Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

Dilemmas in the Choice of Adequate Therapeutic Treatment in Patients with Acute Pulmonary Embolism - from Modern Recommendations to Clinical Application

Ratko Lasica
* ORCID logo ,
Milika Asanin
,
Lazar Djukanovic
ORCID logo ,
Nebojsa Radovanovic
,
Lidija Savic
,
Marija M. Polovina
,
Sanja Stankovic
ORCID logo ,
Arsen Ristic
,
Marija Zdravković
,
Andjelka Lasica
,
Jelena Kravic
,
Jovan Perunicic
Version 1 : Received: 29 July 2022 / Approved: 2 August 2022 / Online: 2 August 2022 (03:12:56 CEST)

A peer-reviewed article of this Preprint also exists.

Lasica, R.; Asanin, M.; Djukanovic, L.; Radovanovic, N.; Savic, L.; Polovina, M.; Stankovic, S.; Ristic, A.; Zdravkovic, M.; Lasica, A.; Kravic, J.; Perunicic, J. Dilemmas in the Choice of Adequate Therapeutic Treatment in Patients with Acute Pulmonary Embolism—From Modern Recommendations to Clinical Application. Pharmaceuticals 2022, 15, 1146. Lasica, R.; Asanin, M.; Djukanovic, L.; Radovanovic, N.; Savic, L.; Polovina, M.; Stankovic, S.; Ristic, A.; Zdravkovic, M.; Lasica, A.; Kravic, J.; Perunicic, J. Dilemmas in the Choice of Adequate Therapeutic Treatment in Patients with Acute Pulmonary Embolism—From Modern Recommendations to Clinical Application. Pharmaceuticals 2022, 15, 1146.

Abstract

Pulmonary thromboembolism is a very common cardiovascular disease, with a still high mortality rate. Despite the clear guidelines, this disease still represents a great challenge both in diagnosis and treatment. Heterogeneous clinical picture, often without pathognomonic signs and symptoms, represents a huge differential diagnostic problem even for experienced doctors. The decision on the therapeutic regimen also represents a major dilemma in the group of patients who are hemodynamically stable at initial presentation and have signs of right ventricular (RV) dysfunction proven by echocardiography and positive biomarker values (pulmonary embolism of intermediate-high risk). Studies have shown conflicting results about the benefit of using fibrinolytic therapy in this group of patients until hemodynamic decompensation, due to the risk of major bleeding. The latest recommendations give preference to new oral anticoagulants (NOACs) compared to vitamin K antagonists (VKA), except for certain categories of patients (patients with antiphospholipid syndrome, mechanical valves, pregnancy). When using oral anticoagulant therapy, special attention should be paid to drug-drug interactions, which can lead to many complications, even to the death of the patient. Special population groups such as pregnant women, obese patients, patients with antiphospholipid syndrome and cancer represent a great therapeutic challenge in the application of anticoagulant therapy. In these patients, not only the effectiveness of the drugs must be taken into account, but great attention must be paid to their safety and possible side effects, which is why a multidisciplinary approach is emphasized in order to provide the best therapeutic option.

Keywords

acute pulmonary embolism; dilemmas; therapeutic treatment; recommendations; clinical application

Subject

Medicine and Pharmacology, Cardiac and Cardiovascular Systems

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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