Contemporary management of pulmonary embolism: the answers to ten questions

Journal of Internal Medicine
H Bounameaux

Abstract

Pulmonary embolism (PE) cannot be diagnosed solely on a clinical basis, because of the lack of sensitivity and specificity of clinical signs and symptoms. Pulmonary angiography is invasive and resource demanding. Because the prevalence of PE is relatively low (20% or less) amongst individuals who are clinically suspected of having the disease, submitting all of them to imaging (multi-detector CT angiography or ventilation/perfusion lung scintigraphy) would not be cost-effective. Therefore, diagnostic algorithms have been developed that include clinical probability assessment and D-dimer measurement to select the patients who require noninvasive imaging. Once the diagnosis is suspected or confirmed, therapy must be started to avoid potentially fatal recurrence. Treatment starts for an initial 3-month period with a 5-day course of parenteral unfractionated or low-molecular-weight heparin or fondaparinux overlapping with and followed by oral vitamin K antagonists monitored to maintain an international normalized ratio of 2-3. This initial period of 3 months may then be followed by a long-term secondary prevention period in patients who experience an idiopathic thromboembolic event and are at low risk of bleeding. New oral anticoag...Continue Reading

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Citations

Feb 8, 2013·BMC Pulmonary Medicine·Subani ChandraRubin I Cohen
Feb 10, 2012·International Journal of General Medicine·Nitin ChopraPratap C Kumar
Sep 26, 2013·AJR. American Journal of Roentgenology·Lawrence R Goodman
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Jul 12, 2011·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Khalil ZarrabiAzimeh Azimifar

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