Pulmonary embolism in hospital practice: Certain crucial procedures were omitted

doi:10.1136/bmj.332.7536.304

BMJ 2006;332:304 (4 February), doi:10.1136/bmj.332.7536.304

Letter

Pulmonary embolism in hospital practice

Certain crucial procedures were omitted

The first 150 words of the full text of this article appear below.

EDITOR—Robinson says that diagnosis of pulmonary embolismcan be difficult but does not mention the available scoringsystems that are useful in defining the likelihood of pulmonarythromboembolism.^{1 2} Most importantly, she makes no mention ofbiomarkers and does not emphasise the critical importance ofechocardiography or computed tomography scanning to identifyright ventricular strain.

Patients with a raised troponin concentration (I or T) and echoor computed tomographic evidence of right ventricular overloadhave 10 times the risk of death or major adverse event thanindividuals with a normal troponin value and normal right ventricularfunction.^{3 4}

Importantly, the recommendation of low molecular weight heparinas initial treatment for all applies only to stable patients.Patients with shock should receive intravenous heparin, sincecutaneous perfusion is compromised, and low molecular weightheparin may not be absorbed.

Finally, Robinson makes no mention of life saving surgical embolectomyor percutaneous fragmentation . . . [Full text of this article]

Adrian J B Brady, consultant cardiologist

Glasgow Royal Infirmary, Glasgow G31 2ER a.j.brady@clinmed.gla.ac.uk