B Jayakrishnan
Senior Consultant, Sultan Qaboos Comprehensive Cancer Care &Research Centre
Vivek Ravikumar
Senior Resident, Department of Emergency Medicine, Baby Memorial Hospital,
Sami M Bennji
Consultant, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
Abstract
Submassive pulmonary embolism (PE) represents a subset of patients with disease severity between massive PE and the standard-risk PE. It is characterized by evidence of right ventricular (RV) dysfunction with a normal blood pressure. Risk-stratification in acute PE includes factors related to hemodynamic instability, RV overload, and cardiac biomarkers. The location of the thrombus or the clot burden are not a part of the risk stratification. Patients with confirmed submassive PE should be started on anticoagulation as soon as possible while monitoring closely for deterioration. Thrombolysis or catheter-based therapies may be considered on a case-by-case basis when the benefits outweigh the risk of hemorrhage. Patients who have a large clot burden, severe RV enlargement or dysfunction, high oxygen requirement, or are severely tachycardic needs early multidisciplinary assessment.
