Risk stratification of normotensive patients with acute symptomatic pulmonary embolism

被引:53
|
作者
Jimenez, David [1 ,2 ,6 ]
Aujesky, Drahomir [3 ]
Yusen, Roger D. [4 ,5 ]
机构
[1] Hosp Ramon & Cajal, Resp Dept, E-28034 Madrid, Spain
[2] Univ Alcala de Henares, IRYCIS, Madrid, Spain
[3] Univ Hosp Bern, Div Gen Internal Med, CH-3010 Bern, Switzerland
[4] Washington Univ, Sch Med, Div Pulm & Crit Care Med, St Louis, MO USA
[5] Washington Univ, Sch Med, Div Gen Med Sci, St Louis, MO USA
[6] Hosp Ramon & Cajal, Dept Med, E-28034 Madrid, Spain
关键词
pulmonary embolism; prognosis; mortality; outpatient treatment; thrombolysis; RIGHT-VENTRICULAR DYSFUNCTION; BRAIN NATRIURETIC PEPTIDE; D-DIMER LEVELS; DEEP-VEIN THROMBOSIS; PROGNOSTIC VALUE; SEVERITY INDEX; VENOUS THROMBOEMBOLISM; SELECTING PATIENTS; TROPONIN-I; VALIDATION;
D O I
10.1111/j.1365-2141.2010.08406.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
P>Treatment guidelines recommend strong consideration of thrombolysis in patients with acute symptomatic pulmonary embolism (PE) that present with arterial hypotension or shock because of the high risk of death in this setting. For haemodynamically stable patients with PE, the categorization of risk for subgroups may assist with decision-making regarding PE therapy. Clinical models [e.g. Pulmonary Embolism Severity Index (PESI)] may accurately identify those at low risk of overall death in the first 3 months after the diagnosis of PE, and such patients might benefit from an abbreviated hospital stay or outpatient therapy. Though some evidence suggests that a subset of high-risk normotensive patients with PE may have a reasonable risk to benefit ratio for thrombolytic therapy, single markers of right ventricular dysfunction (e.g. echocardiography, spiral computed tomography, or brain natriuretic peptide testing) and myocardial injury (e.g. cardiac troponin T or I testing) have an insufficient positive predictive value for PE-specific mortality to drive decision-making toward such therapy. Recommendations for outpatient treatment or thrombolytic therapy for patients with PE necessitate further development of prognostic models and conduct of clinical trials that assess various treatment strategies.
引用
收藏
页码:415 / 424
页数:10
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