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.
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