Diagnosis and Management of Pulmonary Embolism (original) (raw)

1986, The Annals of Thoracic Surgery

HOSPITAL MEDICINE CLINICS CHECKLIST 1. The first step in the evaluation of a patient with suspected pulmonary embolism (PE) is assessment of the pretest probability of PE (low, medium, high). Clinical probability tools can assist clinicians with this process. 2. Strategies that use D-dimer testing can reduce unnecessary imaging studies for select patients with low and intermediate pretest probability of PE, including hospital inpatients. 3. The most significant predictor of poor outcome in patients with acute PE is right ventricular (RV) dysfunction. Multiple imaging modalities and laboratory studies can aid in evaluation of RV status. 4. Hemodynamically stable patients should be further risk stratified using validated tools such as the Pulmonary Embolism Severity Index (PESI) and the simplified Pulmonary Embolism Severity Index (sPESI). 5. The American College of Chest Physicians 2016 guidelines recommend the use of the direct oral anticoagulant (DOAC) agents over vitamin K agonist therapy for the treatment of venous thromboembolism, including PE. Some DOACs can be used as initial therapy, but others should be preceded by a period of anticoagulation with another agent. CONTINUED The authors have no financial disclosures.

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