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Research | DOI: https://doi.org/10.31579/2690-1919/563
1East Tennessee State University, Department of Internal Medicine.
2East Tennessee State University, Division of Cardiology, Department of Internal Medicine.
*Corresponding Author: Ashley Sundin., East Tennessee State University, Department of Internal Medicine.
Citation: Ashley Sundin, Dilpat Kumar, Manar Jbara, (2025), Pulmonary Embolism as A Cardiovascular Emergency: Optimizing Early Diagnosis and Management in The Emergency Department, J Clinical Research and Reports, 21(3); DOI:10.31579/2690-1919/563
Copyright: © 2025, Ashley Sundin. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 03 October 2025 | Accepted: 15 October 2025 | Published: 21 October 2025
Keywords: pulmonary embolism; risk stratification; catheter-directed thrombolysis; mechanical thrombectomy; systemic thrombolysis; ultrasound-assisted thrombolysis
Background/Objectives:
Pulmonary embolism (PE) is the third leading cause of cardiovascular mortality and presents significant diagnostic and therapeutic challenges in the emergency department. Utilizing appropriate and accurate screening and risk stratification tools optimizes clinical decision making and patient outcomes. This review seeks to discuss current evidence on the diagnosis, risk stratification, and evolving management strategies for pulmonary embolism, with a focus on advanced therapeutic intervention and its implications for emergency practice.
Methods: We reviewed current literature regarding the epidemiology, diagnosis, risk stratification, and management of PE, with a focus on clinical decision tools and advanced therapeutic interventions. Specific attention was given to diagnostic algorithms, and guidelines regarding risk stratification methods as well as treatment options including catheter-directed thrombolysis (CDT), mechanical thrombectomy, systemic thrombolysis, and ultrasound-assisted thrombolysis (USAT). The literature search was performed using the database PubMed with keywords to include “pulmonary embolism,” “catheter-directed thrombolysis,”, “ultrasound-assisted thrombolysis,” “mechanical thrombectomy,” “systemic thrombolysis,” and “clinical decision support.”. Inclusion criteria included peer-reviewed articles, randomized controlled trials, observational studies, and major guidelines focused on adult patients with acute PE. Exclusion criteria included non-English language publications, case reports, and studies involving pediatric populations. This approach was designed to ensure a thorough and reproducible synthesis of current evidence.
Results: Accurate utilization of risk stratification tools has been shown to improve patient-specific treatment and provide a better insight into patient outcomes. Interventional therapies such as CDT and USAT have demonstrated reduced mortality and morbidity in high- and intermediate-risk PE patients when compared to systemic anticoagulation alone. There is also future discussion on how to improve risk stratification to continue to reduce patient mortality and morbidity, as well as reduce the risk of sequelae and side effects.
Conclusion: This review article highlights the evolving landscape of PE diagnosis and management driven by advances in risk-stratification tools and interventional therapies. By discussing current evidence, we underscore the importance of accurate risk stratification and the judicious use of different treatment modalities. We also discuss ongoing research focused on refining treatment algorithms, improving the accuracy of clinical decision-making, comparing new and more mature treatment therapies, and preventing long-term complications. The ultimate goal of this review article to provide further discussion on PE to improve patient outcomes.
Pulmonary embolism (PE) is a common and potentially life-threatening cardiovascular emergency, ranking as the third leading cause of cardiovascular mortality worldwide [1]. It is frequently encountered in the Emergency Department (ED), where timely recognition and management are critical. PE typically arises when a part of a thrombus from a deep vein in the lower extremities enters the pulmonary circulation and obstructs the pulmonary arteries. Less commonly, PE may occur from embolizing other materials, such as air, fat, or tumor cells [2]. Risk factors for PE are numerous and well-established. They include a history of venous thromboembolism (VTE), recent prolonged immobilization such as hospitalization, obesity, the use of oral contraception, postpartum period, lower extremity surgery, malignancy, and thrombophilias [3]. Despite known risk factors, the clinical presentation of PE is notoriously variable and nonspecific, ranging from mild dyspnea to catastrophic hemodynamic collapse [4]. This wide variation in presentation leads to diagnostic uncertainty, causing PE to be both undiagnosed and over investigated. This unresolved challenge of underdiagnosis can lead to potentially fatal consequences, while over investigation can give rise to unnecessary imaging, increased healthcare costs, and additional burden on an already overextended ED [5]. Despite its high clinical burden, therapeutic advances for PE have previously lagged compared to other cardiovascular emergencies, such as myocardial infarction (MI) and stroke, the first and second leading causes of cardiovascular death, respectively. Historically, treatment has been limited to anticoagulation alone for more hemodynamically stable patients or systemic thrombolytic therapy for life-threatening PE. This has left a critical gap in the availability of effective, targeted, and safer therapies for patients who fall between these extremes of severity. However, in recent years, there has been a surge of renewed interest in developing safer and more effective interventions, such as ultrasound-assisted catheter-directed thrombolysis (USCDT) and mechanical thrombectomy, with the goal of improving outcomes while minimizing complications in these intermediate-risk patients [6]. This review addresses this therapeutic gap by examining the expanding role of interventional therapies for acute PE management in the ED. We will evaluate both traditional and emerging therapies, highlight the potential of emerging therapies to bridge the current treatment void, and explore how these newer treatment options may be incorporated into contemporary cardiovascular emergency care. Additionally, we will explore future directions and implementation strategies for optimizing PE management across varying risk stratifications.
0.16% of all emergency department visits, with the incidence rising every year [7][8]. With PE having an increased burden of morbidity and mortality worldwide, early identification of the severity of PE on initial presentation is vital to therapy-directed treatment options. There have been several evidence-based clinical decision support systems (CDSS) that have been developed to assist in the determination of PE, including the Wells Criteria, Revised Geneva Score, and the Pulmonary Embolism Rule-Out Criteria (PERC) [9]. The Wells score remains one of the most widely used tools, stratifying patients into low, intermediate, or high probability categories based on clinical criteria. When combined with D-dimer testing, the Wells score can safely rule out PE in many patients without requiring imaging [10]. However, the subjectivity and interobserver variability associated with the clinician’s assessment of whether a PE is the most likely diagnosis limit the Wells score and should be accounted for when utilizing this CDSS. Similarly, the revised Geneva score is another scoring system in assisting with the pretest probability of PE, similar to the Wells score, however, relying purely on objective clinical variables [11]. In low-risk patients, pre-test probability (≤15%), the Pulmonary Embolism Rule-Out Criteria (PERC) can be employed to safely discharge patients without further testing if all criteria are negative [12][13]. As with the Wells score, the PERC rule does incorporate physicians’ pre-test probability, which may lead to reduced specificity of these CDSS in patients with multiple comorbidities, leading to diagnostic uncertainty and potential overuse of imaging in certain populations. More recently, the YEARS algorithm has been introduced, which reduces unnecessary imaging by adjusting D-dimer thresholds based on clinical suspicion and has been shown to reduce imaging in special populations such as pregnant patients, where minimizing radiation exposure is critical[14]. There have been studies to show that the YEARs criteria have also shown superior efficacy in safely reducing imaging utilization and maintaining diagnostic accuracy compared to the previous Wells criteria [15]. In parallel with clinical scoring tools, imaging plays a central role in confirming or excluding PE. Computed tomography pulmonary angiography (CTPA) is the preferred first-line imaging modality due to its high sensitivity and specificity, as well as its ability to provide additional information about possible right ventricular dysfunction. In patients with renal insufficiency, contrast allergies, or other contraindications to CTPA, ventilation-perfusion (V/Q) scintigraphy offers a viable alternative. Although less specific than CTPA, a normal V/Q scan has a high negative predictive value and is particularly useful in patients who are pregnant or have chronic pulmonary disease. Additionally, chest graph can provide a valuable initial imaging tool, particularly in patients with nonspecific symptoms. It can assist in excluding alternative causes of dyspnea or chest pain, such as pneumonia and pneumothorax. It also may identify classic but rare signs of PE such as Hampton’s hump or Westermark’s sign. A D-dimer is a blood test that specifically measures the fibrin degradation products that are released when a blood clot is broken down in the body. It is typically used in patients with low pre-test probability, where a negative result can reliably exclude pulmonary embolism without the need for imaging. Patients in a high-risk category or who have a high clinical suspicion for PE should receive imaging instead of the D-dimer test because D-dimer testing cannot confirm an active clot and can be elevated in a myriad of other conditions. Additionally, patients who are elderly, have malignancy, liver disease, are pregnant, have a chronic inflammatory state, or have been hospitalized for a significant amount of time will have baseline elevations in their D-dimer levels. These limitations should be taken into account when considering ordering D-dimers in the aforementioned patient population and are the limitations of this blood test. In moderate-risk patients, one can either obtain a D-dimer (a negative D-dimer would rule out PE) or go straight to imaging if clinical suspicion remains high [16]. Gold standard use of the D-dimer test should be used in conjunction with CDSS, as described above, such as the YEARs criteria to best identify possible PE.
Once PE is suspected or identified, immediate risk stratification to guide treatment by identifying patients most likely to experience adverse outcomes. The most widely adopted classification systems for determining the severity of pulmonary embolism (PE) are those established by the American Heart Association (AHA) and the European Society of Cardiology (ESC) [17] [18]. These two systems, which share many similarities, categorize PE severity into three primary levels: massive, submassive, and nonmassvive, determined by the AHA, and high-risk, intermediate-risk, and low-risk PE defined by the ESC (Table 1).
These categories are determined based on hemodynamic effects and the short-term prognosis of the patient. Management strategies are then decided upon, tailored to the severity of PE based on risk and benefits to best decrease mortality and morbidity in patients presenting with PE. The first category is termed massive (high-risk) PE as defined by the AHA/ESC, respectively. Massive (high-risk) PE has traditionally been defined by the basis of angiographic burden of the emboli by use of the Miller index, however, most recent registry data now support the presence of circulatory arrest or hypotension as defining criteria in the diagnosis of massive (high-risk) PE [18][19]. Further definition of hypotension can be described as a systolic blood pressure <90>40 mm Hg for at least 15 minutes, or need for vasopressor support, which identifies these patients [20]. These patients have approximately 650-day mortality [21]. The next category is submissive (intermediate risk), which the AHA defines as a normotensive patient with evidence of right ventricular (RV) strain or myocardial ischemia (MI). The ECS has a broader definition that also incorporates the use of the simplified Pulmonary Embolism Severity Index (sPESI) for PE-related 30-day mortality. Patients with a sPESI score of 1 or greater are then subdivided into two subgroups according to whether the patients have both RV dysfunction and RV injury (intermediate risk-high) or only one of neither of these findings (intermediate risk-low) [22]. RV strain does encompass RV dysfunction as evidenced on transthoracic echocardiography (TTE), RV dilation (RV/LV ratio .0.9) via contrast topography (CT) or TTE, and RV pressure overload and injury secondary to elevated biomarkers such as biomarkers such as troponin and brain natriuretic peptide (BNP) [18-,21]. Clot burden viewed on CT scan does not predict overall mortality in patients with submassive (intermediate risk) PE [22]. MI is often assessed by an electrocardiogram (ECG). This group of patients accounts for approximately 35-55% of hospitalized patients [18]. Nonmassive (low-risk) PE is defined as patients with PE who do not meet the criteria for massive (high-risk) or submassive (intermediate-risk) PE. This group of patients accounts for approximately 40-60% of hospitalized patients with PE and has an average mortality of approximately 1% in one month [23]. Though there are limitations to risk stratification, such as PE severity varying over time with unique patient presentations and histories, it is a useful tool that has been validated by multiple studies [18] [19]. Additionally, risk stratification allows providers to decrease overall mortality and morbidity of PE in patients while also reducing the risk associated with different therapy modalities.
Historically, PE has mainly been treated with anticoagulation (AC), mainly Heparin, especially in more hemodynamically stable patients; however, there have been several novel treatment modalities created in recent years. These new treatment modalities have aimed at reducing the
duration of anticoagulation needed and improving outcomes from the sequelae of high-risk and intermediate-risk PE. Current guidelines still recommend therapeutic anticoagulation with subcutaneous low molecular weight heparin (LMWH), intravenous or subcutaneous unfractionated heparin (UFH), weight-based subcutaneous UFG, or subcutaneous fondaparinux should be administered to patients with confirmed PE and no contraindications to AC [1]. Additionally, therapeutic anticoagulation should be given to patients during the diagnostic work-up with intermediate or high clinical probability of PE with no contraindications to AC [1]. Management strategies have evolved to include a range of advanced interventional therapies such as systemic thrombolysis, catheter-directed thrombolysis (CDT), mechanical thrombectomy, and ultrasound-assisted thrombolysis (e.g., EKOS)[24]. Patients with massive or submassive PE who have hemodynamic compromise and/or have cardiogenic shock may also benefit from additional techniques such as invasive hemodynamic support devices, such as extracorporeal membrane oxygenation (ECMO) or isolated percutaneous RV support in conjunction with treatment modalities [25-27]. CDT technique involves delivering thrombolytic agents directly to the clot through a multi-side hole infusion catheter, typically reserved for cases of massive or submassive PE where systemic thrombolysis may lead to increased risk of major and intracranial bleeding. By localizing the thrombolytic action, CDT offers an advantage in terms of reducing the systemic bleeding risk. CDT has reported a significantly lower total dose of thrombolytic agents by approximately 25% of what is usually given systemically [28]. Ultrasound-Assisted Thrombolysis (USAT) with the EKOSonic endovascular system (EKOS Corp, Bothell, WA) combines the use of low-frequency ultrasound waves with thrombolytic agents, which enhances the ability of the clot-dissolving drugs to penetrate the thrombus [29]. The EKOS catheter has two lumens, with one lumen holding a filament with multiple ultrasound transducers that emit high-frequency, low-energy ultrasound. The second lumen releases local thrombolytic delivery through multiple ports along the length. The low-energy ultrasound breaks down fibrin strands, leading to a more effective thrombolysis at lower doses. The primary proposed advantage of EKOS over CDT is its potential for more effective penetration of the thrombolytic agent over a shorter duration of time [30]. Though this benefit remains theoretical, as it has not yet been confirmed by a randomized controlled trial (RCT) [31]. Ultrasound-assisted thrombolysis can be used for patients with intermediate-risk PE, offering a less invasive alternative to mechanical thrombectomy or systemic thrombolysis. Both USAT and CDT are more recent additions in the therapeutic toolbox that physicians can use in the treatment of patients with submassive (intermediate-risk) PE. While both modalities aim to deliver targeted thrombolytic therapy for pulmonary embolism, they differ in the mechanism of action, treatment duration, and thrombolytic dosing (Table 2).
Mechanical thrombectomy or embolectomy is becoming increasingly recognized as a viable option for patients with massive (high-risk) and submassive (intermediate-risk) PE especially when rapid clot removal is needed and thrombolytics are contraindicated. There are several different types of catheters and techniques used; however, the general idea is that mechanical thrombectomy physically removes the embolus using specialized devices, improving both right ventricular function and overall hemodynamic stability [32]. Usually, a pre-procedural CT scan is ordered, which assists in guiding the catheter. This treatment is often used in combination with other therapies, such as CDT, in severe cases [18]. Devices such as FlowTriever and Indigo have been the topic of recent studies, which showed increased safety and hemodynamic improvements. Notably, the FLARE trial evaluated the FlowTriever device in patients with submassive (intermediate-risk) PE and showed significant improvements in patients’ RV/LV ratio and low major bleeding rates [33]. More recently, the PEERLESS trial, a RCT, compared mechanical thrombectomy to CDT in intermediate-high risk PE and found comparable improvement in RV function with a trend towards fewer bleeding complications in the thrombectomy group [34]. These studies have shown support in mechanical thrombectomy as a viable alternative to systemic anticoagulation and CDT however, long-term outcomes and broader clinical adoption will require further validation. Systemic Thrombolysis therapy remains a cornerstone for massive (high-risk) PE management, particularly in cases with hemodynamic compromise. These medications actively promote clot degradation and reduce right heart strain [35]. While this approach has a proven benefit in reducing mortality and improving clinical outcomes, it carries a significant risk of bleeding, particularly in patients with contraindications, such as active bleeding or recent surgery [36]. However, systemic thrombolysis has failed to show a mortality benefit in patients with submassive (intermediate-risk) PE, as shown in the PEITHO trial, which revealed an increased risk of major bleeding in this treatment arm [37]. These findings highlight the importance of accurate PE classification to determine appropriate management and interventional therapy. Patients with massive PE (high-risk) with significant right ventricular strain and hemodynamic compromise may benefit from a more invasive procedure, such as ECMO in conjunction with other treatment modalities. These patients are at a significantly higher risk for cardiac arrest, and some observational studies have shown benefit in starting ECMO as a bridging therapy in these patients [38]. However, with ECMO being an advanced interventional therapy, it may not be universally accessible due to cost constraints, specialized equipment requirements, and limited availability in non-tertiary centers [39]. Ultimately, treatment decisions should involve a multidisciplinary approach, with patient history and objective information contributing to the overall decision for treatment of PE. By focusing on individualized care, physicians can minimize complications while improving the chances of recovery and reducing mortality in patients with pulmonary embolism.
Pulmonary embolism management has evolved significantly, with a strong emphasis on early diagnosis, risk stratification, and individualized treatment approaches. The variety of treatment modalities, including systemic thrombolysis, CDT, mechanical thrombectomy, and USAT, has allowed for more tailored care aimed at improving outcomes, minimizing complications, and preventing long-term sequelae like chronic thromboembolic pulmonary hypertension (CTEPH) or recurrent PE from deep venous thromboembolism (DVT). Preventing CTEPH remains a critical goal in post-PE care. Current strategies include the early initiation and appropriate duration of anticoagulation, often with direct oral anticoagulants (DOACs) as well as close follow-up. Additionally, TTE and ventilation-perfusion (V/Q) scans can be used post-PE to monitor for persistent pulmonary hypertension or unresolved thromboembolic burden. However, there still remains evidence gaps in duration of surveillance intervals, duration of follow-up imaging, and long-term anticoagulation strategies in patients at higher risk for CTEPH. High-risk patients may benefit from prompt, aggressive interventions such as systemic thrombolysis or mechanical thrombectomy, which can dramatically reduce mortality by rapidly reversing hemodynamic compromise compared to just AC if implemented early [36]. However, the bleeding risks associated with systemic thrombolysis, especially intracranial hemorrhage, necessitate careful patient selection. Intermediate-risk patients, the goal is often to avert hemodynamic collapse and death resulting from progressive right-sided heart failure. This group can benefit from catheter-directed therapies, including USAT, which deliver lower doses of thrombolytics directly to the clot. This approach improves right ventricular function and reduces clot burden with fewer bleeding complications compared to systemic thrombolysis. Non-massive PE patients typically achieve excellent outcomes with anticoagulation alone, and many can even be safely managed as outpatients [38]. This patient-centered approach minimizes hospitalization, reduces costs, and maintains high safety profiles. Another goal of modern PE management is the prevention of CTEPH, a debilitating long-term complication of unresolved PE characterized by persistent pulmonary artery obstruction and pulmonary hypertension, prevention of recurrent PE, and reintroduction of exercise. Early and effective clot resolution is key to minimizing these risks. Permanent or temporary Inferior Vena Cava (IVC) filters are also a treatment modality utilized in recent years for the prevention of recurrent PE in patients with known DVT where systemic AC is contraindicated [41-43]. Furthermore, the CDSS such as the PERC rule, Wells score, and the YEARS algorithm assist in identifying patients who can avoid unnecessary imaging or treatment, thus sparing them from potential procedural risks and radiation exposure. The precision in risk stratification, ensuring the right therapy is used for the right patient at the right time, enhances survival and significantly reduces the occurrence of treatment-related complications.
One major future direction is the continued refinement of risk stratification models. Artificial intelligence (AI) and machine learning algorithms are beginning to play a role in predicting PE risk, which could include a more accurate risk stratification system, determining severity, and guiding diagnostic and therapeutic decisions. Future studies are needed to identify where risk stratification can be improved upon and how to better categorize treatment plans for patients to reduce mortality and morbidity [44]. Additionally, current and future studies such as the HI-PEITHO trial, a large multicenter RCT, aims to address the gap in treatment options for submassive (intermediate-risk) patients by comparing USAT plus anticoagulation to anticoagulation alone. The findings of this study will be pivotal in determining treatment options for these patients and also on the therapeutic advantages that USAT may or may not provide [45].As data continue to support the safety and effectiveness of catheter-directed thrombolysis and mechanical thrombectomy, these modalities are expected to become the standard of care for intermediate-risk PE. Future devices may offer even more precise clot targeting, improved ease of use, and further reduced doses of thrombolytic agents. Combination strategies, such as low-dose systemic thrombolysis followed by catheter-based clot disruption, are being explored to optimize outcomes while preserving safety. Additional studies are also needed to determine the benefit of USAT and CDT in patients with high-risk or intermediate-risk PE to create a unified guideline and reduce the risk of sequelae or side effects of therapeutic modalities.
patients who present to the ED. To reduce the risk of mortality and optimize patient outcomes, PE requires prompt diagnosis, accurate risk stratification, and tailored therapeutic strategies. PE has a wide variety of presentations, ranging from sudden cardiac death to asymptomatic, making it a difficult diagnosis to determine with just clinical gestalt. Clinical decision tools such as the Wells score, revised Geneva score, PERC, and the YEARS algorithm have become regular practice in improving diagnostic efficiency while minimizing unnecessary testing. Risk stratification not only guides immediate management but also determines long-term prognosis. This allows physicians to select appropriate therapies, from AC to advanced interventions like CDT, mechanical thrombectomy, and USAT. For clinicians, a practical takeaway is the importance of integrating validated clinical decision tools with imaging and biomarker data to tailor diagnostic and therapeutic strategies to better treat patients presenting with a possible PE. Current guidelines still recommend treating patients with confirmed PE with systemic thrombolytics unless there is otherwise a contraindication for AC. Mechanical thrombectomy may be considered in patients with contraindications to thrombolysis, while CDT/USAT may have more benefit in patients with right ventricular dysfunction and evidence of myocardial injury. Clinicians should have a discussion with hospital leadership to determine what treatment options are available at their facility and whether there are appropriate resources, expertise, and protocols in place to safely implement them. Advancements in treatment modalities have significantly improved survival and reduced morbidity, especially through individualized care approaches that balance efficacy with the minimization of bleeding risks. Modern management strategies have also placed a new emphasis on the prevention of CTEPH, recurrent PE, and earlier initiation of exercise therapy. Looking forward, the future of PE management lies in further studies exploring more accurate risk stratification and in the expanding role of CDT, USAT, and developing safer pharmacologic agents. By continuing to evolve in response to emerging technologies and research, emergency medicine physicians and interventional cardiologists will be increasingly equipped to provide the right care for the right patient at the right time, ultimately reducing mortality and improving quality of life for patients with pulmonary embolism.
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Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
