Risk Stratification in Pulmonary Embolism

Pulmonary embolism is a common medical problem and although many patients have a benign clinical course there is still appreciable morbidity and mortality associated with the diagnosis. It is generally accepted that thrombolysis is the treatment of choice in patients with haemodynamic compromise but the management of haemodynamically stable patients with large pulmonary embolism is less well defined. A significant proportion of this latter group have a complicated hospital course and require escalation of therapy. There is increasing interest in markers that can potentially identify at risk patients who would benefit from intensive monitoring and therapy. Conversely these markers would also identify low risk patients who could be managed on an outpatient basis alone. This article reviews the current evidence for the use of the clinical history and examination, electrocardiogram, echocardiography, computed tomography and cardiac biochemical markers, principally troponin and brain natriuretic peptide, for risk stratification in pulmonary embolism.