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January 23, 2006

Diagnosis and Management of Pulmonary EmbolismAre We Moving Toward an Outcome Standard?

Arch Intern Med. 2006;166(2):147-148. doi:10.1001/archinte.166.2.147

Pulmonary embolism (PE) is a common and sometimes fatal disease. Diagnosis is challenging because the signs and symptoms are nonspecific. The gold standard test for many years has been pulmonary angiography. Angiography is frequently not performed, however, likely owing to the inconvenience and perceived risks of the procedure. Do we really need to diagnose every PE, regardless of size, that might be identified on invasive testing? The important question may not be who has PE but who is likely to have a recurrent fatal PE? Diagnostic approaches now center on sequential noninvasive testing to help physicians identify patients not likely to have significant venous thromboembolism (VTE), in whom anticoagulation can be safely withheld. Two studies reported in this issue of the ARCHIVES further our understanding about how this can be done in a cost-effective manner by limiting the number of patients who require radiologic imaging.2,3

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