Management of Acute Pulmonary Embolism: Pro/Con Debates

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Several treatment aspects of acute PE are controversial. One is treatment of intermediate risk PE with thrombolytics. According to the Pulmonary Embolism Thrombolysis (PEITHO) study, thrombolytics were possibly better for intermediate risk PE, but all-cause mortality was not different. According to a recent meta-analysis, thrombolytics were useful, but the rates of intracranial bleeding were high, and summative effect is controversial. A second is catheter-based therapy in pulmonary embolism. In a published meta-analysis of available catheter-based PE treatment studies, clinical success was achieved in 86%, but there was significant heterogeneity in the definition of success. A third is the use of NOACS for acute PE. There are several studies comparing NOACs with unfractionated heparin (UFH), low molecular weight heparin (LMWH), and vitamin K antagonists (VKA). All the studies have looked at different long-term and short-term outcomes, as well as rates of major and minor bleeding.

Course Objectives

Identify appropriate pulmonary embolism patients for catheter-based therapy.
Select appropriate newer oral anticoagulant agent for patients with acute PE.
Describe need for thrombolytic therapy in patients with intermediate risk PE.

Supported in part by an educational grant from the Bristol-Myers Squibb and Pfizer Alliance. Supported in part by an educational grant from Janssen Scientific Affairs, LLC. Supported in part by an independent continuing educational grant from Portola Pharmaceuticals, Inc.

Item Number: 7207.44

Faculty

Bhavinkumar D. Dalal, MD, FCCP
Associate Professor
Oakland University William Beaumont School of Medicine
Rochester, MI

Lisa K. Moores, MD, FCCP
Associate Dean for Student Affairs
Professor of Medicine
Uniformed Services of the Health Sciences
Bethesda, MA

Christopher J. Mullin, MD
Johns Hopkins University
Baltimore, MA

Josanna Rodriguez-Lopez, MD, FCCP
Director, HHT Center
Massachusetts General Hospital
Boston, MA

Physician Credit
The American College of Chest Physicians is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The American College of Chest Physicians designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Credit
Provider approved by the California Board of Registered Nursing, Provider Number 16433, for 1.0 contact hour.

Nurse Practitioners
The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts AMA PRA Category 1 Credit™ from organizations accredited by the ACCME. Individuals are responsible for checking with the AANPCP for further guidelines.

Physician Assistants
American Academy of Physician Assistants (AAPA) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. PAs may receive a maximum of 1.0 Category 1 credit for completing this activity.

Maintenance of Certification Statement
Successful completion of this CME activity enables the participant to earn up to 1.0 MOC point in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC points.

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CHEST Learning Category(s)
Learning Category 2: Self-Directed

Maintenance of Licensure
Scope of Practice – Pulmonary Education