title: [Update on diagnosis and treatment of high-risk pulmonary embolism].
abstract: BACKGROUND
  High-risk pulmonary embolism (PE) is associated with a significant early mortality, approaching 25%, and is defined by the presence of cardiogenic shock.
  
  
  BACKGROUND
  The high early mortality rate for patients with shock requires a rapid diagnostic approach with bedside tests. Right ventricular dilatation assessed by echocardiography in patients with a high clinical probability for PE confirms the diagnosis without the need for additional testing. Spiral CT pulmonary angiography remains the first line investigation for patients without shock. Anticoagulant treatment should be started as soon as pulmonary embolism is suspected. Fibrinolytic therapy is recommended for patients with high-risk pulmonary embolism. The prognostic value of cardiac biomarkers, such as B natriuretic peptide, troponins and right ventricular dilatation for early mortality has been demonstrated. These markers permit the identification of an intermediate risk group of patients with normotensive pulmonary embolism and prognostic scores have been developed.
  
  
  CONCLUSIONS
  It remains to be established whether fibrinolysis can have a clinical benefit or reduce mortality in patients with intermediate risk pulmonary embolism. A large randomised placebo-controlled study is currently under way to answer this question. Further studies will more clearly define the role of various predictive rules to identify patients requiring hospital care or those who should be considered for outpatient management.
authors: Université Paris-Descartes, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 75015 Paris, France. benjamin.planquette@egp.aphp.fr
authors: B
authors: B
authors: Planquette
authors: L
authors: L
authors: Belmont
authors: Guy
authors: G
authors: Meyer
authors: Olivier
authors: O
authors: Sanchez
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D015415:Biomarkers; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005440:Fluid Therapy; D005602:France / Q000453:epidemiology; D006801:Humans; D015337:Multicenter Studies as Topic; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010102:Oxygen Inhalation Therapy; D018579:Patient Selection; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality; D036542:Tomography, Spiral Computed; D020107:Troponin T / Q000097:blood; D014463:Ultrasonography; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D002316:Cardiotonic Agents; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D005338:Fibrin Fibrinogen Degradation Products; D005343:Fibrinolytic Agents; D020107:Troponin T; C036309:fibrin fragment D; D020097:Natriuretic Peptide, Brain