**13. Conclusion**

58 Pulmonary Embolism

et al., 2010). Therefore, if d-dimer test results are negative, deep vein thrombosis or pulmonary embolism is unlikely to be present, but positive test results are not useful in patients

The use of d-dimers as a secondary strategy to exclude the diagnosis of VTE has been recommended because the test has a high sensitivity, although a low specificity. False positives may occur in patients with recent trauma or surgery, malignancy, pregnancy,

The mortality rate for hospitalized patients > 65 with pulmonary embolism is 21%. If pulmonary embolism is the primary diagnosis, the mortality rate is 13%; if it is a secondary diagnosis, the rate is 31%. Thus, many diseases and medical conditions--including heart failure, chronic obstructive pulmonary disease, cancer, myocardial infarction, stroke, and hip fracture--greatly increase the risk of death among hospitalized patients > 65 with pulmonary embolism. Prognosis is poorest for patients with severe underlying cardiac or

In patients > 65 with a pulmonary embolus, the recurrence rate in the first year is 8%, and the 1-year mortality rate is 39% (21% inpatient mortality and an additional 18% mortality during the first year). Elderly patients with deep vein thrombosis but without pulmonary

Pulmonary embolectomy is not recommended in the elderly because it has a very low success rate and medical therapy is generally quite effective. These procedures should

**Heparin** prevents clot formation and extension. As the risk of death from pulmonary embolism is the greatest in the first few hours of development of a clot and since diagnostic test results often are not available for 8 to 12 hours, heparin should be given to patients with a moderate to high clinical probability of pulmonary embolism or deep vein thrombosis until all diagnostic results are available. Low-molecular-weight heparin (LMWH) is preferred to unfractionated heparin. **LMWH** can be given subcutaneously once or twice a

Long-term anticoagulation is begun in the hospital with heparin and is continued after

**Thrombolytic (fibrinolytic) therapy** should be considered for patients with deep vein thrombosis involving the iliofemoral system. It is also useful for patients with massive pulmonary embolism who have significant pulmonary hypertension, obstruction of multiple segments of the pulmonary circulation, right ventricular dysfunction, or systemic

Prophylaxis reduces the incidence of fatal pulmonary emboli by two thirds in hospitalized patients at risk of developing venous clots. LMWH (eg, enoxaparin 40 mg sc once daily) is as effective and safe as prophylaxis with subcutaneous heparin (5000 IU sc bid or tid) and may reduce drug-induced adverse effects. Postoperative prophylaxis with LMWH (eg, sc q 12 h for up to 14 days) also dramatically reduces the incidence of venous thrombosis after

> 70.

severe infections, and liver disease.

emboli have a 21% mortality rate in the first year.

regularly be found in the armamentarium of geriatritians.

day, and laboratory monitoring may not be necessary.

discharge, usually with **warfarin**.

**12.2.5 Prognosis** 

pulmonary disease.

**12.2.6 Treatment** 

hypotension.

**12.2.7 Prophylaxis** 

The approach to older patients should be consistently individualised. New diagnostic methods and therapeutic algorithms used in acute geriatric wards together enable us to treat successfully also multi-morbid patients in advanced age admitted by hospital's doctors. Modern iatrotechniques make possible also the treatment (including recovery) and protect self-sufficiency and preserve quality of life in the elderly being acutely ill.

Physicians committed to the care of elderly patients, are challenged with the diagnosis of venous thrombembolism due to a higher incidence, co-morbidities masking signs and symptoms and burdening referrals (Siccama et al., 2011).

We would like to emphasize the need to permanently think of the possibility of PE in elderly persons with present risk factors and in suspected cases the use of pretest probability scale as Wells or Geneva score as soon as possible (Carrier et al., 2009` Pasha et al., 2010). The requirement of correctly assessed diagnosis and starting of therapeutic procedures is crucial and essential proceeding for giving the hope to patient and generally, from the professional viewpoint, improvement of the prognosis.
