Current approaches to risk stratification in choosing the optimal strategy for examination and early treatment of patients with pulmonary embolism

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Abstract

Epidemiological data indicate a high prevalence of pulmonary embolism (PE) and a poor prognosis for this disease. The high rate of adverse outcomes of PE is due to the presence of multiple comorbidities in persons with this pathology and to errors in diagnosis and antithrombotic therapy. The review provides the most modern ideas about pre-test diagnosing patients with suspected PE. Clinical, laboratory, and instrumental risk stratification and early treatment approaches for PE are discussed in detail.

About the authors

Andrey L. Komarov

Chazov National Medical Research Center of Cardiology

Author for correspondence.
Email: andrkomarov@mail.ru
ORCID iD: 0000-0001-9141-103X

доктор медицинских наук, вед. науч. сотр. отд. клинических проблем атеротромбоза

Russian Federation, Moscow

References

  1. Cohen AT, Agnelli G, Anderson FA, et al.; VTE Impact Assessment Group in Europe (VITAE). Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost. 2007;98(4):756-4. doi: 10.1160/TH07-03-0212
  2. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonaryembolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603. doi: 10.1093/eurheartj/ehz405
  3. Панченко Е.П., Балахонова Т.В., Данилов Н.М., и др. Диагностика и лечение тромбоэмболии легочной артерии: клинические рекомендации Евразийской ассоциации кардиологов для практических врачей (2021). Евразийский кардиологический журнал. 2021;(1):44-77 [Panchenko EP, Balahonova TV, Danilov NM, et al. Diagnosis and management of pulmonary Embolism Eurasian Association of Cardiology (EAC) Clinical Practice Guidelines (2021). Eurasian Heart Journal. 2021;(1):44-77 (in Russian)]. doi: 10.38109/2225-1685-2021-1-44-77
  4. Zhao Y, Cheng Y, Wang H, et al. The Legend score synthesizes Wells, PERC, Geneva, D-dimer and predicts acute pulmonary embolism prior to imaging tests. Pulmonology. 2025;31(1):2416828. doi: 10.1016/j.pulmoe.2023.10.002
  5. Geersing GJ, Takada T, Klok FA, et al. Ruling out pulmonary embolism across different health care settings: A systematic review and individual patient data meta-analysis. PLoS Med. 2022;19(1):e1003905. doi: 10.1371/journal.pmed.1003905
  6. Jaff MR, McMurtry MS, Archer SL, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: A scientific statement from the American Heart Association. Circulation. 2011;123(16):1788-830. doi: 10.1161/CIR.0b013e318214914f
  7. Barco S, Mahmoudpour SH, Planquette B, et al. Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: A systematic review and meta-analysis. Eur Heart J. 2019;40(11):902-10. doi: 10.1093/eurheartj/ehy873
  8. Ebner M, Pagel CF, Sentler C, et al. Venous lactate improves the prediction of in-hospital adverse outcomes in normotensive pulmonary embolism. Eur J Intern Med. 2021;86:25-31. doi: 10.1016/j.ejim.2021.01.021
  9. Barco S, Vicaut E, Klok FA, et al.; PEITHO Investigators. Improved identification of thrombolysis candidates amongst intermediate-risk pulmonary embolism patients: Implications for future trials. Eur Respir J. 2018;51(1):1701775. doi: 10.1183/13993003.01775-2017
  10. Zondag W, Mos IC, Creemers-Schild D, et al.; Hestia Study Investigators. Outpatient treatment in patients with acute pulmonary embolism: The Hestia Study. J Thromb Haemost. 2011;9(8):1500-7. doi: 10.1111/j.1538-7836.2011.04388.x
  11. Селиверстов Е.И., Лобастов К.В., Илюхин Е.А., и др. Профилактика, диагностика и лечение тромбоза глубоких вен. Рекомендации российских экспертов. Флебология. 2023;17(3):152-296 [Seliverstov EI, Lobastov KV, Ilyukhin EA, et al. Prevention, diagnostics and treatment of deep vein thrombosis. Russian Experts Consensus. Journal of Venous Disorders. 2023;17(3):152-296 (in Russian)]. doi: 10.17116/flebo202317031152

Supplementary files

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2. Fig. 1. Algorithm for assessing the risk of death in the next 30 days in a patient with PE without signs of hemodynamic instability [2, 3].

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3. Fig. 2. Additional tools for assessing outcomes that determine the prognosis in patients with PE of moderate to high risk.

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