Management dilemmas in acute pulmonary embolism

被引:47
作者
Condliffe, Robin [1 ,2 ]
Elliot, Charlie A. [1 ,2 ]
Hughes, Rodney J. [2 ]
Hurdman, Judith [1 ,2 ]
Maclean, Rhona M. [3 ]
Sabroe, Ian [1 ,2 ,4 ]
van Veen, Joost J. [3 ]
Kiely, David G. [1 ,2 ]
机构
[1] Royal Hallamshire Hosp, Sheffield Pulm Vasc Dis Unit, Sheffield S10 2JF, S Yorkshire, England
[2] Sheffield Teaching Hosp NHS Fdn Trust, Acad Dept Resp Med, Sheffield, S Yorkshire, England
[3] Royal Hallamshire Hosp, Sheffield Haemophilia & Thrombosis Ctr, Sheffield S10 2JF, S Yorkshire, England
[4] Univ Sheffield, Dept Infect & Immunol, Sheffield, S Yorkshire, England
关键词
RIGHT HEART THROMBI; IMMEDIATE POSTOPERATIVE PERIOD; ACUTE ISCHEMIC-STROKE; DEEP-VEIN THROMBOSIS; THROMBOLYTIC THERAPY; VENOUS THROMBOEMBOLISM; CARDIOPULMONARY-RESUSCITATION; PLASMINOGEN-ACTIVATOR; SYSTEMIC THROMBOLYSIS; SURGICAL-TREATMENT;
D O I
10.1136/thoraxjnl-2013-204667
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Background Physicians treating acute pulmonary embolism (PE) are faced with difficult management decisions while specific guidance from recent guidelines may be absent. Methods Fourteen clinical dilemmas were identified by physicians and haematologists with specific interests in acute and chronic PE. Current evidence was reviewed and a practical approach suggested. Results Management dilemmas discussed include: submassive PE, PE following recent stroke or surgery, thrombolysis dosing and use in cardiac arrest, surgical or catheter-based therapy, failure to respond to initial thrombolysis, PE in pregnancy, right atrial thrombus, role of caval filter insertion, incidental and sub-segmental PE, differentiating acute from chronic PE, early discharge and novel oral anticoagulants. Conclusion The suggested approaches are based on a review of the available evidence and guidelines and on our clinical experience. Management in an individual patient requires clinical assessment of risks and benefits and also depends on local availability of therapeutic interventions.
引用
收藏
页码:174 / 180
页数:7
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