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LETTERS: Adrian J B Brady Pulmonary embolism in hospital practice: Certain crucial procedures were omitted BMJ 2006; 332: 304 [Full text]

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Risk Stratification of Pulmonary Embolism : does it influence at all how we treat it?

Sujoy Maitra   (5 February 2006)

Risk Stratification of Pulmonary Embolism : does it influence at all how we treat it? 5 February 2006
Sujoy Maitra, SpR General Medicine & Gastroenterology RVI, Newcastle; NE1 4LP Send response to journal: Re: Risk Stratification of Pulmonary Embolism : does it influence at all how we treat it?	Dr Brady highlights the importance of routine troponin, CT scan and Echocardiogram to identify the patients who are more likely to have adverse outcome from a Pulmonary Embolism (PE). At present CT Scan is used as a tool for diagnosing PE in patients who have established lung disease or in whom Ventilation/Perfusion(V/Q) Scan is inconclusive but there is a good clinical suspicion of PE .Apart from that how would it change our practice if we start using CT Scan, troponin or Echocardiogram routinely,simply to stratify risk,in patients where a diagnosis of PE has already been established? Even if all these tests show evidence of RV strain or increased risk of adverse outcome, I believe, we would still continue to treat them with Low molecular weight heparin,with or without an initial bolus of intravenous unfractionated heparin(depending on local practice),as we do at the moment.And obviously we would thrombolyse them if there is significant haemodynamic instability. So as far as I understand doing all these investigations is more of research interest than something which would substantially change the way we treat Pulmonary Embolism at present. Competing interests: None declared