Pulmonary embolism - Revision history

DLBronstein: /* Epidemiology */

2026-04-18T21:58:05Z

Epidemiology

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	=== Epidemiology ===		=== Epidemiology ===
	* ~~The best estimates indicate that 350~~,000 ~~to 600~~,000 ~~Americans each year suffer from DVT and PE~~<ref>~~Mozaffarien D~~ et al. Heart ~~disease~~ and ~~stroke statistics~~ - ~~2015 report from~~ the American Heart Association. Circulation. ~~2015~~;~~131~~:~~d29~~-~~e322~~</ref>		*In the US, approximately 370,000-390,000 PE’s are diagnosed annually <ref> Freund Y, Cohen-Aubart F, Bloom B. Acute Pulmonary Embolism: A Review. JAMA. 2022;328(13):1336-1345. doi:10.1001/jama.2022.16815 </ref> <ref> Tsao CW, Aday AW, Almarzooq ZI, et al. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation. 2023;147(8):e93-e621. doi:10.1161/CIR.0000000000001123 </ref>
	* ~~Survival~~<ref>U. S. ~~Department of Health and Human Services~~. ~~www~~.~~ncbi.nlm.nih~~.~~gov/blooks~~/~~NBK44178. The surgeon general's call to prevent deep vein thrombosis and pulmonary embolism. 2008~~</ref>		*Mortality
	**PE is the 3rd leading cause of cardiovascular morbidity and mortality		**Hemodynamically stable (AHA/ACC Class A & B or ESC Low Risk) patients with a PE have a direct mortality of about 1%, however hemodynamically unstable patients mortality ranges from 25-50% <ref> Schultz J, Giordano N, Zheng H, et al. EXPRESS: A Multidisciplinary Pulmonary Embolism Response Team (PERT) - Experience from a national multicenter consortium. Pulm Circ. Published online January 11, 2019. doi:10.1177/2045894018824563 </ref>
	**At least 100,000 deaths per year may be directly or indirectly related to DVT and PE		**For almost one quarter of PE patients, the initial clinical presentation is sudden death <ref> Walls R, Hockberger R, Gausche-Hill M, Erickson TB, & Wilcox SR. (2022). Rosen's Emergency Medicine - Concepts and Clinical Practice E-Book (10th ed.). Elsevier - OHCE. </ref>
	**For almost one quarter of PE patients, the initial clinical presentation is sudden death
	**PE is an independent predictor of reduced survival for ≤3 months
	**One of the leading causes of out-of-hospital, non-trauma related sudden deaths <ref>~~Tintinalli~~, ~~J. E~~. (~~2016~~). ~~Venous Thromboembolism In J.E. Tintinali (8th Ed.), Tintinalli~~'s Emergency Medicine~~: A Comprehensive Study Guide~~ (pp. ~~389~~-~~390)~~. ~~New York, New York: McGraw Hill Education~~</ref>

	==Clinical Features==		==Clinical Features==

DLBronstein: /* Background */

2026-04-18T20:58:35Z

Background

← Older revision		Revision as of 20:58, 18 April 2026
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	*[[Fat_embolism_syndrome\|Fat]], [[Arterial_gas_embolism\|Air]], and tumor embolisms can similarly and obstruct a branch of the pulmonary artery, but are not covered in this section		*[[Fat_embolism_syndrome\|Fat]], [[Arterial_gas_embolism\|Air]], and tumor embolisms can similarly and obstruct a branch of the pulmonary artery, but are not covered in this section
	*A pulmonary embolism is on the spectrum of [[Venous_thromboembolism\|Venous thromboembolism (VTE)]]		*A pulmonary embolism is on the spectrum of [[Venous_thromboembolism\|Venous thromboembolism (VTE)]]
	*Most emboli are thought to arise from lower extremity proximal veins (iliac, femoral, and popliteal), whereas a thrombus of the distal veins (calf) resolves spontaneously ⅔ of the time <ref> Kearon C. Natural history of venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I22-I30. doi:10.1161/01.CIR.0000078464.82671.78 </ref>		*Most emboli are thought to arise from lower extremity proximal veins (iliac, femoral, and popliteal), whereas a thrombus of the distal veins (calf) resolves spontaneously ⅔ of the time <ref> Kearon C. Natural history of venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I22-I30. doi:10.1161/01.CIR.0000078464.82671.78 </ref> <ref> Lautz TB, Abbas F, Walsh SJ, et al. Isolated gastrocnemius and soleal vein thrombosis: should these patients receive therapeutic anticoagulation?. Ann Surg. 2010;251(4):735-742. doi:10.1097/SLA.0b013e3181c1ae95 </ref> <ref> Macdonald PS, Kahn SR, Miller N, Obrand D. Short-term natural history of isolated gastrocnemius and soleal vein thrombosis. J Vasc Surg. 2003;37(3):523-527. doi:10.1067/mva.2003.149 </ref>

	[[File:Computed tomograph of pulmonary vessels.jpg\|thumb\|Pulmonary emboli can be classified according to the level along the pulmonary arterial tree.]]		[[File:Computed tomograph of pulmonary vessels.jpg\|thumb\|Pulmonary emboli can be classified according to the level along the pulmonary arterial tree.]]

DLBronstein: /* Background */

2026-04-18T20:57:15Z

Background

← Older revision		Revision as of 20:57, 18 April 2026
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	*[[Fat_embolism_syndrome\|Fat]], [[Arterial_gas_embolism\|Air]], and tumor embolisms can similarly and obstruct a branch of the pulmonary artery, but are not covered in this section		*[[Fat_embolism_syndrome\|Fat]], [[Arterial_gas_embolism\|Air]], and tumor embolisms can similarly and obstruct a branch of the pulmonary artery, but are not covered in this section
	*A pulmonary embolism is on the spectrum of [[Venous_thromboembolism\|Venous thromboembolism (VTE)]]		*A pulmonary embolism is on the spectrum of [[Venous_thromboembolism\|Venous thromboembolism (VTE)]]
	*Most emboli are thought to arise from lower extremity proximal veins (iliac, femoral, and popliteal), whereas a thrombus of the distal veins (calf) resolves spontaneously ⅔ of the time		*Most emboli are thought to arise from lower extremity proximal veins (iliac, femoral, and popliteal), whereas a thrombus of the distal veins (calf) resolves spontaneously ⅔ of the time <ref> Kearon C. Natural history of venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I22-I30. doi:10.1161/01.CIR.0000078464.82671.78 </ref>

	[[File:Computed tomograph of pulmonary vessels.jpg\|thumb\|Pulmonary emboli can be classified according to the level along the pulmonary arterial tree.]]		[[File:Computed tomograph of pulmonary vessels.jpg\|thumb\|Pulmonary emboli can be classified according to the level along the pulmonary arterial tree.]]

DLBronstein: /* Background */

2026-04-18T20:54:10Z

Background

← Older revision		Revision as of 20:54, 18 April 2026
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	==Background==		==Background==
			Pulmonary embolism is an obstruction of one of the branches of the pulmonary arteries by material; typically a thrombus
			*[[Fat_embolism_syndrome\|Fat]], [[Arterial_gas_embolism\|Air]], and tumor embolisms can similarly and obstruct a branch of the pulmonary artery, but are not covered in this section
			*A pulmonary embolism is on the spectrum of [[Venous_thromboembolism\|Venous thromboembolism (VTE)]]
			*Most emboli are thought to arise from lower extremity proximal veins (iliac, femoral, and popliteal), whereas a thrombus of the distal veins (calf) resolves spontaneously ⅔ of the time

	[[File:Computed tomograph of pulmonary vessels.jpg\|thumb\|Pulmonary emboli can be classified according to the level along the pulmonary arterial tree.]]		[[File:Computed tomograph of pulmonary vessels.jpg\|thumb\|Pulmonary emboli can be classified according to the level along the pulmonary arterial tree.]]
	~~{{Venous thromboembolism types}}~~

	{{PE types}}		{{PE types}}

Danbot: Embed Aa Gradient Calculator on clinical page

2026-03-22T09:55:42Z

Embed Aa Gradient Calculator on clinical page

← Older revision		Revision as of 09:55, 22 March 2026
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	== Calculators ==		== Calculators ==
			{{Aa Gradient Calculator}}
	{{Wells_PE_Calculator}}		{{Wells_PE_Calculator}}

Danbot: Move calculators to own section with header (visible in TOC), expanded, before External Links

2026-03-21T15:04:06Z

Move calculators to own section with header (visible in TOC), expanded, before External Links

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 *[[Cardiac ultrasound]]
 {{Thrombolysis Submassive PE Trials}}
 ==External Links==
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 {{Reflist|2}}
 [[Category:Cardiology]]
 [[Category:Pulmonary]]
 [[Category:Vascular]]

Danbot: Add PERC Rule calculator (collapsible)

2026-03-21T13:41:55Z

Add PERC Rule calculator (collapsible)

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	<div class="mw-collapsible-content">		<div class="mw-collapsible-content">
	{{Wells_PE_Calculator}}		{{Wells_PE_Calculator}}
			</div>
			</div>

			<div class="mw-collapsible mw-collapsed" style="border:1px solid #aaa; padding:5px; margin-top:10px;">
			<div style="font-weight:bold;">📊 PERC Rule Calculator [show]</div>
			<div class="mw-collapsible-content">
			{{PERC_Calculator}}
	</div>		</div>
	</div>		</div>

Danbot: Add Wells Score for PE calculator (collapsible)

2026-03-21T13:41:50Z

Add Wells Score for PE calculator (collapsible)

← Older revision		Revision as of 13:41, 21 March 2026
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	{{Reflist\|2}}		{{Reflist\|2}}


			<div class="mw-collapsible mw-collapsed" style="border:1px solid #aaa; padding:5px; margin-top:10px;">
			<div style="font-weight:bold;">📊 Wells Score for PE Calculator [show]</div>
			<div class="mw-collapsible-content">
			{{Wells_PE_Calculator}}
			</div>
			</div>
	[[Category:Cardiology]]		[[Category:Cardiology]]
	[[Category:Pulmonary]]		[[Category:Pulmonary]]
	[[Category:Vascular]]		[[Category:Vascular]]

Danbot: Add MedicationDose SMW annotations for anticoagulation (enoxaparin, heparin, rivaroxaban, apixaban); dosing verified per ACCP/ESC guidelines

2026-03-20T16:23:40Z

Add MedicationDose SMW annotations for anticoagulation (enoxaparin, heparin, rivaroxaban, apixaban); dosing verified per ACCP/ESC guidelines

← Older revision		Revision as of 16:23, 20 March 2026
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	\|}		\|}


			<div style="display:none">
			<!-- SMW MedicationDose annotations for PE anticoagulation -->
			{{MedicationDose\|drug=Enoxaparin\|dose=1 mg/kg SC q12h\|route=SC\|context=Anticoagulation (1st line, LMWH)\|indication=Pulmonary embolism\|notes=Preferred in cancer, liver disease, coagulopathy, pregnancy}}
			{{MedicationDose\|drug=Unfractionated heparin\|dose=80 units/kg IV bolus, then 18 units/kg/hr continuous infusion\|route=IV drip\|context=Anticoagulation (preferred if rapid reversal needed)\|indication=Pulmonary embolism\|display=Heparin (UFH)\|notes=Short half-life; preferred if considering thrombolytics or bleeding risk}}
			{{MedicationDose\|drug=Rivaroxaban\|dose=15 mg PO BID x3 weeks, then 20 mg PO daily\|route=PO\|context=Anticoagulation (DOAC)\|indication=Pulmonary embolism\|notes=Preferred if parenteral therapy to be avoided}}
			{{MedicationDose\|drug=Apixaban\|dose=10 mg PO BID x1 week, then 5 mg PO BID\|route=PO\|context=Anticoagulation (DOAC)\|indication=Pulmonary embolism}}
			</div>
	==See Also==		==See Also==
	*[[Pulmonary Embolism in Pregnancy]]		*[[Pulmonary Embolism in Pregnancy]]

Benalexander: /* Less common risk factors */ Add sickle cell disease

2025-08-05T18:59:09Z

Less common risk factors: Add sickle cell disease

← Older revision		Revision as of 18:59, 5 August 2025
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	*Protein S deficiency		*Protein S deficiency
	*Hyperhomocysteinemia		*Hyperhomocysteinemia
			*[[Sickle cell crisis\|Sickle cell anemia]] (S/S and S/beta thalassemia)<ref>Naik RP, et al. Venous thromboembolism in adults with sickle cell disease: A serious and under-recognized complication. ''Am J Med''. 2013;125(5):443-449.</ref>

	===Evaluate bleeding risk (HAS-BLED)===		===Evaluate bleeding risk (HAS-BLED)===