Essential aspects of the follow‐up after acute pulmonary embolism: An illustrated review
Abstract Care for patients with acute pulmonary embolism (PE) involves more than determination of the duration of anticoagulant therapy. After choosing the optimal initial management strategy based on modern risk stratification schemes, patients require focused attention aimed at prevention of major...
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doaj-cbd933e0af5340768294dbcac8f7f4912020-11-25T03:38:20ZengWileyResearch and Practice in Thrombosis and Haemostasis2475-03792020-08-014695896810.1002/rth2.12404Essential aspects of the follow‐up after acute pulmonary embolism: An illustrated reviewGudula J. A. M. Boon0Harm Jan Bogaard1Frederikus A. Klok2Department of Thrombosis and Hemostasis Leiden University Medical Center Leiden The NetherlandsDepartment of Pulmonary Diseases Institute for Cardiovascular Research (ICaR‐VU)Amsterdam University Medical Centerlocation VUmc Amsterdam The NetherlandsDepartment of Thrombosis and Hemostasis Leiden University Medical Center Leiden The NetherlandsAbstract Care for patients with acute pulmonary embolism (PE) involves more than determination of the duration of anticoagulant therapy. After choosing the optimal initial management strategy based on modern risk stratification schemes, patients require focused attention aimed at prevention of major bleeding, identification of underlying (malignant) disease, prevention of cardiovascular disease, and monitoring for long‐term complications. The most frequent complication of PE is the so‐called “post‐PE syndrome,” a phenomenon of permanent functional limitations after PE occurring in up to 50% of patients. The post‐PE syndrome is caused by persistent deconditioning, anxiety, and/or ventilatory or circulatory impairment as a result of acute PE. The most severe and most feared presentation of the post‐PE syndrome is chronic thromboembolic pulmonary hypertension (CTEPH), a deadly disease if it remains untreated. While CTEPH may be successfully treated with pulmonary endarterectomy, balloon pulmonary angioplasty, and/or pulmonary hypertension drugs, the major challenge is to diagnose CTEPH at an early stage. Poor awareness for the post‐PE syndrome and in particular for CTEPH, high prevalence of persistent symptoms after PE and inefficient application of diagnostic tests in clinical practice all contribute to an unacceptable diagnostic delay and underdiagnosis. Its consequences are dire: increased mortality in patients with CTEPH, and excess health care costs, higher prevalence of depression, more unemployment and poorer quality of life in patients with post‐PE syndrome in general. In this review, we provide an overview of the incidence and impact of the post‐PE syndrome, and illustrate the clinical presentation, optimal diagnostic strategy as well as therapeutic options.https://doi.org/10.1002/rth2.12404complicationsearly diagnosisprognosispulmonary embolismpulmonary hypertensionvenous thromboembolism |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Gudula J. A. M. Boon Harm Jan Bogaard Frederikus A. Klok |
spellingShingle |
Gudula J. A. M. Boon Harm Jan Bogaard Frederikus A. Klok Essential aspects of the follow‐up after acute pulmonary embolism: An illustrated review Research and Practice in Thrombosis and Haemostasis complications early diagnosis prognosis pulmonary embolism pulmonary hypertension venous thromboembolism |
author_facet |
Gudula J. A. M. Boon Harm Jan Bogaard Frederikus A. Klok |
author_sort |
Gudula J. A. M. Boon |
title |
Essential aspects of the follow‐up after acute pulmonary embolism: An illustrated review |
title_short |
Essential aspects of the follow‐up after acute pulmonary embolism: An illustrated review |
title_full |
Essential aspects of the follow‐up after acute pulmonary embolism: An illustrated review |
title_fullStr |
Essential aspects of the follow‐up after acute pulmonary embolism: An illustrated review |
title_full_unstemmed |
Essential aspects of the follow‐up after acute pulmonary embolism: An illustrated review |
title_sort |
essential aspects of the follow‐up after acute pulmonary embolism: an illustrated review |
publisher |
Wiley |
series |
Research and Practice in Thrombosis and Haemostasis |
issn |
2475-0379 |
publishDate |
2020-08-01 |
description |
Abstract Care for patients with acute pulmonary embolism (PE) involves more than determination of the duration of anticoagulant therapy. After choosing the optimal initial management strategy based on modern risk stratification schemes, patients require focused attention aimed at prevention of major bleeding, identification of underlying (malignant) disease, prevention of cardiovascular disease, and monitoring for long‐term complications. The most frequent complication of PE is the so‐called “post‐PE syndrome,” a phenomenon of permanent functional limitations after PE occurring in up to 50% of patients. The post‐PE syndrome is caused by persistent deconditioning, anxiety, and/or ventilatory or circulatory impairment as a result of acute PE. The most severe and most feared presentation of the post‐PE syndrome is chronic thromboembolic pulmonary hypertension (CTEPH), a deadly disease if it remains untreated. While CTEPH may be successfully treated with pulmonary endarterectomy, balloon pulmonary angioplasty, and/or pulmonary hypertension drugs, the major challenge is to diagnose CTEPH at an early stage. Poor awareness for the post‐PE syndrome and in particular for CTEPH, high prevalence of persistent symptoms after PE and inefficient application of diagnostic tests in clinical practice all contribute to an unacceptable diagnostic delay and underdiagnosis. Its consequences are dire: increased mortality in patients with CTEPH, and excess health care costs, higher prevalence of depression, more unemployment and poorer quality of life in patients with post‐PE syndrome in general. In this review, we provide an overview of the incidence and impact of the post‐PE syndrome, and illustrate the clinical presentation, optimal diagnostic strategy as well as therapeutic options. |
topic |
complications early diagnosis prognosis pulmonary embolism pulmonary hypertension venous thromboembolism |
url |
https://doi.org/10.1002/rth2.12404 |
work_keys_str_mv |
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