| Novel management strategy for patients with suspected pulmonary embolism. | |
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MedLine Citation:
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PMID: 12581684 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIMS: A simple management strategy is required for patients with acute pulmonary embolism which allows a rapid and reliable diagnosis in order to start timely and appropriate treatment. METHODS AND RESULTS: Two hundred and four consecutive patients with suspected pulmonary embolism were managed according to a standardized protocol based on the clinical pretest probability and the initial haemodynamic presentation (shock index=heart rate divided by systolic blood pressure). Patients with a high pretest probability and a positive shock index (> or =1) (n=21) underwent urgent transthoracic echocardiography. Based on the presence or absence of right ventricular dysfunction, reperfusion treatment was initiated immediately. Patients with a negative shock index (<1) (n=183) underwent diagnostic evaluation including pretest probability, D-dimer, and spiral computed tomography (CT) as first-line tests. Echocardiography was performed only when a central pulmonary embolism was found in the spiral CT(n=33). According to our strategy, 98 patients met the diagnostic criteria of pulmonary embolism: 75 patients (all shock index <1) were treated with heparin alone, 16 (seven had a shock index > or =1) with thrombolysis, four (all shock index > or =1) with catheter fragmentation, and three (all shock index > or =1) with surgical embolectomy. The all-cause mortality rate at 30 days was 5%, and at 6 months 11%. Right ventricular dysfunction on baseline echocardiography was not associated with a higher mortality rate at 6 months (logrank 2.4, P=0.12). CONCLUSIONS: The novel management strategy for patients with suspected pulmonary embolism resulted in a rapid diagnosis and treatment with a low 30-day mortality. In patients with pulmonary embolism and a positive shock index, time-consuming imaging tests can be avoided to reduce the risk of sudden death and not to delay reperfusion therapy. |
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Authors:
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N Kucher; C M Luder; T Dörnhöfer; S Windecker; B Meier; O M Hess |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: European heart journal Volume: 24 ISSN: 0195-668X ISO Abbreviation: Eur. Heart J. Publication Date: 2003 Feb |
Date Detail:
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Created Date: 2003-02-12 Completed Date: 2003-04-04 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8006263 Medline TA: Eur Heart J Country: England |
Other Details:
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Languages: eng Pagination: 366-76 Citation Subset: IM |
Affiliation:
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Cardiology, Swiss Cardiovascular Center, University Hospital, CH-3010, Bern, Switzerland. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Administration, Oral Aged Anticoagulants / administration & dosage Echocardiography Female Fibrin Fibrinogen Degradation Products / analysis Humans Male Middle Aged Pulmonary Embolism / diagnosis, therapy* Reperfusion / methods Shock, Cardiogenic / diagnosis, therapy Survival Analysis Tomography, Spiral Computed / methods Vena Cava Filters |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 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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