PMID- 22372172
OWN - NLM
STAT- MEDLINE
DCOM- 20120320
LR  - 20120229
IS  - 0010-6178 (Print)
IS  - 0010-6178 (Linking)
VI  - 76
IP  - 1
DP  - 2012 Jan
TI  - The diagnosis and management of pulmonary embolism.
PG  - 5-14
AB  - Pulmonary embolism (PE), most commonly originating from thrombosis in the deep 
      venous system of the lower extremities, remains a controversial area of medicine 
      that frequently generates lively debate. Its clinical presentation varies from 
      asymptomatic, incidentally detected pulmonary emboli to massive embolism 
      resulting in sudden death. Despite the advances made in recent years, a number of 
      fundamental questions remain unanswered regarding the pathogenesis, clinical 
      presentation, diagnosis and treatment of this disease. The diagnosis of PE is 
      confounded by a presentation that may be subtle, atypical, or obscured by a 
      concomitant condition. Safe, minimally invasive techniques have been developed to 
      improve the diagnostic accuracy of the clinical evaluation, and obviate the need 
      to obtain pulmonary arteriography in all but a minority of patients. However, no 
      single diagnostic test is sufficiently sensitive or specific for diagnosis in all 
      patients. This dilemma has resulted in the development of numerous clinical 
      scoring systems to stratify risk, pretest probability and help guide an 
      appropriate diagnostic approach. Anticoagulation therapy with unfractionated 
      heparin (UFH), low molecular weight heparin (LMWH), and Factor Xa inhibitors are 
      the mainstay of therapy for acute PE. The choice of agent is influenced by 
      disease severity, presence or absence of provokingfactors, patient comorbidities, 
      and bleeding risk. These factors also determine whether measures such as 
      thrombectomy, thrombolysis and vena cava filter placement may be employed as 
      adjuncts to anticoagulation. Warfarin is the agent of choice for secondary 
      prevention; newer agents such as direct thrombin and factor Xa inhibitors are 
      emerging as safe and effective alternatives.
FAU - Abunasser, Jafar
AU  - Abunasser J
AD  - Pulmonary and Critical Care Medicine Division, University of Connecticut School 
      of Medicine, Farmington, USA.
FAU - Tejada, John Patrick
AU  - Tejada JP
FAU - Foley, Raymond J
AU  - Foley RJ
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Conn Med
JT  - Connecticut medicine
JID - 0372745
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Anticoagulants/administration & dosage/adverse effects/*therapeutic use
MH  - Clinical Protocols
MH  - Comorbidity
MH  - Hemorrhage/chemically induced
MH  - Humans
MH  - Pulmonary Embolism/*diagnosis/*drug therapy/epidemiology
MH  - Risk Assessment
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Vena Cava Filters
EDAT- 2012/03/01 06:00
MHDA- 2012/03/21 06:00
CRDT- 2012/03/01 06:00
PHST- 2012/03/01 06:00 [entrez]
PHST- 2012/03/01 06:00 [pubmed]
PHST- 2012/03/21 06:00 [medline]
PST - ppublish
SO  - Conn Med. 2012 Jan;76(1):5-14.