Document Detail

Risk stratification and treatment strategy of pulmonary embolism.
MedLine Citation:
PMID:  22614324     Owner:  NLM     Status:  Publisher    
PURPOSE OF REVIEW: Pulmonary embolism remains one of the leading causes of cardiovascular mortality. The wide range of reported mortality rates reflects heterogeneity in comorbidity and severity of pulmonary embolism. Optimizing risk stratification to prognose pulmonary embolism patients appears to be important to improve management, treatment and clinical outcome. RECENT FINDINGS: Hemodynamic status is the most important short-term prognostic factor. High-risk pulmonary embolism or massive pulmonary embolism is defined by the patient response more than the clot size: patients with circulatory shock including sustained hypotension should receive thrombolytic therapy in absence of contraindications. Nonmassive or normotensive pulmonary embolism can be further stratified using clinical features, imaging (echocardiography, computed tomography) and biomarkers (troponins, natriuretic peptides): low-risk pulmonary embolism, evaluated by clinical model (Pulmonary Embolism Severity Index; PESI) can potentially be treated as outpatients; and intermediate-risk pulmonary embolism, which can be further stratified into less-severe and more-severe intermediate risk. The last may benefit from intensive clinical surveillance but the risk-benefit ratio for thrombolysis has been inadequately quantified to make any strong recommendation. New anticoagulants may transform traditional pulmonary embolism treatment. SUMMARY: Optimizing risk stratification of patients with normotensive pulmonary embolism before they develop overt hemodynamic instability is the challenge of current pulmonary embolism management. Treatment strategy has to integrate this risk stratification and new anticoagulants arrival.
Andrea Penaloza; Pierre-Marie Roy; Jeffrey Kline
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-5-19
Journal Detail:
Title:  Current opinion in critical care     Volume:  -     ISSN:  1531-7072     ISO Abbreviation:  -     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-5-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9504454     Medline TA:  Curr Opin Crit Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
aEmergency Department, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium bEmergency Department, LUNAM Université, Angers, Université d'Angers, CHU Angers, France cDepartment of Emergency Medicine, Carolinas Medical Center, Charlotte, USA.
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