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Pulmonary Embolism

Luis Diaz-Quintero, MD and Alfonso Tafur, MD, MS Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Pulmonary embolism (PE) is the most serious presentation of venous thromboembolism (VTE).

  • Classified based on severity:

    • Low-risk PE: acute and absence of clinical markers of adverse pr...

DIAGNOSIS

  • Establish a pretest probability based on clinical criteria.

    • Wells score

      • Clinical signs and symptoms of DVT +3

      • Alternative diagnosis is less likely than PE +3.

      • Heart rate >100 +1.5

      • Immobilizati...

TREATMENT

MEDICATION

  • Start LMWH, fondaparinux, UFH, as initial therapy for first 5 to 10 days. VKA can be started the 1st day and must overlap with parenteral treatment for minimum of 5 days, until int...

ONGOING CARE

Duration of anticoagulation 
  • Provoked PE (trigger no longer present): 3 months (1)[B]

  • Unprovoked PE: >3 months; consider long-term or prolonged secondary prophylaxis if bleeding risk is ...

REFERENCES

1
Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J.  2014;35(43):3033–3069, 3069a–3069k. [Vi...

CODES

ICD10

  • I26.99 Other pulmonary embolism without acute cor pulmonale

  • I27.82 Chronic pulmonary embolism

ICD9

  • 415.19 Other pulmonary embolism and infarction

  • 416.2 Chronic pulmonary embolism

SNOMED

  • 59282003 ...

CLINICAL PEARLS

  • Perform cancer-oriented review of systems and age/gender-appropriate cancer screening in patients >40 years, recurrent VTE, upper extremity DVT (not related to catheter or lines), b...

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