Management of pulmonary embolism

Abstract

Introduction. Pulmonary embolism is a common condition with high morbidity and mortality, particularly if misdiagnosed or untreated. It has non-specific clinical manifestations, often presenting with symptoms similar to other cardiovascular or common respiratory diseases. Dyspnea is the most common symptom. The main goals of pulmonary embolism therapy are to stop blood clots from getting bigger and prevent formation of new clots. The aim of this article was to review the clinical presentation, incidence, diagnostic algorithms and prevention of pulmonary embolism. Management of pulmonary embolism. The management of pulmonary embolism depends on patients' hemodynamic stability (hemodynamically stabile and hemodynamically unstable patients), as well as on specific conditions (population who cannot receive the same therapy as the previously mentioned patients). The management is largely focused on medical therapy of pulmonary embolism, as the first line therapy (emergency) and then on medical options for this disease. Special attention was given to urgent intravenous thrombolytic therapy in hemodynamically unstable patients, considering that these patients are the most vitally compromised, in shock and with high mortality rate. The initial treatment in hemodynamically stable patients consists of low molecular weight heparin and unfractionated heparin, which is later replaced by long term oral anticoagulation therapy. Its duration depends on the nature of the basic disease. Some populations cannot receive any thrombolytic therapy (pregnant women, patients suffering from malignant diseases and heparin-induced thrombocytopenia). These patients may receive low molecular weight heparin, unfractionated heparin and warfarin; patients with malignant diseases receive life-long anticoagulation therapy; argatroban or lepirudin are used in the management of heparin-induced thrombocytopenia. Conclusion. Prevention of pulmonary embolism is lifesaving. It includes prophylactic medical regimens and 'mechanical' supportive therapy (elastic graduated compression stockings, inferior vena cava filters).