Document Detail

Problems in the management of pulmonary embolism.
MedLine Citation:
PMID:  2661386     Owner:  NLM     Status:  MEDLINE    
Pulmonary angiography remains the definitive technique for the diagnosis of pulmonary embolism but in practice is not universally available. Many patients can be managed quite safely without it but it should be employed without hesitation in certain problem patients. Thrombolytic treatment probably improves survival in patients who suffer an acute massive pulmonary embolus but it should not be used unless the embolus causes considerable haemodynamic disturbance. The best thrombolytic agent and the best administration regime remain uncertain. At present the simplest and cheapest effective regime for most patients is provided by a twelve to 24 hour infusion of streptokinase although in the future the new "clot-specific" agents such as rTPA and APSAC may be shown to be safer and/or more effective. In nearly all situations other than acute massive pulmonary embolism thrombolytic treatment is more expensive, slightly more dangerous but no more effective than heparin. When heparin is given there seems little to choose between intermittent injection and continuous infusion. Although there is no scientific proof it is logical to continue heparin for seven days since this is the time taken for any residual clot in the venous system to become firmly adherent to the vessel wall. The value of coagulation tests as a guide to adjustment of heparin dosage is not proved and seems to need reassessment in the light of the recent discovery of large diurnal variations in heparin activity.(ABSTRACT TRUNCATED AT 250 WORDS)
R Hall
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Herz     Volume:  14     ISSN:  0340-9937     ISO Abbreviation:  Herz     Publication Date:  1989 Jun 
Date Detail:
Created Date:  1989-08-10     Completed Date:  1989-08-10     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  7801231     Medline TA:  Herz     Country:  GERMANY, WEST    
Other Details:
Languages:  eng     Pagination:  148-56     Citation Subset:  IM    
University Hospital of Wales, Heath Park, Cardiff, U.K.
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MeSH Terms
Anticoagulants / administration & dosage*
Fibrinolytic Agents / administration & dosage*
Pulmonary Embolism / drug therapy*,  radiography
Risk Factors
Reg. No./Substance:
0/Anticoagulants; 0/Fibrinolytic Agents

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

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