such as systemic thrombolysis, catheter-directed thrombolysis, mechanical thrombectomy, and IVC filter placement. The latter, particularly IVC filters, has witnessed increased usage, with evolving types like retrievable and convertible filters. However, concerns arise regarding complications and the need for timely retrieval. This review delves into the role of IVC filters in acute PE management, addressing their indications, types, complications, and retrieval considerations. The ongoing debate surrounding IVC filter use, especially in patients with less conventional indications, reflects the need for further research and data. Despite complications, recent studies suggest that clinically significant issues are rare, sparking discussions on the appropriate and safe utilization of IVC filters in select PE cases. The review concludes by highlighting current trends, gaps in knowledge, and potential avenues for advancing the role of IVC filters in future acute PE management. Full article
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20 pages, 354 KiB  
Review
A Comprehensive Review of Risk Factors and Thrombophilia Evaluation in Venous Thromboembolism
by Andrew B. Dicks, Elie Moussallem, Marcus Stanbro, Jay Walls, Sagar Gandhi and Bruce H. Gray
J. Clin. Med. 2024, 13(2), 362; https://doi.org/10.3390/jcm13020362 - 9 Jan 2024
Cited by 2 | Viewed by 2560
Abstract
Venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant cause of morbidity and mortality worldwide. There are many factors, both acquired and inherited, known to increase the risk of VTE. Most of these result in increased [...] Read more.
Venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant cause of morbidity and mortality worldwide. There are many factors, both acquired and inherited, known to increase the risk of VTE. Most of these result in increased risk via several common mechanisms including circulatory stasis, endothelial damage, or increased hypercoagulability. Overall, a risk factor can be identified in the majority of patients with VTE; however, not all risk factors carry the same predictive value. It is important for clinicians to understand the potency of each individual risk factor when managing patients who have a VTE or are at risk of developing VTE. With this, many providers consider performing a thrombophilia evaluation to further define a patient’s risk. However, guidance on who to test and when to test is controversial and not always clear. This comprehensive review attempts to address these aspects/concerns by providing an overview of the multifaceted risk factors associated with VTE as well as examining the role of performing a thrombophilia evaluation, including the indications and timing of performing such an evaluation. Full article
12 pages, 1119 KiB  
Review
Choice and Duration of Anticoagulation for Venous Thromboembolism
by Aroosa Malik, Nghi B. Ha and Geoffrey D. Barnes
J. Clin. Med. 2024, 13(1), 301; https://doi.org/10.3390/jcm13010301 - 4 Jan 2024
Viewed by 3965
Abstract
Venous thromboembolism (VTE) is a prevalent medical condition with high morbidity, mortality, and associated costs. Anticoagulation remains the main treatment for VTE, though the decision on when, how, and for how long to administer anticoagulants is increasingly complex. This review highlights the different [...] Read more.
Venous thromboembolism (VTE) is a prevalent medical condition with high morbidity, mortality, and associated costs. Anticoagulation remains the main treatment for VTE, though the decision on when, how, and for how long to administer anticoagulants is increasingly complex. This review highlights the different phases of VTE management, with special circumstances for consideration such as antiphospholipid syndrome, coronary artery disease, cancer-associated thrombus, COVID-19, and future anticoagulation options. Anticoagulation management will continue to be a complex decision, applying evidence-based medicine to individual patients with the hope of maximizing effectiveness while minimizing risks. Full article
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20 pages, 1260 KiB  
Review
Risk Stratification and Management of Intermediate-Risk Acute Pulmonary Embolism
by Nichole Brunton, Robert McBane, Ana I. Casanegra, Damon E. Houghton, Dinu V. Balanescu, Sumera Ahmad, Sean Caples, Arashk Motiei and Stanislav Henkin
J. Clin. Med. 2024, 13(1), 257; https://doi.org/10.3390/jcm13010257 - 2 Jan 2024
Cited by 1 | Viewed by 6889
Abstract
Pulmonary embolism (PE) is the third most common cause of cardiovascular death and necessitates prompt, accurate risk assessment at initial diagnosis to guide treatment and reduce associated mortality. Intermediate-risk PE, defined as the presence of right ventricular (RV) dysfunction in the absence of [...] Read more.
Pulmonary embolism (PE) is the third most common cause of cardiovascular death and necessitates prompt, accurate risk assessment at initial diagnosis to guide treatment and reduce associated mortality. Intermediate-risk PE, defined as the presence of right ventricular (RV) dysfunction in the absence of hemodynamic compromise, carries a significant risk for adverse clinical outcomes and represents a unique diagnostic challenge. While small clinical trials have evaluated advanced treatment strategies beyond standard anticoagulation, such as thrombolytic or endovascular therapy, there remains continued debate on the optimal care for this patient population. Here, we review the most recent risk stratification models, highlighting differences between prediction scores and their limitations, and discuss the utility of serologic biomarkers and imaging modalities to detect right ventricular dysfunction. Additionally, we examine current treatment recommendations including anticoagulation strategies, use of thrombolytics at full and reduced doses, and utilization of invasive treatment options. Current knowledge gaps and ongoing studies are highlighted. Full article
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Other

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13 pages, 1447 KiB  
Systematic Review
The Benefits and Imperative of Venous Thromboembolism Risk Screening for Hospitalized Patients: A Systematic Review
by Ebtisam Bakhsh
J. Clin. Med. 2023, 12(22), 7009; https://doi.org/10.3390/jcm12227009 - 9 Nov 2023
Viewed by 943
Abstract
Venous thromboembolism (VTE) is a major preventable condition in hospitalized patients globally. This systematic review evaluates the effectiveness and clinical significance of venous thromboembolism (VTE) risk-screening protocols in preventing VTE events among hospitalized patients. Databases, including PubMed, Embase and Cochrane, were searched without [...] Read more.
Venous thromboembolism (VTE) is a major preventable condition in hospitalized patients globally. This systematic review evaluates the effectiveness and clinical significance of venous thromboembolism (VTE) risk-screening protocols in preventing VTE events among hospitalized patients. Databases, including PubMed, Embase and Cochrane, were searched without date limits for studies comparing outcomes between hospitalized patients who did and did not receive VTE risk screening using standard tools. Twelve studies, enrolling over 139,420 patients, were included. Study quality was assessed using the ROBVIS tool. The results were summarized narratively. The findings show significant benefits of using VTE risk screening versus usual care across various outcomes. Using recommended tools, like Caprini, Padua and IMPROVE, allowed for the accurate identification of high-risk patients who benefited most from prevention. Formal screening was linked to much lower VTE rates, shorter hospital stays, fewer deaths and better use of preventive strategies matched to estimated clot risk. This review calls for the widespread adoption of VTE risk screening as an important safety step for at-risk hospital patients. More high-quality comparative research is needed to validate screening tools in different settings and populations. In summary, VTE risk screening is essential for healthcare systems to reduce life-threatening VTE events and improve patient outcomes through properly targeted preventive methods. Full article
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