Acute Pulmonary Embolism - Current Problems in by Paul D. Stein, MD, and Fadi Matta, MD

By Paul D. Stein, MD, and Fadi Matta, MD

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Extra resources for Acute Pulmonary Embolism - Current Problems in Cardiology-Vol.35, July 2010 No. 7, p307

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It is speculated that 64-detector units may show PE more accurately in subsegmental branches, but this has not been tested. 112 Magnetic Resonance Angiography (MRA) Gadolinium-enhanced MRA is a potentially useful imaging modality for patients with suspected acute PE in whom it is important to avoid exposure to ionizing radiation, or for patients allergic to iodinated Curr Probl Cardiol, July 2010 343 FIG 22. Gadolinium-enhanced magnetic resonance pulmonary angiogram showing PE in the left lower lobe pulmonary artery.

153 It may be that UFH is more likely to cause heparin-associated thrombocytopenia than LMWH, and the difference of risk becomes apparent only after prolonged administration. 154 J. E. Dalen: Idiopathic, or unprovoked VTE, that is, VTE occurring without risk factors, is an indication for prolonged therapy with vitamin K antagonists in patients with or without thrombophilia. Genetic causes of thrombophilia are shown in Table 18. The most common acquired cause is antiphospholipid syndrome. 155 Some physicians screen for thrombophilia to aid making decisions concerning the duration of anticoagulant therapy.

For patients with a second episode of unprovoked VTE, “long-term” treatment is recommended. For patients with cancer and VTE, 3-6 months of treatment with LMWH is recommended, followed by treatment indefinitely with LMWH or a vitamin K antagonist, or until the cancer is resolved. 195 Elevations in BNP195 and N-terminal prohormone of brain natriuretic peptide (NT-pro BNP)196 are associated with right ventricular dysfunction in acute PE. Elevated levels of BNP in patients with PE usually predicted a higher mortality than when normal.

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