Raza Alikhan, Luke S Howard, Martin Johnson, Shruti Sweeney, David G Kiely, Joanna Pepke-Zaba
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Practical guide to management after an acute pulmonary embolism.
Follow-up after acute pulmonary embolism (PE) is important to assess recovery, consider the need for on-going anticoagulation and identify chronic thromboembolic pulmonary hypertension (CTEPH), a rare but serious complication of PE. 16 dilemmas in the follow-up of acute PE were identified by a steering committee of four pulmonologists and a haematologist with interest in PE and/or CTEPH. Current literature was reviewed and a practical approach suggested based on expert consensus. Dilemmas discussed included: (1) how to manage a breathless patient; (2) what to do if CTEPH is suspected; (3) the difference between CTEPH and post-PE syndrome, (4) testing for thrombophilia, (5) when to investigate for cancer, (6) anticoagulation duration and dose, (7) approaches to discussions and decision-making with respect to anticoagulation, (8) use of aspirin and whether antiplatelet therapy should be stopped during anticoagulation and (9) advice for patients on discharge from hospital at 3 months and information for first-degree relatives. Given the occurrence of complications that may require assessment, follow-up of patients post-PE should be systematic and consider the individual needs of the patient.
期刊介绍:
BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.