PE is the third leading cause of vascular mortality, after myocardial infarction and stroke. It is an enormously heterogeneous and unpredictable disease, which makes treatment difficult. As such, it should not be surprising that PE therapy remains highly controversial. For example, the new European Society of Cardiology guidelines recommend anticoagulation and watchful waiting for high-risk submassive PE (with salvage thrombolysis as needed). Meanwhile, in the United States, PE response teams (PERT teams) are typically employing more aggressive approaches to these same high-risk submassive PE patients. The use of systemic thrombolysis, interventional radiology strategies, and ECMO remain highly variable across different countries and different centers. Additional research is needed to resolve these controversies.
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The IBCC chapter is located here.
- The podcast & comments are below (the podcast is our longest yet at ~90 minutes of PE insanity! It's taking a little while, but will be out soon.)
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Josh Farkas
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Amazing review. One question I have for you which I can’t seem to find a straight answer for anywhere is, how long do you wait before you check a PTT and fibrinogen after the tPA is done (i.e., 30 minutes, 1 hour? etc…)