pulmonary%20thromboembolism
PULMONARY THROMBOEMBOLISM
Pulmonary embolism is the blockage of the blood vessels in the lungs usually due to blood clots from the veins, especially the veins in the legs and pelvis.
Dyspnea, chest pain, syncope or tachypnea (respiratory rate of ≥20/min) occur in most cases of pulmonary embolism.
Pleuritic chest pain with or without dyspnea is one of the most frequent presentations of this disease.
Syncope or shock are the hallmark signs of central pulmonary embolism and usually result in severe hemodynamic repercussions.
Signs of hemodynamic compromise and reduced heart flow are also usually present.

Follow Up

  • Patients w/ acute pulmonary embolism (PE) have a high frequency (20-50%) of symptomatic extension of thrombus &/or recurrent venous thromboembolism (VTE) & therefore require long-term anticoagulant treatment
  • Treatment w/ oral anticoagulant is the preferred method of long-term management of most PE patients
  • Adjusted doses of unfractionated heparin (UFH)  or low-molecular-weight heparin (LMWH) may be indicated for selected patients in whom oral anticoagulants are contraindicated or impractical

Low-molecular-weight heparin (LMWH)

  • Preferred drug for patients w/ PE & cancer
    • Should be used for the 1st 3-6 months of long-term anticoagulant therapy, then continued as oral therapy indefinitely or until cancer has resolved

Oral Anticoagulant

  • Duration of anticoagulation is dependent on the type of event & the coexistence of prolonged risk factors:
    • PE due to transient or reversible risk factor: Oral anticoagulation is recommended for at least 3 months
    • Unprovoked PE: Oral anticoagulation is recommended for at least 3 months
    • Unprovoked PE (1st episode), w/ low-risk of bleeding & in whom stable anticoagulation can be achieved: Consider long-term oral anticoagulation
    • Unprovoked PE (2nd episode): Long-term treatment is recommended

Risk Factors for Major Bleeding during Anticoagulation

  • Age >75 years
  • Previous gastrointestinal (GI) bleeding
  • Previous noncardioembolic stroke
  • Chronic hepatic & renal disease
  • Concomitant antiplatelet therapy
  • Poor anticoagulant control
  • Suboptimal monitoring of therapy
  • Comorbid illness

Monitoring during Anticoagulation

  • International normalized ratio (INR) should be checked at least weekly during the 1st several weeks of Warfarin therapy
  • If stable, monitor every 2 weeks then every 4 weeks, but not >4 weeks
  • Target INR is 2.5 for most patients & 3.0 for patients w/ recurrent VTE
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Respirology - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
Pearl Toh, 19 Jun 2016
Infants with persistent rhinitis have a higher abundance of Actinobacteria, especially Corynebacterium spp., in their nasal microbiome compared with healthy controls, according to a Singapore-based study presented at the European Academy of Allergy and Clinical Immunology (EAACI) Annual Congress 2016 held in Vienna, Austria.
Gabriel Angelo Sembrano, 16 Sep 2014

“At present, there is a limited development of new antibiotics. There is also a fast development of resistance to antibiotics. There are pathogens no longer susceptible to all antibiotics, and many pathogens are no longer susceptible to most antibiotics,” said Dr. Andre Villanueva, chief of party of the USAID’s Innovations and Multisectoral Partnerships to Achieve Control of TB (IMPACT) Project at the recent Annual Convention of the Philippine Pharmacists’ Association in Davao City.

Audrey Abella, 06 Jan 2017
Persistent wheeze or childhood asthma may be reduced by fish oil supplementation, particularly n-3 long-chain polyunsaturated fatty acids (LCPUFAs), during pregnancy, a recent Danish study found.
Pearl Toh, 31 May 2016
Synbiotic mixture of oligosaccharides and Bifidobacterium breve (B. breve) M-16V probiotic strain in infant formula restores gut colonisation by B. breve and supports healthy gut development in infants delivered by Caesarean-section (C-section), according to a study presented at the recent European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) annual meeting held in Athens, Greece.