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Pulmonary Thromboembolism: Title and subTitle BreakDiagnosis and Treatment FREE

Arthur A. Sasahara, MD; G. V. R. K. Sharma, MD; Ernest M. Barsamian, MD; Michael Schoolman, MD; Giuseppe Cella, MD
[+] Author Affiliations

This article is one of a series sponsored by the American Heart Association.

Reprint requests to Veterans Administration Medical Center, 1400 VFW Pkwy, West Roxbury, MA 02132 (Dr Sasahara).


JAMA. 1983;249(21):2945-2950. doi:10.1001/jama.1983.03330450075032
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PULMONARY embolism (PE) is a common complication that usually afflicts patients who are hospitalized for other medical or surgical problems. Its continued prevalence seems to be the result of increasing numbers of older and sicker patients who are hospitalized and subjected to longer periods of bed rest and more complex operations. Although the true incidence of PE is not known, a reasonable estimate can be made from various studies that suggest that fatal PE occurs in about three to five patients per 1,000 inpatients in a general hospital population, including both hipsurgery patients and patients with malignant neoplasms undergoing surgical procedures, and nonfatal PE occurs in about 15 to 20 patients per 1,000 inpatients.

The mortality of undiagnosed and therefore untreated PE is relatively high, ranging from about 18% to 35%,1 whereas, once diagnosed and treated, a substantial reduction to about 8% occurs. This observation underscores the importance of

REFERENCES

Barritt DW, Jordan SC:  Anticoagulant drugs in treatment of pulmonary embolism: Controlled trial . Lancet 1960;;1:1309-1312.
Dalen JE, Haffajee CI, Alpert JS, et al:  Pulmonary embolism, pulmonary hemorrhage and pulmonary infarction . N Engl J Med 1977;; 296:1431-1435.
 The urokinase pulmonary embolism trial: A national cooperative study . Circulation 1973;; 47( (suppl 2) ):II-1-II-108.
Littmann D:  Observations on the electrocardiographic changes in pulmonary embolism , in Sasahara AA, Stein M (eds): Pulmonary Embolic Disease . New York, Grune & Stratton Inc, 1965;, pp 186-198.
Stein PD, Dalen JE, McIntyre KM, et al:  The electrocardiogram in acute pulmonary embolism . Prog Cardiovasc Dis 1975;;17:247-254.
McIntyre KM, Sasahara AA:  The hemodynamic response to pulmonary embolism in patients without prior cardiopulmonary disease . Am J Cardiol 1971;;28:288-294.
McNeill BJ, Holman BL, Adelstein SJ:  The scintigraphic definition of pulmonary embolism . JAMA 1974;;227:753-756.
Sevitt S, Gallagher NG:  Venous thrombosis and pulmonary embolism: A clinico-pathologic study in injured and burned patients . Br J Surg 1961;;48:475-489.
Wheeler HB, O'Donnell JA, Anderson FA:  Occlusive impedance phlebography: A diagnostic procedure for venous thrombosis and pulmonary embolism . Prog Cardiovasc Dis 1974;;17:199-206.
Sasahara AA, Sharma GVRK, Parisi AF:  New developments in the detection and prevention of venous thromboembolism . Am J Cardiol 1979;;43:1214-1224.
Salzman EW, Deykin D, Shapiro RM, et al:  Management of heparin therapy: Controlled prospective trial . N Engl J Med 1975;;292:1046-1051.
Wessler S, Reiner L, Freiman DG, et al:  Serum-induced thrombosis: Studies of its induction and evolution under controlled conditions in vivo . Circulation 1959;;20:864-874.
Coon WW, Willis PW, Symous MJ:  Assessment of anticoagulant treatment of venous thromboembolism . Ann Surg 1969;;170:559-567.
 Urokinase-streptokinase pulmonary embolism trial: Phase 2 results, a cooperative study . JAMA 1974;;229:1606-1613.
Kakkar VV, Howe CT, Laws JW, et al:  Late results of treatment of deep vein thrombosis . Br Med J 1969;;1:810-811.
Kakkar VV:  Results of streptokinase therapy in deep venous thrombosis . Postgrad Med J 1973;;49(August (suppl) ):60-65.
Sharma GVRK, Burleson VA, Sasahara AA:  Effect of thrombolytic therapy on pulmonary capillary blood volume in patients with pulmonary embolism . N Engl J Med 1980;; 303:842-845.
De Soyza NDB, Murphy ML:  Persistent postembolic pulmonary hypertension . Chest 1972;;62:665-668.
 Thrombolytic therapy in thrombosis . NIH Consensus Dev Conf Summ 1980;;3:1-6.
Sasahara AA, Sharma GVRK, Tow DE, et al:  Clinical use of thrombolytic agents in venous thromboembolism . Arch Intern Med 1982;; 142:684-688.
Berstein EF:  The place of venous interruption in the treatment of pulmonary embolism , in Moser KM, Stein M (eds): Pulmonary Thromboembolism . Chicago, Year Book Medical Publishers, 1973;, pp 312-323.
Sasahara AA, Barsamian EM:  Another look at pulmonary embolectomy . Ann Thorac Surg 1973;;16:317-320.

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Barritt DW, Jordan SC:  Anticoagulant drugs in treatment of pulmonary embolism: Controlled trial . Lancet 1960;;1:1309-1312.
Dalen JE, Haffajee CI, Alpert JS, et al:  Pulmonary embolism, pulmonary hemorrhage and pulmonary infarction . N Engl J Med 1977;; 296:1431-1435.
 The urokinase pulmonary embolism trial: A national cooperative study . Circulation 1973;; 47( (suppl 2) ):II-1-II-108.
Littmann D:  Observations on the electrocardiographic changes in pulmonary embolism , in Sasahara AA, Stein M (eds): Pulmonary Embolic Disease . New York, Grune & Stratton Inc, 1965;, pp 186-198.
Stein PD, Dalen JE, McIntyre KM, et al:  The electrocardiogram in acute pulmonary embolism . Prog Cardiovasc Dis 1975;;17:247-254.
McIntyre KM, Sasahara AA:  The hemodynamic response to pulmonary embolism in patients without prior cardiopulmonary disease . Am J Cardiol 1971;;28:288-294.
McNeill BJ, Holman BL, Adelstein SJ:  The scintigraphic definition of pulmonary embolism . JAMA 1974;;227:753-756.
Sevitt S, Gallagher NG:  Venous thrombosis and pulmonary embolism: A clinico-pathologic study in injured and burned patients . Br J Surg 1961;;48:475-489.
Wheeler HB, O'Donnell JA, Anderson FA:  Occlusive impedance phlebography: A diagnostic procedure for venous thrombosis and pulmonary embolism . Prog Cardiovasc Dis 1974;;17:199-206.
Sasahara AA, Sharma GVRK, Parisi AF:  New developments in the detection and prevention of venous thromboembolism . Am J Cardiol 1979;;43:1214-1224.
Salzman EW, Deykin D, Shapiro RM, et al:  Management of heparin therapy: Controlled prospective trial . N Engl J Med 1975;;292:1046-1051.
Wessler S, Reiner L, Freiman DG, et al:  Serum-induced thrombosis: Studies of its induction and evolution under controlled conditions in vivo . Circulation 1959;;20:864-874.
Coon WW, Willis PW, Symous MJ:  Assessment of anticoagulant treatment of venous thromboembolism . Ann Surg 1969;;170:559-567.
 Urokinase-streptokinase pulmonary embolism trial: Phase 2 results, a cooperative study . JAMA 1974;;229:1606-1613.
Kakkar VV, Howe CT, Laws JW, et al:  Late results of treatment of deep vein thrombosis . Br Med J 1969;;1:810-811.
Kakkar VV:  Results of streptokinase therapy in deep venous thrombosis . Postgrad Med J 1973;;49(August (suppl) ):60-65.
Sharma GVRK, Burleson VA, Sasahara AA:  Effect of thrombolytic therapy on pulmonary capillary blood volume in patients with pulmonary embolism . N Engl J Med 1980;; 303:842-845.
De Soyza NDB, Murphy ML:  Persistent postembolic pulmonary hypertension . Chest 1972;;62:665-668.
 Thrombolytic therapy in thrombosis . NIH Consensus Dev Conf Summ 1980;;3:1-6.
Sasahara AA, Sharma GVRK, Tow DE, et al:  Clinical use of thrombolytic agents in venous thromboembolism . Arch Intern Med 1982;; 142:684-688.
Berstein EF:  The place of venous interruption in the treatment of pulmonary embolism , in Moser KM, Stein M (eds): Pulmonary Thromboembolism . Chicago, Year Book Medical Publishers, 1973;, pp 312-323.
Sasahara AA, Barsamian EM:  Another look at pulmonary embolectomy . Ann Thorac Surg 1973;;16:317-320.
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