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Clots

July 2010

FocusClots

Pulmonary embolism

Volume 39, No.7, July 2010 Pages 462-466

Simon McRae MBBS, FRCPA, FRACP, is Consultant Haematologist, Department of Haematology, South Australia Pathology, Royal Adelaide Hospital, South Australia.

Background

Pulmonary embolism remains a common and potentially preventable cause of death.

Objective

This article reviews the epidemiology, clinical features, diagnostic process, and treatment of pulmonary embolism.

Discussion

Well recognised risk factors include recent hospitalisation, other causes of immobilisation, cancer, and oestrogen exposure. Diagnostic algorithms for pulmonary embolism that incorporate assessment of pretest probability and D-dimer testing have been developed to limit the need for diagnostic imaging. Anticoagulation should be administered promptly to all patients with pulmonary embolism with low molecular weight heparin being the initial anticoagulant of choice, although thrombolysis is indicated for patients presenting with haemodynamic compromise. Following initial anticoagulation warfarin therapy should be continued for a minimum of 3 months. Long term anticoagulation with warfarin should be considered in patients with unprovoked pulmonary embolism, due to an increased risk of recurrence after ceasing anticoagulation. The availability of new anticoagulants is likely to significantly impact on the treatment of patients with pulmonary embolism, although the exact role of these drugs is still to be defined.

More than 150 years after the first Virchow description of his triad of risk factors for venous thromboembolism (VTE), pulmonary embolism (PE) remains an important preventable cause of morbidity and mortality. It was estimated that in 2008 there were approximately 15 000 episodes of VTE in Australia, a substantial proportion of which were PE.1 Both the diagnosis and initial management of PE still largely take place within the hospital setting. However an understanding and awareness of PE by the primary care clinician remains important, due to the need for a high diagnostic suspicion of PE to enable prompt recognition of a potentially fatal disease and also the increasing tendency for early discharge of patients being treated for PE.

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Correspondence afp@racgp.org.au

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