Wednesday, April 23, 2008

Risk stratification in pulmonary embolism

Why is it important? Because there are now so many different management decisions. Is the patient a candidate for thrombolytic therapy? Does the patient need ICU? Is early discharge or out patient treatment an option?

Exciting research over the last few years has validated new tools for establishing risk. Right ventricular function assessment and cardiac biomarkers are useful. In February’s issue of Chest is a study showing high predictive value of the echocardiographic determination of RV to LV diameter ratio. An echocardiogram is often obtained in patients with PE. However, for a bigger bang for the buck, if the patient’s PE is diagnosed via CT, that study be used to obtain the RV to LV diameter ratio.

An editorial accompanying the Chest paper reviews the topic.

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