By American College of Chest Physicians
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Pulmonary angiography was considered to be the reference “gold standard,” especially with the subselective injection of contrast media and the use of magnified views. A negative finding for a pulmonary angiogram with magnification appears to exclude clinically relevant PE, based on data from two follow-up studies. 5%, and the morbidity rate is about 5% (usually caused by catheter insertion and contrast reactions). Because of the expense and invasiveness of pulmonary angiography, alternative diagnostic algorithms have been sought.
Rubin LJ. American College of Chest Physicians. Diagnosis and management of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest 2004; 126(suppl):75S−105S In this brief introduction to the guidelines, Dr. Rubin gives an excellent review of the evolution and current classification of PH. Schulman S, Granquvist S, Holmstrom M, et al. The duration of oral anticoagulant therapy after a second episode of venous thromboembolism. N Engl J Med 1997; 336:393−398 Prophylactic anticoagulation that was continued for an indefinite period after a second episode of VTE was associated with a much lower rate of recurrence during 4 years 35 7/10/09 8:03:56 PM of follow-up than treatment for 6 months.
Radiology 2005; 234:740−748 Helical CT scanning has better discriminatory power than . V/Q scanning for excluding PE, but the two tests have a similar discriminatory power in the diagnosis of PE when . ” Heit JA, Kobbervig CE, James AH, et al. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 2005; 143:697−706 Among pregnant women, the greatest risk for PE and VTE is during the postpartum period. Prophylaxis should be especially targeted to postpartum women.