Pulmonary embolism natural history, complications and prognosis
|
Pulmonary Embolism Microchapters |
|
Diagnosis |
|---|
|
Pulmonary Embolism Assessment of Probability of Subsequent VTE and Risk Scores |
|
Treatment |
|
Follow-Up |
|
Special Scenario |
|
Trials |
|
Case Studies |
|
Pulmonary embolism natural history, complications and prognosis On the Web |
|
FDA on Pulmonary embolism natural history, complications and prognosis |
|
CDC on Pulmonary embolism natural history, complications and prognosis |
|
Pulmonary embolism natural history, complications and prognosis in the news |
|
Blogs on Pulmonary embolism natural history, complications and prognosis |
|
Directions to Hospitals Treating Pulmonary embolism natural history, complications and prognosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [2]
Synonyms and keywords: PE
Natural History, Complications & Prognosis
Without treatment almost 1/3 of patients will die, usually from recurrent PE. However, with diagnosis and treatment, the mortality rate is only ~ 2 – 8%. Unfortunately, 2/3 of all cases of PE are not diagnosed before the autopsy.
Prognosis
Mortality from untreated PE is said to be 26%. This figure comes from a trial published in 1960 by Barrit and Jordan[1] which compared anticoagulation against placebo for the management of PE. Barritt and Jordan performed their study in the Bristol Royal Infirmary in 1957. This study is the only placebo controlled trial ever to examine the place of anticoagulants in the treatment of PE, the results of which were so convincing that the trial has never been repeated as to do so would be considered unethical. That said, the reported mortality rate of 26% in the placebo group is probably an overstatement, given that the technology of the day may have detected only severe PEs.
Prognosis depends on the amount of lung that is affected and on the co-existence of other medical conditions; chronic embolisation to the lung can lead to pulmonary hypertension. There is controversy over whether or not small subsegmental PEs need to be treated at all[2] and some evidence exists that patients with subsegmental PEs may do well without treatment.[3][4]
According to Pulmonary Embolism Severity Index (PESI) trial, Hypotension(blood pressure �100 mm Hg) is a significant risk factor causing mortality in half of the patient group [5]
References
- ↑ "Anticoagulant drugs in the treatment of pulmonary embolism: a controlled trial". Lancet. 1: 1309&ndash, 1312. 1960. PMID 13797091. Text " Barritt DW, Jorden SC " ignored (help)
- ↑ Le Gal G, Righini M, Parent F, van Strijen M, Couturaud F (2006). "Diagnosis and management of subsegmental pulmonary embolism". J Thromb Haemost. 4 (4): 724–31. PMID 16634736.
- ↑ Perrier A, Bounameaux H (2006). "Accuracy or outcome in suspected pulmonary embolism". N Engl J Med. 354 (22): 2383–5. PMID 16738276.
- ↑ Stein P, Fowler S, Goodman L, Gottschalk A, Hales C, Hull R, Leeper K, Popovich J, Quinn D, Sos T, Sostman H, Tapson V, Wakefield T, Weg J, Woodard P (2006). "Multidetector computed tomography for acute pulmonary embolism". N Engl J Med. 354 (22): 2317–27. PMID 16738268.
- ↑ Donzé J, Le Gal G, Fine MJ, Roy PM, Sanchez O, Verschuren F; et al. (2008). "Prospective validation of the Pulmonary Embolism Severity Index. A clinical prognostic model for pulmonary embolism". Thromb Haemost. 100 (5): 943–8. PMID 18989542.