ABSTRACT
I. Introduction 480
II. Etiology 480
A. Inherited Risk Factors 481
Antithrombin, Protein C, and Protein S Deficiencies 481
Factor V Leiden 481
Prothrombin G20210A Mutation 481
B. Acquired Risk Factors 482
III. Prognosis 482
A. Echocardiography 483
B. BNP and Cardiac Troponins 483
IV. Therapy 484
V. Diagnostic Strategies 485
A. Proper Methodological Evaluation of
Diagnostic Strategies 485
Summary of Phases in Implementing New
Diagnostic Strategies 485
B. Criteria in Reviewing Clinical Outcome Studies 486
C. Clinical Strategies to Exclude or Confirm
Pulmonary Embolism 486
Which Strategies Have Proven to Safely Exclude
Pulmonary Embolism? 486
Which Strategies Have Proven to Adequately Confirm
Pulmonary Embolism? 489
D. Recommended Diagnostic Algorithms 492
References 492
I. Introduction
In western society, pulmonary embolism is a common disease in both in-and out-
patients, with an estimated incidence of one to two per 1000 inhabitants per year.
This number increases with age, likely because of the higher prevalence of
known risk factors for pulmonary embolism in the elderly. Besides increasing
age, many other factors including previous venous thromboembolism, malig-
nancy, immobilization, surgery, pregnancy, the use of oral contraceptives, and
genetic risk factors are known to increase the incidence of pulmonary embolism.
