All patients with known PE should be admitted for close monitoring and AC or thrombolytic therapy. Patients strongly suspected of having PE should be admitted if the diagnosis cannot be rapidly confirmed. Generally, the patient should be admitted to the service of an internist, pulmonologist, or cardiologist. A radiologist must be consulted to arrange and interpret invasive and noninvasive leg studies for DVT, V/Q scans, spiral CT, MRI, and pulmonary arteriograms. Consultation with a thoracic surgeon is necessary if pulmonary embolectomy is contemplated.
The decision to initiate AC therapy prior to establishing the diagnosis of PE should be made in consultation with the admitting physician. The clinical situation and degree of suspicion for PE dictate this decision. AC therapy should be continued for at least 3 months in patients with first-time PE. Recurrent PE may dictate the need for chronic AC therapy.
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