| Contemporary management of pulmonary embolism: the answers to ten questions. | |
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MedLine Citation:
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PMID: 20626551 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 anticoagulants that do require patient monitoring and might exhibit a more favourable benefit-risk balance are currently under extensive clinical testing and might change the situation in the near future. A critical appraisal of the contemporary management of suspected PE is given in this overview with the discussion of 10 practical questions. |
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Authors:
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H Bounameaux |
Publication Detail:
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Type: Journal Article; Review Date: 2010-06-14 |
Journal Detail:
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Title: Journal of internal medicine Volume: 268 ISSN: 1365-2796 ISO Abbreviation: J. Intern. Med. Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-10 Completed Date: 2010-09-13 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8904841 Medline TA: J Intern Med Country: England |
Other Details:
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Languages: eng Pagination: 218-31 Citation Subset: IM |
Affiliation:
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Division of Angiology and Hemostasis, Department of Internal Medicine, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland. henri.bounameaux@unige.ch |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Age Factors Aged Aged, 80 and over Algorithms Anticoagulants / therapeutic use Biological Markers / blood Drug Administration Schedule Fibrin Fibrinogen Degradation Products / analysis Humans Middle Aged Prognosis Pulmonary Embolism / diagnosis*, drug therapy* Tomography, X-Ray Computed / methods |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Biological Markers; 0/Fibrin Fibrinogen Degradation Products; 0/fibrin fragment D |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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