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.
Pulmonary embolism remains a common and potentially
preventable cause of death.
This article reviews the epidemiology, clinical features,
diagnostic process, and treatment of pulmonary embolism.
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.
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