What is considered a massive PE?

What is considered a massive PE?

Massive pulmonary embolism is defined as obstruction of the pulmonary arterial tree that exceeds 50% of the cross-sectional area, causing acute and severe cardiopulmonary failure from right ventricular overload.

When do you Thrombolyse a PE?

Thrombolytics provide the greatest benefit if they are administered within 48 hours of symptom onset. PE patients with transient, less-severe signs of hypotension or shock, but who later experience sudden clinical deterioration, may still be considered for systemic thrombolytics.

What is the difference between massive and Submassive PE?

Massive pulmonary embolism has a high mortality rate despite advances in diagnosis and therapy. A subgroup of patients with nonmassive PE who are hemodynamically stable but with right ventricular (RV) dysfunction or hypokinesis confirmed by echocardiography is classified as submassive PE.

How do you use Thrombolyse PE?


  1. alteplase (patients 65 kg or more) 10 mg IV bolus, followed by 90 mg IV infusion over 2 hours (the MOPPET trial used half-dose, i.e. total of 50 mg)
  2. For patients weighing less than 65 kg, the total dose should be adjusted so that it does not exceed 1.5 mg/kg.

What is Submassive?

Submassive (or intermediate-risk) PE refers to those patients with acute PE without systemic hypotension but with evidence of either right ventricle (RV) dysfunction or myocardial necrosis.

Does PE cause hypotension?

Massive pulmonary emboli may manifest with hypotension, tachycardia, light-headedness/presyncope, syncope, or cardiac arrest. Less commonly, patients have hypotension.

How long do you Anticoagulate after PE?

Current guidelines recommend patients with provoked PE or those with transient risk factors, such as major surgery or immobilization, be treated for a duration of 3 months.

Why is there no tPA for PE?

For patients with (sub)massive PE who are receiving tPA or who will immediately receive tPA, heparin increases the risk of bleeding without providing any proven benefit.

What is the standard treatment for PE?

Anticoagulation therapy is the primary treatment option for most patients with acute PE. The utilization of factor Xa antagonists and direct thrombin inhibitors, collectively termed Novel Oral Anticoagulants (NOACs) are likely to increase as they become incorporated into societal guidelines as first line therapy.

How do you rule out PE?

Diagnosing Pulmonary Embolism (PE)

  1. Chest X-ray.
  2. Ventilation-perfusion scan (V/Q scan)
  3. Pulmonary angiogram.
  4. Spiral computed tomography.
  5. Magnetic resonance imaging (MRI)
  6. Duplex ultrasound.
  7. Electrocardiogram (ECG or EKG)

What is PE protocol?

A CT PE (Pulmonary Embolus) Study is a CT exam of the chest that uses a combination of high speed CT imaging and an Iodine contrast to make very thin (1.5mm) and very detailed pictures of the pulmonary artery and vein.

What is the BTS guideline for initial op management of PE?

The British Thoracic Society (BTS) Guideline for the initial OP management of PE provides guidance on how to risk-stratify patients with suspected and confirmed PE and subsequently manage them in an OP or ambulatory care setting.

What is included in the BTS quality standards?

The BTS Quality Standards include evidence and recommendations summarised in the BTS Guideline for the Initial Outpatient Management of Pulmonary Embolism (PE), which was published in 2018. 2 Each quality standard includes the following: A quality statement, which describes a key marker of high-quality, cost-effective care for this condition.

What does BTS stand for?

Quality statements are based on the British Thoracic Society (BTS) Guideline for the Initial Outpatient Management of Pulmonary Embolism.

What are the new guidelines on suspected pulmonary embolism (PE)?

It was decided that the updated guidelines would concentrate on suspected pulmonary embolism (PE) and only include deep vein thrombosis (DVT) where relevant, even though both are part of venous thromboembolism (VTE).