More than 800,000 patients each year in the United States have pulmonary embolisms, and multiple specialties deal with them. A variety of clinical scenarios fuel an ongoing debate about how to manage these patients because pulmonary embolisms occur in so many different situations.

Thoracic specialists will move that debate to ATS 2017 when they examine the use of IVC (inferior vena cava) filters and the role of thrombolytics for managing intermediate risk pulmonary embolisms. The session also will include a lecture on evaluating and managing pulmonary embolisms in the emergency room and a panel discussion on management of difficult cases.

“There is evolving literature in the area of pulmonary embolism and continued debate on how to approach this common and potentially fatal disease. I think the pro-con approach of this session is an excellent way to get these points across,” says Todd Bull, MD, one of the session moderators. “You will have the opportunity to hear experts in this area discuss their approaches or the reasons they think this is the appropriate response to these various, somewhat controversial topics. It then falls on the audience to decide if this fits in best with their practice pattern.”

The goal of the session is to increase the understanding of evidence for management of pulmonary embolisms and focus the debate on how to manage clinical scenarios that frequently occur in hospital settings, says Dr. Bull, professor of medicine and director of the pulmonary vascular disease program at the University of Colorado Denver.

Two pro-con debates on the use of IVC filters and thrombolytics are expected to examine data from the recent PREPIC 2 (Prevention of Recurrent Pulmonary Embolism by Vena Cava Interruption 2) study, the PEITHO (Pulmonary Embolism Thrombolysis) study, and its recently published, long-term follow-up study.

“PREPIC 2 examines the efficacy of retrievable IVC filters. Do they prevent pulmonary embolisms?” Dr. Bull asks. “In terms of thrombolytic therapy, this is an area where we go back and forth in the discussion around catheter-based thrombolytics as well as systemic and reduced-dose thrombolytics.

“While there is evolving evidence, there remain a number of unclear areas, and that is what we are trying to focus on.”

The session’s one didactic presentation will present an evidence-based approach to evaluation of pulmonary embolisms in the emergency room. The symposium will conclude with a panel discussing difficult cases.

“This is a highly relevant clinical area that you have to have a good feel for in your approach because sometimes the decisions have to be made quickly,” Dr. Bull says. “It is important to understand where the literature resides. The thing that comes up in this situation is trying to take this literature base and applying it directly to the patient. We all know as practitioners that there frequently is a twist in the management of the individual patient.

“We hope that once you see both sides of this discussion, then you can figure out where your particular patient or your particular clinical issue is best served by the literature that is there.”

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