Document Detail


Pulmonary embolism in the elderly.
MedLine Citation:
PMID:  11270125     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The elderly are at increased risk for pulmonary embolism because of both the conditions common to this age group, and the immobility that often accompanies them. Whether aging alone represents a hypercoagulable state is unclear. The incidence of pulmonary embolism rises with age, however, as does pulmonary embolism mortality. The diagnosis of pulmonary embolism is difficult and frequently missed because elderly patients and their physicians may attribute nonspecific symptoms to underlying cardiopulmonary disease or to age itself. Routine laboratory examinations are also nonspecific. Lower extremity studies to diagnose DVT should always be pursued because a positive study results in identical treatment, without the need for further testing. D-dimer concentrations are useful when low, but are commonly elevated in the elderly because of other comorbid conditions. Lung scanning remains the most common initial study to diagnose pulmonary embolism, although spiral CT is as sensitive and specific. Pulmonary angiography should always be considered when the initial studies are nondiagnostic and clinical suspicion is high, and this test is well tolerated in the elderly. The role of newer diagnostic techniques, such as MR imaging, cannot be determined until well-designed outcomes trials are completed. Prophylaxis with appropriate pharmacologic agents or mechanical measures should be administered not only to patients undergoing hip or knee reconstruction surgery, but to all bed-ridden elderly medical and general surgery patients. Treatment for pulmonary embolism with anticoagulation reduces the mortality rate and should be administered in all elderly patients without contraindications. In addition, thrombolysis should be considered for all hemodynamically unstable patients with pulmonary embolism, regardless of age. Vena caval filters are warranted when anticoagulation is contraindicated, although evidence of the long-term benefit of these devices is lacking. At present, pulmonary embolism is underdiagnosed and undertreated in the elderly. By heightening awareness of this diagnosis and its appropriate management in this age group, considerable morbidity and mortality may be avoided.
Authors:
A R Berman
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Publication Detail:
Type:  Comparative Study; Journal Article; Review    
Journal Detail:
Title:  Clinics in geriatric medicine     Volume:  17     ISSN:  0749-0690     ISO Abbreviation:  Clin. Geriatr. Med.     Publication Date:  2001 Feb 
Date Detail:
Created Date:  2001-03-28     Completed Date:  2001-05-03     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8603766     Medline TA:  Clin Geriatr Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  107-30     Citation Subset:  IM    
Affiliation:
Division of Pulmonary Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Anticoagulants / administration & dosage*
Clinical Trials as Topic
Female
Humans
Incidence
Male
Middle Aged
Prognosis
Pulmonary Embolism / diagnosis,  drug therapy*,  epidemiology*
Risk Factors
Sex Distribution
Survival Rate
United States / epidemiology
Chemical
Reg. No./Substance:
0/Anticoagulants

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


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