Care of patients with acute pulmonary emboli: a clinical review with cardiovascular focus

Abstract

Acute pulmonary embolism (PE) is a common, multidisciplinary disease with substantial associated morbidity, mortality and healthcare expense. In this article we present a succinct review of diagnostic tools, risk stratification and medical therapies for cardiovascular care of patients with acute PE. While pulmonary angiography remains the 'gold standard' for diagnosis, a host of diagnostic modalities, interpreted in the setting of clinical probability, are available for patient assessment, including ECG, chest radiography, D-dimer, lower-extremity venous ultrasound, ventilation-perfusion scans, computed tomography and magnetic resonance angiography, and echocardiography, each with associated value. Diagnostic algorithms incorporate multiple tools in order to obtain a more comprehensive evaluation. Therapeutic anticoagulation remains the mainstay of therapy in PE. In massive PE, utilization of thrombolysis is reasonable in the absence of contraindications. Submassive PE, characterized by right ventricular dysfunction as assessed by echocardiography and ECG, is associated with higher mortality. Use of thrombolysis in submassive PE remains controversial. Catheter-directed therapies are emerging as an added approach to acute PE and have the potential to improve outcomes in PE. Use of inferior vena cava filters should be pursued in a select patient population as they serve to reduce recurrent acute PE; however, they are associated with more frequent deep venous thrombosis and provide no mortality benefit. In risk-stratified hemodynamically stable patients, an outpatient management strategy inclusive of therapeutic anticoagulation and careful clinical follow-up may be appropriate.

Analysis of National Trends in Admissions for Pulmonary Embolism

“…Pulmonary embolism (PE) is a common condition with significant morbidity and mortality, often requiring hospital admission. 1 The overall incidence of PE in the general population was reported at 69 per 100,000 in 1998. 2 Since that estimate, significant changes in PE management have occurred, including trends toward more (and higher quality) CT angiography (CTA) studies, more sensitive D-dimer assays, and new treatment options, including low-molecular heparins and new oral anticoagulants.…”

Pulmonary embolism as a complication of fracture of the proximal end of the humerus - literature review

“…According to analyzes in the European Union, they can reach up to EUR 8,500,000,000 and hospitalization of one patient may be associated with an expense of USD 30,000. [10,11] Such high costs result from a wide and comprehensive diagnosis, treatment and a large number of involved medical personnel during hospitalization and subsequent rehabilitation of patients. The high risk of PE after orthopedic procedures in the area of the lower limb is known and widely described, while the relationship of PE with injuries of the upper limb is less of interest to scientists and clinicians.…”