Pulmonary embolism medical therapy

Revision as of 20:23, 10 May 2012 by Kashish Goel (talk | contribs)
Jump to navigation Jump to search

Pulmonary Embolism Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pulmonary Embolism from other Diseases

Epidemiology and Demographics

Risk Factors

Triggers

Natural History, Complications and Prognosis

Diagnosis

Diagnostic criteria

Assessment of Clinical Probability and Risk Scores

Pulmonary Embolism Assessment of Probability of Subsequent VTE and Risk Scores

History and Symptoms

Physical Examination

Laboratory Findings

Arterial Blood Gas Analysis

D-dimer

Biomarkers

Electrocardiogram

Chest X Ray

Ventilation/Perfusion Scan

Echocardiography

Compression Ultrasonography

CT

MRI

Treatment

Treatment approach

Medical Therapy

IVC Filter

Pulmonary Embolectomy

Pulmonary Thromboendarterectomy

Discharge Care and Long Term Treatment

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Follow-Up

Support group

Special Scenario

Pregnancy

Cancer

Trials

Landmark Trials

Case Studies

Case #1

Pulmonary embolism medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Pulmonary embolism medical therapy

CDC on Pulmonary embolism medical therapy

Pulmonary embolism medical therapy in the news

Blogs on Pulmonary embolism medical therapy

Directions to Hospitals Treating Pulmonary embolism medical therapy

Risk calculators and risk factors for Pulmonary embolism medical therapy

Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

In most cases, anticoagulant therapy is the mainstay of treatment. For details, visit treatment approach. This chapter discusses the recommended doses.

Treatment Protocol[1]

 
 
 
 
 
 
 
Stabilize the patient
  • Respiratory Support
  • Hemodynamic Support
  • Anticoagulation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Initial Treatment options (≤5 Days)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Long term treatment (≥3 Month) (INR target, 2.0-3.0)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Extended treatment (Indefinite) (INR target, 2.0-3.0 OR 1.5-1.9)

Heparin

Subcutaneous Low molecular weight heparin, fondapariux or or Intravenous heparin is indicated in hemodynamically stable patients.

Dosages

Following doses are recommended[2]:

  • Factor Xa Inhibitors/Fondaparinux
    • Patient weighing less than 50 Kg (110 lb) : 5 mg (once daily).
    • Patient weighing 50 Kg (110 lb) to 110 Kg (220 lb): 7.5 mg (once daily).
    • Patient weighing more than 100 Kg (220 lb) : 10 mg (once daily).
  • Unfractionated heparin
    • Loading Dose: 80 IU/Kg or 5000 IU
    • Mantainace Dose: 18 IU/Kg/Hr to achieve a target aPTT 1.5 to 2.5 times the normal value.

Warfarin

  • The recommended therapeutic INR on warfarin is 2.0-3.0.

References

  1. Agnelli G, Becattini C (2010). "Acute pulmonary embolism". N Engl J Med. 363 (3): 266–74. doi:10.1056/NEJMra0907731. PMID 20592294.
  2. Raschke RA, Gollihare B, Peirce JC (1996). "The effectiveness of implementing the weight-based heparin nomogram as a practice guideline". Arch Intern Med. 156 (15): 1645–9. PMID 8694662.

Template:WH Template:WS