The
therapy of acute
pulmonary thromboembolism (APTE) is based on the clinical grade and ranges from ambulant
therapy with anticoagulation, to thrombolysis, inferior vena cava (IVC) filtration, and
catheter thrombectomy. In the absence of
contraindications, initial treatment of APTE should consist of parenteral anticoagulation with
unfractionated heparin. Long-term anticoagulation
therapy, usually with
warfarin, should be administered according to the individual risk profile of the patient.
Thrombolytic therapy may be appropriate for patients with massive APTE with cardiac
shock,
syncope, etc. Similarly, thrombolysis has been reported to be effective in submassive APTE with right ventricular overload on echocardiography. IVC filters should be reserved for APTE with
deep vein thrombosis (DVT) in which there are absolute
contraindications to anticoagulation, recurrent thromboemboli despite therapeutic anticoagulation, and status after surgical
thrombectomy. Relative indications for IVC filters that require individualized decision making include proximal DVT, especially with free-floating thrombi or in patients with limited cardiopulmonary reserve. For patients with massive APTE with
contraindications to anticoagulation or in whom anticoagulation is uneffective, transcatheter aspiration with catheterization or fragmentation using a guidewire and rotating pig-tail
catheter can be used. In addition, cardiopulmonary management such as supplemental
oxygen,
catecholamine administration, percutaneous cardiopulmonary support, etc. may be necessary for individual patients.