[Strategies for utilization of anticoagulants in pulmonary embolism]

Anticoagulant therapy significantly reduces the incidence of fatal recurrent thromboembolism and mortality. Today, initial anticoagulant therapy in acute pulmonary embolism mostly consists in the use of intravenous non fractioned heparin associated with simultaneous oral anticoagulation. Treatment with non fractioned heparin is continued until the INR is between 2 and 3 for 2 consecutive days. Long term therapy with antivitamin K should be continued for at least 3 months. It is recommended that patients with recurrent venous thromboembolism should be treated indefinitively. Long term anticoagulant therapy will be discussed individually in the presence of a persistent risk factor. Low molecular weight heparins have been evaluated in the initial treatment of patients with acute, hemodynamically stable pulmonary embolism and are as effective and safe as continuous intravenous non fractioned heparin. Low molecular weight heparins will probably replace non fractioned heparin in the initial treatment of acute hemodynamically stable pulmonary embolism, on a short term perspective.