Treating Acute Pulmonary Embolism: Outpatient or Inpatient or Somewhere in between

摘要

It is estimated that about 237,000 non-fatal and 294,000 fatal cases of pulmonary embolism occur in the United States each year . Acute pulmonary embolism generally can be classified as either massive pulmonary embolism or non-massive stable pulmonary embolism . Patients with massive acute pulmonary embolism have a poor prognosis and the first few hours is the critical period when the majority of deaths occur. It is during this narrow window when prompt diagnosis and rigorous treatment strategies can save lives . Hemodynamic instability with systemic hypotension, cardiogenic shock, severe dyspnea, or respiratory failure at the time of presentation defines a physiologically massive pulmonary embolism. Massive acute pulmonary embolism is associated with increased risk for early mortality . According to reports from the International Cooperative Pulmonary Embolism Registry (ICOPER), the incidence of mortality at 3 months in patients with hemodynamic instability was 58% compared with 15% in patients who were hemodyna-mically stable .The question is whether this latter group be treated as inpatients or outpatients