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Meet the Faculty
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Geoffrey Barnes, MD, MSc is a cardiologist and vascular medicine specialist at the University of Michigan. His clinical and research expertise centers on improving safe use of anticoagulation therapy for patients with atrial fibrillation, venous thromboembolism, and other thrombotic conditions.
Geoffrey Barnes
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Acute pulmonary embolism (PE) occurs when a thrombus occludes blood flow in one or more pulmonary arteries
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Risk Stratification Tool and Initial Treatment
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Complications occur from acute PE.
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PESI and SPESI scores indicate:
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PE Treatment
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No clear risk factor for VTE > secondary prevention recommended Two options • Continue treatment dose of anticoagulation (especially for warfarin, edoxaban, dabigatran) • Reduce dose (apixaban 2.5mg twice a day or rivaroxaban 10mg daily)
After 24-48 hours, if stable, transition to oral anticoagulant • DOAC preferred if possible • Apixaban 10mg twice a day (7 days total) or Rivaroxaban 15mg twice a day (21 days total) • Continue parenteral LMWH if needed • 5-10 day course
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Summary
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How to Use
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Learning Objectives
Thrombus  embolizes through the inferior vena cava and right side of the heart before lodging in the pulmonary arteries
F
Apply risk stratification tools for patients with acute pulmonary embolism
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Select appropriate initial anticoagulants for patients with acute venous thromboembolism
Determine which patients benefit from secondary prevention anticoagulation for venous thromboembolism
PE Complications
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PE usually starts as a deep vein thrombus in the lower extremities.
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Risk Stratification Tool The Risk Stratification Tool is provided to help you assess which of your patients will experience poor short-term outcomes (7-30 days) after PE. Based on this assessment, the tool will present initial recommended treatment options.  The tool incorporates the: - PE Severity Index (PESI)  - Simplified PESI (sPESI) - European Society for Cardiology (ESC) guidelines A short guide on how to use this tool will follow.
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Patient Case
ABC
Case Presentation
Assess Patient's Risk
Treatment Progression
Continue DOAC and standard treatment dose • Apixaban 5mg twice a day or Rivaroxaban 20mg daily Switch from parenteral heparin to oral agent • Dabigatran 150mg twice a day, Edoxaban 60mg daily, warfarin (INR goal 2-3)
When considering long term anticoagulation (secondary prevention), many patients are eligible for lower-dose DOAC therapy
Many patients are eligible for oral only anticoagulant strategies (apixaban, rivaroxaban) to treat acute PE
Risk stratification tools (e.g., PESI and ESC) can be used to assess short-term mortality risk and determine initial treatment for patients with acute PE
Help
The embolus breaks off
Global Anticoagulation Management Course
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The embolus travels through the veins to the lung
PE Overview