Reperfusion dans l'embolie pulmonaire: état de l'art et consensus d'experts: position du groupe soins intensifs de cardiologie de la société française de cardiologie

Translated title of the contribution: Reperfusion therapies in pulmonary embolism–state of the art and expert opinion: A position paper from the “Unité de Soins Intensifs de Cardiologie” group of the French Society of Cardiology

Clément Delmas, Nadia Aissaoui, Nicolas Meneveau, Helene Bouvaist, Hervé Rousseau, Etienne Puymirat, Marc Sapoval, Erwan Flecher, Guy Meyer, Olivier Sanchez, Costantino Del Giudice, François Roubille, Laurent Bonello

Research output: Contribution to journalShort surveypeer-review

Abstract

Acute pulmonary embolism is a frequent cardiovascular emergency with an increasing incidence. The prognosis of patients with high-risk and intermediate-high-risk pulmonary embolism has not improved over the last decade. The current treatment strategies are mainly based on anticoagulation to prevent recurrence and reduce pulmonary vasculature obstruction. However, the slow rate of thrombus lysis under anticoagulation is unable to acutely decrease right ventricle overload and pulmonary vasculature resistance in patients with severe obstruction and right ventricle dysfunction. Therefore, patients with high-risk and intermediate-high-risk pulmonary embolism remain a therapeutic challenge. Reperfusion therapies may be discussed for these patients, and include systemic thrombolysis, catheter-directed therapies and surgical thrombectomy. High-risk patients require systemic thrombolysis, but may have contraindications as a result of the high risk of bleeding. In addition, intermediate-high-risk patients should not receive systemic thrombolysis, despite its high efficacy, because of prohibitive bleeding complications. Recently, percutaneous reperfusion techniques have been developed to acutely decrease pulmonary vascular obstruction with lower-dose or no thrombolytic agents and, thus, potentially higher safety than systemic thrombolysis. Some of these techniques improve key haemodynamic variables. Cardiac surgical techniques and venoarterial extracorporeal membrane oxygenation as temporary circulatory support may be useful in selected cases. The development of pulmonary embolism centres with multidisciplinary pulmonary embolism teams is mandatory to enable adequate use of reperfusion and improve outcomes. We aim to present the state of the art regarding reperfusion therapies in pulmonary embolism, but also to provide guidance on their indications and patient selection.

Translated title of the contributionReperfusion therapies in pulmonary embolism–state of the art and expert opinion: A position paper from the “Unité de Soins Intensifs de Cardiologie” group of the French Society of Cardiology
Original languageFrench
Pages (from-to)749-759
Number of pages11
JournalArchives of Cardiovascular Diseases
Volume113
Issue number11
DOIs
StatePublished - Nov 2020

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Reperfusion therapies in pulmonary embolism–state of the art and expert opinion: A position paper from the “Unité de Soins Intensifs de Cardiologie” group of the French Society of Cardiology'. Together they form a unique fingerprint.

Cite this