Document Detail


Advanced treatment strategies for acute pulmonary embolism, including thrombolysis and embolectomy.
MedLine Citation:
PMID:  19630826     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The optimal treatment strategy for acute pulmonary embolism relies upon a multidisciplinary team that rapidly assesses available data, performs additional testing if necessary, weighs treatment options, and recommends an appropriate therapeutic plan to the patient and family. Round-the-clock availability is imperative. Centers that specialize in pulmonary embolism management offer a wide range of therapeutic options. Hospitals with more limited facilities should establish pulmonary embolism patient referral and transfer contingency plans that can be activated at a moment's notice. Management options include anticoagulation alone, thrombolysis plus anticoagulation, insertion of an inferior vena caval filter, catheter embolectomy, or surgical embolectomy. The decision-making process requires accurate risk stratification, which is comprised of several crucial components: clinical evaluation that includes history and physical examination, biomarker measurement especially of troponin, as well as assessment of right ventricular size and function based upon chest CT scanning and echocardiography. The 'old school' approach of declaring a benign prognosis based solely upon the presence of normal systemic arterial pressure can delay advanced therapy until after the onset of irreversible cardiogenic shock. We have now formulated a more contemporary, comprehensive, and multifaceted strategy to prognosticate. Our 'new approach' uses advanced treatment strategies in addition to anticoagulation for those pulmonary embolism patients deemed to be at high risk for a poor outcome.
Authors:
S Z Goldhaber
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of thrombosis and haemostasis : JTH     Volume:  7 Suppl 1     ISSN:  1538-7836     ISO Abbreviation:  J. Thromb. Haemost.     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-07-27     Completed Date:  2009-12-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101170508     Medline TA:  J Thromb Haemost     Country:  England    
Other Details:
Languages:  eng     Pagination:  322-7     Citation Subset:  IM    
Affiliation:
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. sgoldhaber@partners.org
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Disease Management
Embolectomy
Humans
Prognosis
Pulmonary Embolism / diagnosis,  therapy*
Thrombolytic Therapy

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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