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Pulmonary Embolism

Reviewed 06/2018
 


BASICS

DESCRIPTION

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

  • Mortality exceeds 15% during the first 3 months. In 25% of patients, first manifestation is s...

DIAGNOSIS

  • Establish a pretest probability based on clinical criteria (2).

    • Wells score

      • Clinical signs and symptoms of DVT +3

      • Alternative diagnosis is less likely than PE +3.

      • Heart rate >100 +1.5

      • Immo...

TREATMENT

MEDICATION

  • If clinical suspicion is high and no contraindications, start treatment immediately.

  • Start LMWH, fondaparinux, UFH, as initial therapy for first 5 to 10 days. VKA can be started the...

ONGOING CARE

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

  • Unprovoked PE: Minimum of 3 months, consider long-term or prolonged secondary prophylaxis if bleeding r...

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. [V...

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

  • PE can be excluded in patients who have low pretest probability and negative D-dimer testing.

  • Perform cancer-oriented review of systems and age/gender-appropriate cancer screening in pa...

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