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. 2017 Aug 10;5:170. doi: 10.3389/fped.2017.00170

Table 2.

Advantages and disadvantages of diagnostic modalities and therapies.

Advantages and disadvantages of diagnostic tools and therapies in the management of pulmonary embolism in children
Diagnostic Tool Advantages Disadvantages

Ventilation/perfusion scan
  • Safe and easy to perform

  • Low sensitivity

  • False-positives from other diagnosis

  • Difficult in younger patients

  • Technically demanding


CT pulmonary angiography
  • Non-invasive

  • Short study time

  • Widely available

  • Identifies alternate thoracic etiologies

  • May miss small peripheral emboli

  • Radiation exposure, particularly in young females

  • Contraindicated in renal insufficiency


Pulmonary angiography
  • Gold standard

  • Generally diagnostic

  • Invasive

  • Radiation exposure

  • May not be easily available


Magnetic resonance imaging/magnetic resonance pulmonary angiography
  • No need for radiation or contrast

  • Can assess cardiovascular anatomy

  • May miss small peripheral emboli

  • Long duration of examination

  • May not be easily available


Therapy Advantages Disadvantages

Unfractionated heparin (UFH)
  • Short half-life

  • Reversal agent available

  • Continuous intravenous infusion

  • Unable to administer outside of medical setting

  • Possible development of heparin-induced thrombocytopenia (HIT)

  • Frequent monitoring needed

  • Risk of bleeding


Low molecular weight heparin
  • Easy to administer

  • Reversal agent available

  • Effectiveness uncertain in obese patients

  • Possible pain with administration

  • Difficult to achieve therapeutic levels in infants

  • Possible development of HIT (less than UFH)

  • Risk of bleeding


Warfarin
  • Oral

  • Able to monitor therapeutic level

  • Reversible

  • Frequent monitoring

  • Difficult to maintain in therapeutic window in children

  • Multiple drug/food interactions

  • Risk of bleeding


Direct oral anticoagulant
  • Oral

  • No frequent blood draws

  • No way to monitor

  • Few reversal agents

  • Not approved for patients <18 years

  • Risk of bleeding