Pulmonary embolism discharge care and long term treatment: Difference between revisions
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==Overview== | ==Overview== | ||
Pulmonary embolism patient are at increased risk of second attack of PE (If un-treated almost 1/3 patient die, usually from recurrent PE) and therefore a patient should be discharged only after proper diagnosis and discharge medication. | Pulmonary embolism patient are at increased risk of second attack of PE (If un-treated almost 1/3 patient die, usually from recurrent PE) and therefore a patient should be discharged only after proper diagnosis and discharge medication. | ||
Information pertaining the safety of outpatient treatment of pulmonary embolism is still inadequate due to the lack of a randomized control trial comparing in-patient and outpatient management. | |||
==Discharge Criteria== | ==Discharge Criteria== | ||
High-risk PE patients have a 30-day mortality of greater than 15%, and thus hospital admission is necessary<ref name="pmid18757870">{{cite journal |author=Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, Bengel F, Brady AJ, Ferreira D, Janssens U, Klepetko W, Mayer E, Remy-Jardin M, Bassand JP |title=Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) |journal=Eur. Heart J. |volume=29|issue=18 |pages=2276–315 |year=2008 |month=September|pmid=18757870 |doi=10.1093/eurheartj/ehn310|url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=18757870|accessdate=2011-12-07}}</ref>.. | High-risk PE patients have a 30-day mortality of greater than 15%, and thus hospital admission is necessary<ref name="pmid18757870">{{cite journal |author=Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, Bengel F, Brady AJ, Ferreira D, Janssens U, Klepetko W, Mayer E, Remy-Jardin M, Bassand JP |title=Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) |journal=Eur. Heart J. |volume=29|issue=18 |pages=2276–315 |year=2008 |month=September|pmid=18757870 |doi=10.1093/eurheartj/ehn310|url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=18757870|accessdate=2011-12-07}}</ref>. | ||
Hemodynamically stability is not the criteria for discharge, patients who are hemodynamically stable but with [[RV dysfunction|right ventricular dysfunction]] should be admitted. | |||
Patients having a [[Pulmonary embolism diagnosis#Wells score|low-risk score]] are potential candidates for early discharge and outpatient treatment Patients with absent [[RV dysfunction|Right ventricular dysfunction]] and a normal [[troponin]] level can be discharged and put on out-patient treatment<ref name="pmid20592294">{{cite journal| author=Agnelli G, Becattini C| title=Acute pulmonary embolism. | journal=N Engl J Med | year= 2010 | volume= 363 | issue= 3 | pages= 266-74 | pmid=20592294 | doi=10.1056/NEJMra0907731 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20592294 }} </ref>. | Patients having a [[Pulmonary embolism diagnosis#Wells score|low-risk score]] are potential candidates for early discharge and outpatient treatment Patients with absent [[RV dysfunction|Right ventricular dysfunction]] and a normal [[troponin]] level can be discharged and put on out-patient treatment<ref name="pmid20592294">{{cite journal| author=Agnelli G, Becattini C| title=Acute pulmonary embolism. | journal=N Engl J Med | year= 2010 | volume= 363 | issue= 3 | pages= 266-74 | pmid=20592294 | doi=10.1056/NEJMra0907731 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20592294 }} </ref>. | ||
==Discharge Medications== | ==Discharge Medications== | ||
Outpatient administration of [[LMWH]] is as safe as unfractionated heparin administered in hospital for the treatment of DVT. | Outpatient administration of [[LMWH]] is as safe as unfractionated heparin administered in hospital for the treatment of DVT. | ||
Revision as of 09:35, 11 December 2011
Pulmonary Embolism Microchapters |
Diagnosis |
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Pulmonary Embolism Assessment of Probability of Subsequent VTE and Risk Scores |
Treatment |
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Special Scenario |
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Pulmonary embolism discharge care and long term treatment On the Web |
FDA on Pulmonary embolism discharge care and long term treatment |
CDC on Pulmonary embolism discharge care and long term treatment |
Pulmonary embolism discharge care and long term treatment in the news |
Blogs on Pulmonary embolism discharge care and long term treatment |
Directions to Hospitals Treating Pulmonary embolism discharge care and long term treatment |
Risk calculators and risk factors for Pulmonary embolism discharge care and long term treatment |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [2]
Overview
Pulmonary embolism patient are at increased risk of second attack of PE (If un-treated almost 1/3 patient die, usually from recurrent PE) and therefore a patient should be discharged only after proper diagnosis and discharge medication. Information pertaining the safety of outpatient treatment of pulmonary embolism is still inadequate due to the lack of a randomized control trial comparing in-patient and outpatient management.
Discharge Criteria
High-risk PE patients have a 30-day mortality of greater than 15%, and thus hospital admission is necessary[1].
Hemodynamically stability is not the criteria for discharge, patients who are hemodynamically stable but with right ventricular dysfunction should be admitted.
Patients having a low-risk score are potential candidates for early discharge and outpatient treatment Patients with absent Right ventricular dysfunction and a normal troponin level can be discharged and put on out-patient treatment[2].
Discharge Medications
Outpatient administration of LMWH is as safe as unfractionated heparin administered in hospital for the treatment of DVT.
References
- ↑ Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, Bengel F, Brady AJ, Ferreira D, Janssens U, Klepetko W, Mayer E, Remy-Jardin M, Bassand JP (2008). "Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)". Eur. Heart J. 29 (18): 2276–315. doi:10.1093/eurheartj/ehn310. PMID 18757870. Retrieved 2011-12-07. Unknown parameter
|month=
ignored (help) - ↑ Agnelli G, Becattini C (2010). "Acute pulmonary embolism". N Engl J Med. 363 (3): 266–74. doi:10.1056/NEJMra0907731. PMID 20592294.