RT Journal Article
SR Electronic
T1 Management dilemmas in acute pulmonary embolism
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 174
OP 180
DO 10.1136/thoraxjnl-2013-204667
VO 69
IS 2
A1 Robin Condliffe
A1 Charlie A Elliot
A1 Rodney J Hughes
A1 Judith Hurdman
A1 Rhona M Maclean
A1 Ian Sabroe
A1 Joost J van Veen
A1 David G Kiely
YR 2014
UL http://thorax.bmj.com/content/69/2/174.abstract
AB 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: sub-massive 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.