[Management of pulmonary embolism: A 2015 update].
Pulmonary embolism (PE) is a frequent, serious and multifactorial disease, the incidence of which increases with advanced age. In the absence of pathognomonic clinical signs or symptoms, diagnostic management lies in the evaluation of clinical pre-test probability followed by a laboratory or an imaging test. So far, multidetector computed tomography angiography is the diagnostic test of choice to make a positive diagnosis of PE. Anticoagulants at therapeutic dose for at least 3 months constitute the cornerstones of PE therapeutic management. Duration of anticoagulant treatment is modulated according to the presence of transient (surgery, plaster immobilization, bed rest/hospitalization) and chronic/persistent (age, cancer, clinical or biological thrombophilia…) risk factors of PE. Thrombolysis is usually prescribed only for cases of severe PE with arterial hypotension. Arrival of new oral anticoagulants, which have recently been shown to be as effective and as safe as vitamin K antagonist, should simplify and ease ambulatory management of PE and favor more prolonged treatments with anticoagulant for cases of unprovoked PE or PE provoked by a chronic/persistent risk factor.
Centre d'investigations cliniques, service de médecine vasculaire, département de médecine interne, hôpital Saint-Eloi, CHU de Montpellier, université Montpellier I, Inserm CIC-1001, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France. Electronic address: jp-galanaud@chu-montpellier.fr.
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JP
Galanaud
Service d'explorations cardiovasculaires, CHU de Pointe-à-Pitre, 97159 Pointe-à-Pitre cedex, Guadeloupe.
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Blanchet-Deverly
Service de médecine vasculaire, CHU de Grenoble, université Grenoble Alpes, CNRS/TIMC-IMAG UMR 5525/Themas, 38043 Grenoble cedex 09, France.
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Pernod
Centre d'investigations cliniques, service de médecine vasculaire, département de médecine interne, hôpital Saint-Eloi, CHU de Montpellier, université Montpellier I, Inserm CIC-1001, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
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Quéré
D000792:Angiography / Q000379:methods; D000925:Anticoagulants / Q000008:administration & dosage / Q000145:classification / Q000627:therapeutic use; D003131:Combined Modality Therapy; D019468:Disease Management; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D061330:Multidetector Computed Tomography; D009369:Neoplasms / Q000150:complications; D010353:Patient Education as Topic; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000628:therapy; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D011660:Pulmonary Heart Disease / Q000000981:diagnostic imaging / Q000209:etiology; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy; D019851:Thrombophilia / Q000150:complications / Q000188:drug therapy; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000150:complications / Q000000981:diagnostic imaging
D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
Anticoagulant; Anticoagulants; Diagnosis; Diagnostic; Embolie pulmonaire; Epidemiology; New oral anticoagulants; Nouveaux anticoagulants oraux; Pulmonary embolism; Traitement; Treatment; Épidémiologie