Pulmonary embolism: Difference between revisions
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== Definition == |
=== Definition === |
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* Embolism involving the pulmonary arteries, most often thromboembolism, though other etiologies are possible |
* Embolism involving the pulmonary arteries, most often thromboembolism, though other etiologies are possible |
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== Classification == |
=== Classification === |
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* Massive PE, defined by having all of: |
* Massive PE, defined by having all of: |
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** Hypotension, with SBP <90 OR a decrease of 40 for at least 15 minutes; and |
** Hypotension, with SBP <90 OR a decrease of 40 for at least 15 minutes; and |
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* Submassive PE: RV dysfunction or troponins/BNP elevated |
* Submassive PE: RV dysfunction or troponins/BNP elevated |
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* Low risk: no RV dysfunction, no hypotension or shock, troponins/BNP normal |
* Low risk: no RV dysfunction, no hypotension or shock, troponins/BNP normal |
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== Clinical Manifestations == |
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* Regarding fever, low-grade fevers are common, though they rarely exceed 38.3 °C, peak the day that the PE occurs, and gradually resolve over the course of about a week[[CiteRef::PMID17296860]] |
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== Prognosis == |
== Prognosis == |
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Latest revision as of 20:16, 6 March 2026
Definition
- Embolism involving the pulmonary arteries, most often thromboembolism, though other etiologies are possible
Classification
- Massive PE, defined by having all of:
- Hypotension, with SBP <90 OR a decrease of 40 for at least 15 minutes; and
- Requiring pressors; and
- Not explained by another cause
- Submassive PE: RV dysfunction or troponins/BNP elevated
- Low risk: no RV dysfunction, no hypotension or shock, troponins/BNP normal
Clinical Manifestations
- Regarding fever, low-grade fevers are common, though they rarely exceed 38.3 °C, peak the day that the PE occurs, and gradually resolve over the course of about a week1
Prognosis
- Low risk: mortality <1%
- Sub-massive: mortallity 6-12%
- Massive: mortality 55-70%
Management
| CrCl | BMI | Enoxaparin | Dalteparin | Tinzaparin | Unfractionated Heparin |
|---|---|---|---|---|---|
| ≥30 | <40 | 1 mg/kg SC q12h, or
1.5 mg/kg SC q24h |
200 units/kg SC q24h, or
100 units/kg SC q12h |
175 units/kg SC q24h | IV bolus, with continusuous infusion to titrate to anti-Xa 0.3 to 0.7 IU/mL (or corresponding aPTT) |
| ≥40 | 1 mg/kg SC q12h | 100 units/kg SC q12h | |||
| <30 | Any | Aoivd | Avoid | Avoid |
References
- ^ PMID17296860
