Pulmonary embolism

Pulmonary embolism remains a common and potentially preventable cause of death.

This article reviews the epidemiology, clinical features, diagnostic process, and treatment of pulmonary embolism.

Well recognised risk factors include recent hospitalisation, other causes of immobilisation, cancer, and oestrogen exposure. Diagnostic algorithms for pulmonary embolism that incorporate assessment of pretest probability and D-dimer testing have been developed to limit the need for diagnostic imaging. Anticoagulation should be administered promptly to all patients with pulmonary embolism with low molecular weight heparin being the initial anticoagulant of choice, although thrombolysis is indicated for patients presenting with haemodynamic compromise. Following initial anticoagulation warfarin therapy should be continued for a minimum of 3 months. Long term anticoagulation with warfarin should be considered in patients with unprovoked pulmonary embolism, due to an increased risk of recurrence after ceasing anticoagulation. The availability of new anticoagulants is likely to significantly impact on the treatment of patients with pulmonary embolism, although the exact role of these drugs is still to be defined.