Kartika Widayati Taroeno Hariadi(1*)

(*) Corresponding Author



Acute pulmonary embolisms is a major cause of complications and death associated in surgery, medical illnesses, injury, and also may occurs after  a long-distance air travel. It is often originating from deep-vein thrombosis and has a wide spectrum of clinical manifestation ranging from asymptomatic, incidentally discovered emboli, to massive embolism causing immediate death. Incidence of pulmonary embolism ranges from 23-69 cases per 100,000 populations. Case fatality rates vary widely depending on the severity of the cases; at an average case fatality rate within 2 week of diagnosis of approximately 11%. It may have chronic sequele as post thrombotic syndrome and chronic thromboembolism pulmonary hypertension.

            Acute pulmonary embolism is often difficult to diagnose. The predisposing factors for pulmonary embolisms consist of hereditary factors, acquired factors, and probable factors. Patients with symptoms of dyspnea, chest apnea, tachypnea or tachycardia arise suspiciousness of pulmonary embolisms therefore should be screened their probability for developing the disease. Low risk patients will then be evaluated for d-dimer test. Treatment should be initiated promptly in high risk patients, followed by imaging procedure evaluation. Chest radiographs, CT scan arteriography, VQ scan are performed to either include or exclude diagnosis of pulmonary embolisms.

            Treatments consist of thrombolysis for acute and unstable massive pulmonary embolisms, and anticoagulation with heparin for stable acute pulmonary embolism. A meta-analysis of several major trials showed that low molecular weight heparin is at least as effective as unfractionated heparin in preventing the recurrence of venous thromboembolism events and at least as safe with respect to the rate of major bleeding.

            This review will further describe in detail the pathomechanisms, diagnosis, and management of acute pulmonary embolisms.



Konstantinides S. Acute Pulmonary Embolism. N Engl J Med 2008;359:2804-13.

Goldhaber S.Z. Pulmonary thromboembolism in Kasper D.L., Braunwald E., Fauci A.S.,Harrison's Principles of Internal Medicine (16th ed.). New York, NY: McGraw-Hill. 2005 pp. 1561–65.

Tapson V.F. Acute Pulmonary Embolism. N Engl J Med 2008;358:1037-52.

Leizorovicz A, Turpie A.G.G., Cohen A.T., Wong L., Yoo M.C., Dans A. Epidemiology of venous thromboembolism in Asian patients undergoing major orthopedic surgery without thromboprophylaxis: the SMART Study. J Thromb Haemost 2005; 3:28-34.

Torbicki A, Perrier A, Konstantinides S. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur. Heart J. 2008;29:(18): 2276–315.

Goldhaber S.Z., Elliott C.G. Acute Pulmonary Embolism: Part I Epidemiology, Pathophysiology, and Diagnosis. Circulation. 2003;108:2726-2729

Goldhaber S.Z. and Elliott C.G. Acute Pulmonary Embolism: Part II: Risk Stratification, Treatment, and Prevention. Circulation 2003;108;2834-2838

Becattini C., Vedovati M.C., Agnelli G. Prognostic Value of Troponins in Acute Pulmonary Embolism A Meta-Analysis. Circulation. 2007;116:427-433

Wells P.S.., Ginsberg J.S., Anderson D.R. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med 1998;129:997- 1005.

Wells P.S., Anderson D.R., Rodger M. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and D-dimer. Ann Intern Med: 2001;1:35:98-107.

Wells P.S., Anderson D.R., Rodger M. Derivation of a simple clinical model to categorize patients‘ probability of pulmonary embolism: increasing the model’s utility with the SimpliRED D-dimer. Thromb Haemost 2000;83:41717-20.

Fedullo, P.F.; Tapson V.F.The Evaluation of Suspected Pulmonary Embolism. N Engl J Med 2003;349:1247-56

Palareti G.,Cosmi B., Legnani C, Tosetto A, Brusi C. ,Iorio A. for the PROLONG Investigators. D-Dimer Testing to Determine the Duration of Anticoagulation Therapy. N Engl J Med 2006;355:1780-9.

Lee A.Y., Levine M.N., Baker R.I., Bowden C, Kakkar A.K. , Prins M, Rickles F.R., Julian J.A., Haley S, Kovacs M.J., Gent M. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003; 349 (2): 146–53.

Schulman S, Kearon C, Kakkar A.K., Mismetti, Schellong S, Eriksson H for the RE-COVER Study Group. Dabigatran versus Warfarin in the Treatment of Acute Venous Thromboembolism. N Engl J Med 2009;361:2342-52.

Kucher N, Rossi E,De Rosa M, Goldhaber S.Z.Massive Pulmonary Embolism Circulation 2006;113:577-582

Wan S., Quinlan D.J., Agnelli G., Eikelboom J.W. Thrombolysis Compared With Heparin for the Initial Treatment of Pulmonary Embolism A Meta-Analysis of the Randomized Controlled Trials. Circulation. 2004;110:744-749.

Warkentin T.E., Greinacher A., Koster A., Lincoff A.M. Treatment and prevention of heparin-induced thrombocytopenia: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 2008;133:Suppl:340S-380S.

Fedullo P.F. Auger W.R, Kerr K.M., Rubin L.J. Chronic Thromboembolic Pulmonary Hypertension. N Engl J Med 2001;345:1465-1472.

Gibson N.S., Sohne M., Gerdes, V.E.A.,Nijkeuter M.,Buller H.R. The Importance of Clinical Probability Assessment in Interpreting a Normal d-Dimer in Patients with Suspected Pulmonary Embolism. Chest 2008:134:789-793.

Eichinger S., Weltermann A., Minar E., Stain M., Scho’nauer V.,Schneider B. Symptomatic Pulmonary Embolism and the Risk of Recurrent Venous Thromboembolism. Arch Intern Med 2004:164:92-96

Prandoni P., Noventa F., Ghirarduzz A., Pengo V., Bernard E. The Risk of Recurrent Venous Thromboembolism after Discontinuing Anticoagulation in Patients with Acute Proximal Deep Vein Thrombosis or Pulmonary Embolism. A Prospective Cohort Study in 1,626 Patients.Haematologica 2007; 92:199-205.

Mismetti P.,Quenet S., Levine M. Enoxaparin in the Treatment of Deep Vein Thrombosis With or Without Pulmonary Embolism An Individual Patient Data Meta-analysis. Chest 2005; 128:2203–2210.

Nijkeuter M., So¨hne M, Tick L.W. The Natural Course of Hemodynamically Stable Pulmonary Embolism: Clinical Outcome and Risk Factors in a Large Prospective Cohort Study. Chest 2007; 131:517–523.

Becattini C.,Agnelli G.,Pesavento R. Incidence of Chronic Thromboembolic Pulmonary Hypertension after a First Episode of Pulmonary Embolism. Chest 2006;130:172-175

Grifoni S., Vanni S.,Magazzini S. Association of Persistent Right Ventricular Dysfunctionat Hospital Discharge After Acute Pulmonary Embolism With Recurrent Thromboembolic Events. Arch Intern Med. 2006;166:2151-2156

Quiros R., Kucher N.,Zou K.H. Clinical Validity of Negative Computed Tomography Scan in Patients with Suspected Pulmonary Embolisms a Systematic Review. JAMA 2005;293:2012-2017

Eichinger S.,Heinze G., Jandeck L.M., Kyrle P.A., Risk Assessment of Recurrence in Patients With Unprovoked Deep Vein Thrombosis or Pulmonary Embolism: The Vienna Prediction Model Circulation 2010; 121: 1630 - 1636.


Article Metrics

Abstract views : 318 | views : 104


  • There are currently no refbacks.

Copyright (c) 2011 Acta Interna The Journal of Internal Medicine

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Acta Interna The Journal of Internal Medicine Indexed by:


 Indonesia Onesearch Google Scholar IPI Indonesian Publication Index

 website statistics View My Stats  



Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.