By American College of Chest Physicians
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Extra info for ACCP pulmonary medicine board review
Sorensen HT, Mellemkjaeer L, Steffensen FH, et al. The risk of a diagnosis of cancer after primary deep venous thrombosis or pulmonary embolism. N Engl J Med 1998; 338:1169−1173 Among 15,348 patients with DVT and 11,305 patients with PE, there were 1,727 cases of cancer. 33). Forty percent of patients with a diagnosis of cancer within 1 year of hospitalization for VTE had distant metastases at the time of the diagnosis of cancer. The authors conclude that an aggressive search for hidden cancer in patients presenting with VTE is not warranted.
Treatment with warfarin should not be initiated until the platelet count has returned to normal, especially in those with active thrombosis, as there is the potential for worsening thrombotic complications. Bed rest is not recommended for the treatment of acute DVT unless there is significant pain and swelling. indd 26 entirely as outpatients. Although some patients with PE likely can also be treated as outpatients, the data for this population are less robust. Recently, prognostic scores in patients with acute PE have been developed and validated and may help to accurately identify low-risk patients.
The first is prevention. Because some forms of PAH have clear causal mechanisms, these factors should be eliminated where possible. The second line of treatment is screening of high-risk patients (as previously discussed) because it is generally believed that earlier diagnosis and treatment may improve outcomes. The third is to optimize the therapy for any related diseases, such as heart failure, hypoxemia, sleep disorders, or collagen vascular diseases. The fourth line of therapy is supportive—directed at the consequences of PAH.
ACCP pulmonary medicine board review by American College of Chest Physicians