Document Detail


Acute phase treatment of pulmonary embolism.
MedLine Citation:
PMID:  24846228     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Pulmonary embolism (PE) is a common and potentially life threatening disease if left untreated. This is due to a natural tendency towards early recurrence of pulmonary emboli which may lead to right ventricular failure. Thus, anticoagulant treatment should be administered to all patients upon high or intermediate clinical probability of acute PE, while awaiting definitive confirmation by imaging procedures. With the exception of severe renal impairment, high bleeding risk, arterial hypotension, and extremes of body weight and age, unfractionated heparin has been replaced by low molecular-weight heparin or fondaparinux given subcutaneously at weight-adjusted doses. In hemodynamically unstable patients with confirmed (high-risk) PE, thrombolysis should be administered without delay; if thrombolysis is absolutely contraindicated or has failed, surgical embolectomy or catheter-based thrombus removal is a valuable alternative. In normotensive (non-high-risk) patients, low-molecular-weight heparin or fondaparinux is adequate treatment in most cases, and thrombolysis is generally not recommended as a first-line therapeutic option. An ongoing randomized trial will determine whether normotensive patients with evidence of right ventricular dysfunction plus myocardial injury may benefit from early thrombolysis. Finally, selected normotensive patients without serious comorbidity or signs of heart failure (low-risk PE) may be candidates for out-of-hospital treatment. This strategy may be facilitated by the use of new oral anticoagulants in the future.
Authors:
George Chalikias; Stavros Konstantinides
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Current vascular pharmacology     Volume:  12     ISSN:  1875-6212     ISO Abbreviation:  Curr Vasc Pharmacol     Publication Date:  2014  
Date Detail:
Created Date:  2014-05-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101157208     Medline TA:  Curr Vasc Pharmacol     Country:  United Arab Emirates    
Other Details:
Languages:  eng     Pagination:  393-400     Citation Subset:  IM    
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