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Feature Article

Improving long-term outcomes following acute pulmonary embolism

Christopher CY Wong, Vincent Chow, Leonard Kritharides, Austin CC Ng

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Abstract

Acute pulmonary embolism (PE) can result in complications many years after the initial event. An understanding of the long-term outcomes in patients following a PE is important to improve their management.

Key Points

  • Pulmonary embolism (PE) has been thought of as an acute condition with few long-term sequelae; however, data from recent studies have revealed an effect on mortality many years after the original insult.
  • Patients who experience an episode of PE are predisposed to later venous thromboembolic (VTE) events: VTE provoked by cancer is likely to have the highest recurrence rate, whereas VTE after surgery has the lowest recurrence rate.
  • GPs have a vital role in the intermediate- to long-term anticoagulation management of patients who have had a PE.
  • Chronic thromboembolic pulmonary hypertension should be considered in patients with previous PE or VTE who present with ongoing or unexplained dyspnoea, exercise intolerance, atypical chest pain, syncope or peripheral oedema.
  • There is increasing evidence of persistent functional and right ventricular impairment among long-term survivors of submassive PE.
  • Patients who have had a PE have been found to have a threefold increase in 30-year mortality compared with controls, even after adjustment for comorbidities.

    Picture credit: © Scott Bodell

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