Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:19

1244 Pulmonary Embolism Pulmonary Hypertension

Drug interactions require more frequent testing

Anti-phospholid antibody may require more intensive therapy

➣Duration:

First DVT/PE, reversible risk factors: 3–6 months

Idiopathic DVT/PE:=six months.

Recurrent thromboembolism or continuing risk factors: opti-

mum duration unclear, suggest 1 year then reassess

Consider indefinite if >2 episodes or irreversible risk factor

➣Complications:

Bleeding

Skin necrosis: highest risk in first weeks & in Protein C or S

deficiency

May increase complications from cholesterol emboli

Spontaneous abortions

Embryopathies

➣Contraindications:

Absolute: Pregnancy; hypersensitivity to warfarin; blood

dyscrasias; active bleeding; intracranial hemorrhage, inability

to obtain/follow INRs

Relative: bleeding disorders; GI bleeding or active ulcer;

severe liver disease; protein C or S deficiency; uncontrolled

hypertension; recent surgery; need for invasive procedures;

risk of falling

follow-up

■Monitor anti-coagulation

■DVT prophylaxis with future hospitalizations/bed rest

complications and prognosis

■PE mortality 2.5% at 1 year

■Overall mortality 24% at 1 year (from underlying diseases)

■20–25% with idiopathic DVT/PE have recurrence in 5 years

■Risk of major bleeding: 3–7% per year

PULMONARY HYPERTENSION

MARIA ANSARI, MD

history & physical

History

■Primary Pulmonary HTN(PPH)