en
Scientific article
Review
English

Contemporary management of pulmonary embolism: the answers to ten questions

ContributorsBounameaux, Henri
Published inJournal of internal medicine, vol. 268, no. 3, p. 218-231
Publication date2010
Abstract

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.

Keywords
  • 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
Citation (ISO format)
BOUNAMEAUX, Henri. Contemporary management of pulmonary embolism: the answers to ten questions. In: Journal of internal medicine, 2010, vol. 268, n° 3, p. 218–231. doi: 10.1111/j.1365-2796.2010.02254.x
Main files (1)
Article
accessLevelRestricted
Identifiers
ISSN of the journal0954-6820
501views
0downloads

Technical informations

Creation05/23/2012 8:44:22 AM
First validation05/23/2012 8:44:22 AM
Update time03/14/2023 5:31:53 PM
Status update03/14/2023 5:31:53 PM
Last indexation02/12/2024 8:09:13 PM
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack