Treatment Algorithm Guides PE Management

A treatment algorithm developed by Duke ensures safe, efficient care for patients presenting with pulmonary embolism (PE) by incorporating the expertise of many specialists from different disciplines who treat conditions related to blood clots in the lungs.

The algorithm is based on guidelines from the American Heart Association, the American College of Chest Physicians, and the European Society of Cardiology, says Talal Dahhan, MD, MSEd, a Duke pulmonologist who created a team of specialists to develop the Duke PE plan. The pulmonary vascular disease group leads Duke's response to PE cases.

“The goal is to identify high-risk patients quickly and initiate more aggressive intervention,” says Dahhan. The algorithm guides emergency referrals that are common for academic medical centers. “We try to communicate to regional centers that if a patient is diagnosed with an enlarged right ventricle or if a clot appears large on the CT scan, it’s best to refer them as soon as possible to a center where a multidisciplinary team can assess the patient quickly,” Dahhan says.

Clinically stable patients presenting with dyspnea or chest pain, a diagnosis of PE, and a normal right ventricle when viewed on CT scan are typically at lower risk, Dahhan says. These patients can usually be discharged after observation in the emergency department, preventing an unnecessary hospital stay.

The algorithm helps physicians incorporate the varied treatment approaches that different specialists bring to PE management. “If you ask pulmonologists, cardiologists, and internists the best ways to manage patients with PE, you hear different answers depending on training and specialty,” Dahhan says. “The core approaches are similar, but each specialist brings a slightly different perspective.”

Physicians from pulmonology, cardiology, hematology, hospital medicine, cardiac and medical intensive care units, interventional radiology, and emergency medicine formed the initial working team that created the algorithm.

“While typical long-term treatment for PE requires the use of anticoagulants, therapeutic approaches require flexibility,” Dahhan says. “About 20% of the cases presenting each year at regional hospitals are patients at high risk, and urgent interventions may save lives for patients whose condition may deteriorate.”