Highlights
- •The post-PE syndrome is common and affects functional capacity and quality of life.
- •Impaired thrombus resolution and right ventricular damage following acute PE are likely causative factors.
- •Treatment of the post-PE syndrome is only established for chronic thromboembolic pulmonary hypertension.
- •No current treatment is known to prevent the post-PE syndrome.
Abstract
The post-Pulmonary Embolism (post-PE) syndrome is being increasingly recognized as
a long-term consequence of PE. Its most severe manifestation, chronic thromboembolic
pulmonary hypertension (CTEPH), affects a small proportion of PE survivors. However,
many more with less severe post-PE syndrome have reduced quality of life and functional
capacity. The pathophysiology is incompletely understood, but involves unresolved
pulmonary artery thrombi, right ventricular damage, and abnormal gas exchange. Treatment
has only been established for CTEPH, and further studies are required to determine
how less severe forms of the post-PE syndrome should be treated and if preventive
strategies can reduce its incidence.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Thrombosis ResearchAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Long-term clinical course of acute pulmonary embolism.Blood Rev. 2013; 27: 185-192
- Risk of arterial cardiovascular events in patients after pulmonary embolism.Blood. 2009; 114: 1484-1488
- Patient outcomes after acute pulmonary embolism. A pooled survival analysis of different adverse events.Am. J. Respir. Crit. Care Med. 2010; 181: 501-506
- Clinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism: a meta-analysis.Ann. Intern. Med. 2003; 139: 893-900
- Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism.N. Engl. J. Med. 2004; 350: 2257-2264
- Cancer and venous thromboembolism.Lancet Oncol. 2005; 6: 401-410
- The risk of recurrent venous thromboembolism after discontinuing anticoagulation in patients with acute proximal deep vein thrombosis or pulmonary embolism. A prospective cohort study in 1,626 patients.Haematologica. 2007; 92: 199-205
- The post-PE syndrome: a new concept for chronic complications of pulmonary embolism.Blood Rev. 2014; 28: 221-226
- Chronic thromboembolic pulmonary hypertension.N. Engl. J. Med. 2001; 345: 1465-1472
- Right ventricle dysfunction and pulmonary hypertension in hemodynamically stable pulmonary embolism.Respir. Med. 2010; 104: 1370-1376
- Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a contemporary view of the published literature.Eur. Respir. J. 2017; 49
- Echocardiographic and functional cardiopulmonary problems 6 months after first-time pulmonary embolism in previously healthy patients.Eur. Heart J. 2007; 28: 2517-2524
- Prevalence and potential determinants of exertional dyspnea after acute pulmonary embolism.Respir. Med. 2010; 104: 1744-1749
- Prospective evaluation of right ventricular function and functional status 6 months after acute submassive pulmonary embolism: frequency of persistent or subsequent elevation in estimated pulmonary artery pressure.Chest. 2009; 136: 1202-1210
- Quality of life, dyspnea and functional exercise capacity following a first episode of pulmonary embolism: results of the ELOPE cohort study.Am. J. Med. 2017;
- Thrombolytic therapy for pulmonary embolism.Cochrane Database Syst. Rev. 2009; 3CD004437
- Perfusion defects after pulmonary embolism: risk factors and clinical significance.J. Thromb. Haemost. 2010; 8: 1248-1255
- Thromboembolic resolution assessed by CT pulmonary angiography after treatment for acute pulmonary embolism.Thromb. Haemost. 2015; 114: 26-34
- Residual pulmonary thromboemboli after acute pulmonary embolism.Eur. J. Intern. Med. 2012; 23: 379-383
- Residual emboli on lung perfusion scan or multidetector computed tomography after a first episode of acute pulmonary embolism.Intern. Emerg. Med. 2011; 6: 521-528
- Clot resolution after 3 weeks of anticoagulant treatment for pulmonary embolism: comparison of computed tomography and perfusion scintigraphy.J. Thromb. Haemost. 2013; 11: 679-685
- Pulmonary embolism: one-year follow-up with echocardiography doppler and five-year survival analysis.Circulation. 1999; 99: 1325-1330
- Impact of thrombolytic therapy on the long-term outcome of intermediate-risk pulmonary embolism.J. Am. Coll. Cardiol. 2017; 69: 1536-1544
- Incidence of venous thromboembolism: a community-based study in western France. EPI-GETBP study group. Groupe d'Etude de la thrombose de Bretagne Occidentale.Thromb. Haemost. 2000; 83: 657-660
- The epidemiology of venous thromboembolism in the community.Thromb. Haemost. 2001; 86: 452-463
- Chronic thromboembolic pulmonary hypertension. epidemiology and risk factors.Ann. Am. Thorac. Soc. 2016; 3: S201-S206
- Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry.Circulation. 2011; 124: 1973-1981
- Longterm follow-up of patients with pulmonary thromboembolism. Late prognosis and evolution of hemodynamic and respiratory data.Chest. 1982; 81: 151-158
- Chronic thromboembolic pulmonary hypertension.Semin Respir Crit Care Med. 2009; 30: 471-483
- Why acute pulmonary embolism becomes chronic thromboembolic pulmonary hypertension: clinical and genetic insights.Curr. Opin. Pulm. Med. 2013; 19: 422-429
- Risk factors and basic mechanisms of chronic thromboembolic pulmonary hypertension: a current understanding.Eur. Respir. J. 2013; 41: 462-468
- High prevalence of elevated clotting factor VIII in chronic thromboembolic pulmonary hypertension.Thromb. Haemost. 2003; 90: 372-376
- Lupus anticoagulant, heparin use, and thrombocytopenia in patients with chronic thromboembolic pulmonary hypertension: a preliminary report.Am. J. Med. 1995; 99: 392-396
- Pulmonary microvascular disease in chronic thromboembolic pulmonary hypertension.Proc. Am. Thorac. Soc. 2006; 3: 571-576
- Chronic pulmonary thromboembolism in dogs treated with tranexamic acid.Circulation. 1991; 83: 1371-1379
- Endogenous fibrinolytic system in chronic large-vessel thromboembolic pulmonary hypertension.Circulation. 1992; 86: 1241-1248
- Fibrin derived from patients with chronic thromboembolic pulmonary hypertension is resistant to lysis.Am. J. Respir. Crit. Care Med. 2006; 173: 1270-1275
- Heparin-binding domain of fibrin mediates its binding to endothelial cells.Arterioscler. Thromb. Vasc. Biol. 1996; 16: 1544-1551
- Angiogenic activity of fibrin degradation products is located in fibrin fragment E.J. Pathol. 1992; 168: 47-53
- Endothelial cell spreading on fibrin requires fibrinopeptide B cleavage and amino acid residues 15–42 of the beta chain.J. Clin. Invest. 1992; 89: 842-850
- High prevalence of dysfibrinogenemia among patients with chronic thromboembolic pulmonary hypertension.Blood. 2009; 114: 1929-1936
- Fibrinogen bellingham: a gamma-chain R275C substitution and a beta-promoter polymorphism in a thrombotic member of an asymptomatic family.Am. J. Hematol. 2000; 64: 242-250
- Chronic thromboembolic pulmonary hypertension-associated dysfibrinogenemias exhibit disorganized fibrin structure.Thromb. Res. 2013; 132: 729-734
- Southern Association for Vascular Surgery William J. von Leibig award. Inflammation and intimal hyperplasia associated with experimental pulmonary embolism.J. Vasc. Surg. 2002; 36: 581-588
- Vascular endothelial growth factor naked DNA gene transfer enhances thrombus recanalization and resolution.J. Vasc. Surg. 2005; 42: 1183-1189
- The role of neovascularisation in the resolution of venous thrombus.Thromb. Haemost. 2005; 93: 801-809
- Increased platelet, leukocyte and endothelial microparticles predict enhanced coagulation and vascular inflammation in pulmonary hypertension.J. Thromb. Thrombolysis. 2011; 31: 173-179
- Persistent global hypercoagulability in long-term survivors of acute pulmonary embolism.Blood Coagul. Fibrinolysis. 2015; 26: 537-544
- Platelets are highly activated in patients of chronic thromboembolic pulmonary hypertension.Arterioscler. Thromb. Vasc. Biol. 2014; 34: 2486-2494
- Right ventricular heart failure from pulmonary embolism: key distinctions from chronic pulmonary hypertension.J. Card. Fail. 2010; 16: 250-259
- Pulmonary embolism causes endomyocarditis in the human heart.Heart. 2008; 94: 450-456
- Right ventricular damage due to pulmonary embolism: examination of the number of infiltrating macrophages.Forensic Sci. Int. 2003; 134: 147-153
- Two cases of right ventricular ischemic injury due to massive pulmonary embolism.Forensic Sci. Int. 2001; 116: 189-195
- Inhibition of prostaglandin synthesis during polystyrene microsphere-induced pulmonary embolism in the rat.Am. J. Phys. Lung Cell. Mol. Phys. 2003; 284: L1072-L1081
- Role of inflammation in right ventricular damage and repair following experimental pulmonary embolism in rats.Int. J. Exp. Pathol. 2008; 89: 389-399
- Inhibition of CINC-1 decreases right ventricular damage caused by experimental pulmonary embolism in rats.J. Immunol. 2007; 179: 7820-7826
- Transcriptional profile of right ventricular tissue during acute pulmonary embolism in rats.Physiol. Genomics. 2008; 34: 101-111
- Proinflammatory events in right ventricular damage during pulmonary embolism: effects of treatment with ketorolac in rats.J. Cardiovasc. Pharmacol. 2009; 54: 246-252
- Long-term benefit of thrombolytic therapy in patients with pulmonary embolism.Vasc. Med. 2000; 5: 91-95
- Alveolar dead space as a predictor of severity of pulmonary embolism.Acad. Emerg. Med. 2000; 7: 611-617
- Quality of life in long-term survivors of acute pulmonary embolism.Chest. 2010; 138: 1432-1440
- Quality of life after pulmonary embolism as assessed with SF-36 and PEmb-QoL.Thromb. Res. 2013; 132: 500-505
- Estimating quality of life in acute venous thrombosis.JAMA Intern. Med. 2013; 173: 1067-1072
- Health-related quality of life after pulmonary embolism: a cross-sectional study.BMJ Open. 2016; 6e013086
- Quality of life after pulmonary embolism: validation of the PEmb-QoL questionnaire.J. Thromb. Haemost. 2010; 8: 523-532
- What is the effect of venous thromboembolism and related complications on patient reported health-related quality of life? A meta-analysis.Thromb. Haemost. 2016; 116: 417-431
- Association of fatigue and psychological distress with quality of life in patients with a previous venous thromboembolic event.Thromb. Haemost. 2009; 102: 1219-1226
- Health-related quality of life in a national cohort of patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension.Arch. Bronconeumol. 2013; 49: 181-188
- Effects of surgical and medical treatment on quality of life for patients with chronic thromboembolic pulmonary hypertension.Circ. J. 2015; 79: 2696-2702
- Contribution of fibrinolysis to the physical component summary of the SF-36 after acute submassive pulmonary embolism.J. Thromb. Thrombolysis. 2015; 40: 161-166
- Long-term outcome of patients with chronic thromboembolic pulmonary hypertension: results from an international prospective registry.Circulation. 2016; 133: 859-871
- To screen or not to screen for chronic thromboembolic pulmonary hypertension after acute pulmonary embolism.Thromb. Res. 2017; 151: 1-7
- Management and outcomes in chronic thromboembolic pulmonary hypertension: from expert centers to a nationwide perspective.Int. J. Cardiol. 2016; 203: 938-944
- Feasibility and safety of rehabilitation after venous thromboembolism.Vasc. Health Risk Manag. 2015; 11: 397-401
- The safety and efficacy of early-initiation exercise training after acute venous thromboembolism: a randomized clinical trial.J. Thromb. Haemost. 2015; 13: 1238-1244
- Exercise training improves exercise capacity and quality of life in patients with inoperable or residual chronic thromboembolic pulmonary hypertension.PLoS One. 2012; 7e41603
- Home-based pulmonary rehabilitation in patients with inoperable or residual chronic thromboembolic pulmonary hypertension: a preliminary study.Respir. Investig. 2014; 52: 357-364
- Efficacy of cardiac rehabilitation after balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension.Heart. 2016; 102: 1403-1409
- Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association.Circulation. 2011; 123: 1788-1830
- Outcome of pulmonary endarterectomy in symptomatic chronic thromboembolic disease.Eur. Respir. J. 2014; 44: 1635-1645
- Riociguat for the treatment of chronic thromboembolic pulmonary hypertension.N. Engl. J. Med. 2013; 369: 319-329
- Multiple beneficial effects of balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension.Circ. J. 2016; 80: 980-988
- Effect of thrombolytic therapy on pulmonary-capillary blood volume in patients with pulmonary embolism.N. Engl. J. Med. 1980; 303: 842-845
- Moderate pulmonary embolism treated with thrombolysis (from the “MOPETT” trial).Am. J. Cardiol. 2013; 111: 273-277
- Six-month echocardiographic study in patients with submassive pulmonary embolism and right ventricle dysfunction: comparison of thrombolysis with heparin.Am J Med Sci. 2011; 341: 33-39
- Treatment of submassive pulmonary embolism with tenecteplase or placebo: cardiopulmonary outcomes at 3 months: multicenter double-blind, placebo-controlled randomized trial.J. Thromb. Haemost. 2014; 12: 459-468
- Fibrinolysis for patients with intermediate-risk pulmonary embolism.N. Engl. J. Med. 2014; 370: 1402-1411
- Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism.Circulation. 2014; 129: 479-486
- Pulmonary embolism response to fragmentation, embolectomy, and catheter thrombolysis (PERFECT): initial results from a prospective multicenter registry.Chest. 2015; 148: 667-673
- A prospective, single-arm, multicenter trial of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis for acute massive and Submassive pulmonary embolism: the SEATTLE II study.J. Am. Coll. Cardiol. Intv. 2015; 8: 1382-1392
- Four key questions surrounding thrombolytic therapy for submassive pulmonary embolism.Vasc. Med. 2016; 21: 47-52
- Research priorities in submassive pulmonary embolism: proceedings from a multidisciplinary research consensus panel.J. Vasc. Interv. Radiol. 2016; 27: 787-794
ClinicalTrials.gov: NCT01939301.
Article info
Publication history
Published online: June 16, 2017
Accepted:
June 12,
2017
Received in revised form:
June 5,
2017
Received:
March 27,
2017
Identification
Copyright
© 2017 Elsevier Ltd. All rights reserved.