Pharmacological and Nonpharmacological Interventions for Prevention and Management of Pulmonary Embolism in Patients with Cardiac Comorbidities: A Literature Review

Main Article Content

Dennys Paul Guaraca Huilcarema
Juan Carlos Yánez Tobar
Robinson David Moya Pilay
Shirly Andrea Pagalo Tacuri
Galo Fernando Tulcanaza Ochoa
Mishelle Estefania Garcés López
Melany Dayana Albán Galarza

Abstract

Pulmonary embolism (PE) presents significant healthcare challenges and potentially life-threatening consequences, demanding a nuanced approach to management. This systematic review aimed to critically evaluate available pharmacological and nonpharmacological interventions for PE, analyzing their efficacy and safety in patients with cardiac comorbiditie, ranging from traditional anticoagulants like warfarin to novel direct oral anticoagulants (DOACs) or thrombolytic therapies is commercially available options with varying benefits and limitations. Nonpharmacological interventions, including catheter-directed therapies and embolectomy, provide alternative avenues, especially when thrombolysis is contraindicated despite advancements, and gaps persist, particularly in reconciling efficacy with safety profiles and optimizing resource allocation. Addressing these challenges necessitates a multidisciplinary approach, integrating clinical expertise with evidence-based practices. By exploring these interventions' intricacies and implications, this review aims to inform clinicians, researchers, and policymakers, fostering improved care pathways and better outcomes for patients facing the complex landscape of PE management.

Article Details

How to Cite
Dennys Paul Guaraca Huilcarema, Juan Carlos Yánez Tobar, Robinson David Moya Pilay, Shirly Andrea Pagalo Tacuri, Galo Fernando Tulcanaza Ochoa, Mishelle Estefania Garcés López, & Melany Dayana Albán Galarza. (2024). Pharmacological and Nonpharmacological Interventions for Prevention and Management of Pulmonary Embolism in Patients with Cardiac Comorbidities: A Literature Review. International Journal of Medical Science and Clinical Research Studies, 4(05), 797–806. https://doi.org/10.47191/ijmscrs/v4-i05-02
Section
Articles

References

I. Roland J. Complications of pulmonary embolism [Internet]. Healthline. 2018. Available from: https://www.healthline.com/health/pulmonaryembolismcomplications

II. Fccp DROM. Pulmonary Embolism (PE): practice essentials, background, anatomy [Internet]. Available from:

https://emedicine.medscape.com/article/300901overview#a8

III. Grosse SD, Nelson RE, Nyarko KA, Richardson LC, Raskob GE. The economic burden of incident venous thromboembolism in the United States: A review of estimated attributable healthcare costs. Thrombosis Research [Internet]. 2016 Jan 1;137:3–10. Available from:

https://www.sciencedirect.com/science/article/abs/pii/S0049384815302097

IV. MacDougall D, Feliu AL, Boccuzzi SJ, Lin J. Economic burden of deep vein thrombosis, pulmonary embolism, and postthrombotic syndrome. American Journal of Health-system Pharmacy [Internet]. 2006 Oct 15;63(20_Supplement_6):S5–15. Available from: https://academic.oup.com/ajhp/articleabstract/63/20_Supplement_6/S5/5134711?redirectedFrom=fulltext&login=false

V. Facep WLRBM Faaem,. Thrombolytic therapy: background, thrombolytic agents, thrombolytic therapy for acute myocardial infarction [Internet]. Available from:

https://emedicine.medscape.com/article/811234overview#a4

VI. Gheorghiade M, Vaduganathan M, Fonarow GC, Greene SJ, Greenberg B, Liu PP, et al. Anticoagulation in heart failure: current status and future direction. Heart Failure Reviews [Internet]. 2012 Sep 18;18(6):797–813. Available from: https://pubmed.ncbi.nlm.nih.gov/22987320/

VII. Heestermans M, Poenou G, Hamzeh‐Cognasse H, Cognasse F, Bertoletti L. Anticoagulants: A short history, their mechanism of action, pharmacology, and indications. Cells [Internet]. 2022 Oct 13;11(20):3214. Available from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9600347/

VIII. Solari F, Varacallo M. LowMolecularWeight heparin (LMWH) [Internet]. StatPearls NCBI Bookshelf. 2023. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK525957/

IX. Panahi L, Udeani G, Horseman MA, Weston J, Samuel N, Joseph M, et al. Review of Medical Therapies for the Management of Pulmonary Embolism. Medicina [Internet]. 2021 Jan 26;57(2):110. Available from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912594/

X. Sebaaly J., Covert K. Enoxaparin dosing at extremes of weight: Literature review and dosing recommendations. Ann Pharmacother. 2018; 52: 898–909.

XI. Smythe M.A., Priscilla J., Dobesh P.P., Wirth D., Cuker A., Wittkowsky A.K. Guidance for the practical management of the heparin anticoagulants in treating venous thromboembolism. J. Thromb. Thrombolysis. 2016;41:165–186.

doi: 10.1007/s1123901513152.

XII. Hirsh J., Warkentin T.E., Shaughnessy S.G., Anand S.S., Halperin J.L., Raschke R., Granger C., Ohman E.M., Dalen J.E. Heparin and low molecular weight heparin mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest. 2001;119:64S–94S.

doi 10.1378/chest.119.1_suppl.64S.

XIII. Squibb B.M. Eliquis (Apixaban) Package Insert. Bristol-Myers Squibb; Princeton, NJ, USA: 2014

XIV. Duffett L., Castellucci L.A., Forgie M.A. Pulmonary embolism: Update on management and controversies. BMJ. 2020;5:370.

doi: 10.1136/bmj.m2177.

XV. Wang L., Zhang D., Raghavan N., Yao M., Ma L., Frost C.A., Maxwell B.D., Chen S.Y., He K., Goosen T.C., et al. In vitro assessment of metabolic drug-drug interaction potential of apixaban through cytochrome P450 phenotyping, inhibition, and induction studies. Drug Metab. Dispos. 2010; 38:448–458.

doi: 10.1124/dmd.109.029694.

XVI. Duffett L., Castellucci L.A., Forgie M.A. Pulmonary embolism: Update on management and controversies. BMJ. 2020;5:370.

doi: 10.1136/bmj.m2177.

XVII. FDA Highlights of Prescribing Information Unfractionated Heparin. [(accessed on 21 October 2020)]; Available online:

https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/017029s140lbl

XVIII. Sallah S., Thomas D. P., Roberts H. R. Warfarin and heparin-induced skin necrosis and the purple toe syndrome: Infrequent complications of anticoagulant treatment. Thromb Haemost. 1997; 78:785–790.

doi: 10.1055/s00381657628.

XIX. Hirsh J, Anand SS, Halperin JL, Fuster V. Guide to anticoagulant therapy: Heparin. Circulation [Internet]. 2001 Jun 19;103(24):2994–3018. Available from:

https://www.ahajournals.org/doi/full/10.1161/01.CIR.103.24.2994

XX. Dhakal P, Rayamajhi S, Verma V, Gundabolu K, Bhatt VR. Reversal of anticoagulation and management of bleeding in patients on anticoagulants. Clinical and Applied Thrombosis/Hemostasis [Internet]. 2016 Oct 26;23(5):410–5. Available from:

https://pubmed.ncbi.nlm.nih.gov/27789605/

XXI. Gerotziafas GT, Depasse F, Chakroun T, Samama M, Εlalamy Ι. Recombinant factor VIIa partially reverses the inhibitory effect of fondaparinux on thrombin generation after tissue factor activation in platelet-rich plasma and whole blood. Thrombosis and Haemostasis [Internet]. 2004 Jan 1;91(03):531–7. Available from:

https://pubmed.ncbi.nlm.nih.gov/14983229/

XXII. Qin H, Dong BR, Yue J, Wu T, Liu GJ. Thrombolytic therapy for pulmonary embolism. Cochrane Library [Internet]. 2018 Dec 18; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6516871/

XXIII. Sidhu NS, Kaur S. Thrombolytic therapy in pulmonary thromboembolism. In: IntechOpen eBooks [Internet]. 2022. Available from: https://www.intechopen.com/chapters/78934

XXIV. Ren Y, Patel K, Crane T. A review of antiplatelet drugs, coronary artery diseases and cardiopulmonary bypass [Internet]. PubMed Central (PMC). 2010. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4680033/

XXV. Diep R, García D. Does aspirin prevent venous thromboembolism? Hematology [Internet]. 2020 Dec 4;2020(1):634–41. Available from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7727539/

XXVI. Brown KN, Devarapally SR, Lee LS, Gupta N. Catheter-Directed thrombolysis of pulmonary embolism [Internet]. StatPearls - NCBI Bookshelf. 2023. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK536918/

XXVII. Park H. A suction thrombectomy technique: a rapid and effective method for Intra-Arterial thrombolysis. Journal of Cerebrovascular and Endovascular Neurosurgery [Internet]. 2015 Jan 1;17(1):13. Available from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4394114/

XXVIII. Molvar C. Inferior vena cava filtration in managing venous thromboembolism: Filtering the data. Seminars in Interventional Radiology [Internet]. 2012 Oct 16;29(03):204–17. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3577583/

XXIX. Devcic Z, Kuo WT. Percutaneous Pulmonary Embolism thrombectomy and thrombolysis: technical tips and tricks. Seminars in Interventional Radiology [Internet]. 2018 Jun 1;35(02):129–35. Available from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986568/

XXX. Akay TH, Sezgin A, Ozkan S, Gultekin B, Aslim E, Aslamaci S. Successful Surgical Treatment of Massive Pulmonary Embolism after Coronary Bypass Surgery [Internet]. PubMed Central (PMC). 2006. Available from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764967/

XXXI. Patient education: Pulmonary embolism (Beyond the Basics) - UpToDate [Internet]. UpToDate. Available from:

https://www.uptodate.com/contents/pulmonary-embolism-beyond-the-basics/print

XXXII. Fccp DROM. Pulmonary Embolism (PE) Treatment & Management: Approach considerations, thrombolysis for pulmonary embolism, Anticoagulation for pulmonary embolism [Internet]. Available from:

https://emedicine.medscape.com/article/300901-treatment

XXXIII. Pulmonary embolism [Internet]. Physiopedia. Available from:

https://www.physiopedia.com/Pulmonary_Embolism