Journal of Thrombosis and Thrombolysis

, Volume 46, Issue 1, pp 39–49 | Cite as

Treatment of submassive and massive pulmonary embolism: a clinical practice survey from the second annual meeting of the Pulmonary Embolism Response Team Consortium

  • Thomas M. Todoran
  • Jay Giri
  • Geoffrey D. Barnes
  • Rachel P. Rosovsky
  • Yuchiao Chang
  • Michael R. Jaff
  • Kenneth Rosenfield
  • Christopher Kabrhel
  • on behalf of the PERT Consortium


There is a paucity of robust clinical trial data to guide the treatment of acute pulmonary embolism (PE) thus the clinical guidelines rely heavily on expert opinion. Pulmonary Embolism Response Teams (PERT) have been developed to streamline the care of patients with acute PE. We conducted a survey among 100 experts in the field of PE during the second annual meeting of the PERT Consortium. Respondents were queried with respect to their demographic information, clinical practice questions and clinical vignettes. Clinical practice questions were focused questions about the risk stratification and treatment of patients with acute submassive PE, anticoagulation strategies for patients receiving thrombolysis and the use of inferior vena cava filters. Clinical vignettes were designed to assess participants’ preferred choice of treatment for a variety of commonly encountered clinical scenarios. Among physicians affiliated with a PERT, there is overall agreement with regards to the criteria used for risk classification of patients with PE and its application to patients in the provided clinical vignettes. In contrast, there is substantial variability in the treatment strategies of patients presenting with commonly encountered clinical scenarios. The results of this survey highlight the need for more clinical trial data along with accepted algorithms for treatment of acute PE. In the absence of this, PERTs can facilitate multidisciplinary discussions in order to standardize treatment and provide evidence-based therapies to patients with acute PE.


Acute pulmonary embolism Pulmonary Embolism Response Team PERT PERT Consortium 



Catheter-directed thrombolysis


Pulmonary embolism


Low molecular weight heparin


Pulmonary Embolism Response Team


Right ventricular


Unfractionated heparin


Compliance with ethical standards

Conflict of interest

There is no conflict of interest for any of the authors.

Informed consent

Consent was implied based on voluntary participation in the activity.

Supplementary material

11239_2018_1659_MOESM1_ESM.docx (79 kb)
Supplementary material 1 (DOCX 79 KB)
11239_2018_1659_MOESM2_ESM.pptx (72 kb)
Supplementary material 2 (PPTX 72 KB)


  1. 1.
    Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, Jenkins JS, Kline JA, Michaels AD, Thistlethwaite P, Vedantham S, White RJ, Zierler BK, American Heart Association Council on Cardiopulmonary CCP, Resuscitation, American Heart Association Council on Peripheral Vascular D, American Heart Association Council on Arteriosclerosis T and Vascular B (2011) 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 123:1788–1830CrossRefPubMedGoogle Scholar
  2. 2.
    Kline JA, Nordenholz KE, Courtney DM, Kabrhel C, Jones AE, Rondina MT, Diercks DB, Klinger JR, Hernandez J (2014) Treatment of submassive pulmonary embolism with tenecteplase or placebo: cardiopulmonary outcomes at 3 months: multicenter double-blind, placebo-controlled randomized trial. J Thromb Haemost 12:459–468CrossRefPubMedGoogle Scholar
  3. 3.
    Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galie N, Gibbs JS, Huisman MV, Humbert M, Kucher N, Lang I, Lankeit M, Lekakis J, Maack C, Mayer E, Meneveau N, Perrier A, Pruszczyk P, Rasmussen LH, Schindler TH, Svitil P, Vonk Noordegraaf A, Zamorano JL, Zompatori M (2014) Task Force for the D and management of acute pulmonary embolism of the European Society of C. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 35:3033–3069CrossRefPubMedGoogle Scholar
  4. 4.
    Kabrhel C, Rosovsky R, Channick R, Jaff MR, Weinberg I, Sundt T, Dudzinski DM, Rodriguez-Lopez J, Parry BA, Harshbarger S, Chang Y, Rosenfield K (2016) A multidisciplinary Pulmonary Embolism Response Team: initial 30-month experience with a novel approach to delivery of care to patients with submassive and massive pulmonary embolism. Chest 150:384–393CrossRefPubMedGoogle Scholar
  5. 5.
    Provias T, Dudzinski DM, Jaff MR, Rosenfield K, Channick R, Baker J, Weinberg I, Donaldson C, Narayan R, Rassi AN, Kabrhel C (2014) The Massachusetts general hospital Pulmonary Embolism Response Team (MGH PERT): creation of a multidisciplinary program to improve care of patients with massive and submassive pulmonary embolism. Hosp Pract 42:31–17CrossRefGoogle Scholar
  6. 6.
    Becattini C, Vedovati MC, Agnelli G (2007) Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation 116:427–433CrossRefPubMedGoogle Scholar
  7. 7.
    Klok FA, Mos IC, Huisman MV (2008) Brain-type natriuretic peptide levels in the prediction of adverse outcome in patients with pulmonary embolism: a systematic review and meta-analysis. Am J Respir Crit Care Med 178:425–430CrossRefPubMedGoogle Scholar
  8. 8.
    Sanchez O, Trinquart L, Colombet I, Durieux P, Huisman MV, Chatellier G, Meyer G (2008) Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review. Eur Heart J 29:1569–1577CrossRefPubMedGoogle Scholar
  9. 9.
    Schoepf UJ, Kucher N, Kipfmueller F, Quiroz R, Costello P, Goldhaber SZ (2004) Right ventricular enlargement on chest computed tomography: a predictor of early death in acute pulmonary embolism. Circulation 110:3276–3280CrossRefPubMedGoogle Scholar
  10. 10.
    Meyer G, Vicaut E, Danays T, Agnelli G, Becattini C, Beyer-Westendorf J, Bluhmki E, Bouvaist H, Brenner B, Couturaud F, Dellas C, Empen K, Franca A, Galiè N, Geibel A, Goldhaber SZ, Jimenez D, Kozak M, Kupatt C, Kucher N, Lang IM, Lankeit M, Meneveau N, Pacouret G, Palazzini M, Petris A, Pruszczyk P, Rugolotto M, Salvi A, Schellong S, Sebbane M, Sobkowicz B, Stefanovic BS, Thiele H, Torbicki A, Verschuren F, Konstantinides SV (2014) Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 370:1402–1411CrossRefPubMedGoogle Scholar
  11. 11.
    Konstantinides S, Geibel A, Heusel G, Heinrich F, Kasper W (2002) Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med 347:1143–1150CrossRefPubMedGoogle Scholar
  12. 12.
    Sharifi M, Bay C, Skrocki L, Rahimi F, Mehdipour M, Investigators M (2013) Moderate pulmonary embolism treated with thrombolysis (from the “MOPETT” trial). Am J Cardiol 111:273–277CrossRefPubMedGoogle Scholar
  13. 13.
    Kucher N, Boekstegers P, Müller OJ, Kupatt C, Beyer-Westendorf J, Heitzer T, Tebbe U, Horstkotte J, Müller R, Blessing E, Greif M, Lange P, Hoffmann R-T, Werth S, Barmeyer A, Härtel D, Grünwald H, Empen K, Baumgartner I (2014) Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism. Circulation 129:479–486CrossRefPubMedGoogle Scholar
  14. 14.
    Piazza G, Hohlfelder B, Jaff MR, Ouriel K, Engelhardt TC, Sterling KM, Jones NJ, Gurley JC, Bhatheja R, Kennedy RJ, Goswami N, Natarajan K, Rundback J, Sadiq IR, Liu SK, Bhalla N, Raja ML, Weinstock BS, Cynamon J, Elmasri FF, Garcia MJ, Kumar M, Ayerdi J, Soukas P, Kuo W, Liu PY, Goldhaber SZ, Investigators SI (2015) 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. JACC Cardiovasc Interv 8:1382–1392CrossRefPubMedGoogle Scholar
  15. 15.
    Weinberg I, Kaufman J, Jaff MR (2013) Inferior vena cava filters. JACC Cardiovasc Interv 6:539–547CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Thomas M. Todoran
    • 1
  • Jay Giri
    • 2
  • Geoffrey D. Barnes
    • 3
  • Rachel P. Rosovsky
    • 4
  • Yuchiao Chang
    • 5
  • Michael R. Jaff
    • 6
  • Kenneth Rosenfield
    • 6
  • Christopher Kabrhel
    • 7
  • on behalf of the PERT Consortium
  1. 1.Division of Cardiology, Sections of Interventional Cardiology and Vascular MedicineMedical University of South CarolinaCharlestonUSA
  2. 2.Penn Cardiovascular Outcomes, Quality and Evaluative Research CenterUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaUSA
  3. 3.Frankel Cardiovascular Center and Institute for Healthcare Policy and Innovation, Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborUSA
  4. 4.Division of Hematology and Oncology, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  5. 5.Division of General Internal Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  6. 6.Division of Cardiology, Section of Vascular Medicine, Department of Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  7. 7.Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonUSA

Personalised recommendations