The Diagnostic Assessment of Suspected Pulmonary Embolism on the Acute Medical Take: An Evidence Based Guide

2007 ◽  
Vol 6 (1) ◽  
pp. 20-26
Author(s):  
Alastair Proudfoot ◽  
◽  
Derek Bell ◽  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Clinical Presentation ◽  
Diagnostic Assessment ◽  
Evidence Based ◽  
Suspected Pulmonary Embolism ◽  
The Subject ◽  
Adjusted Incidence ◽  
Age And Sex

Pulmonary Embolism is a common cardiopulmonary illness with an age and sex adjusted incidence of around 117 cases per 100 000 person years. The clinical presentation is extremely heterogeneous and non specific. Risk factors for venous thromboembolism are well established. When combined with presenting features and investigations. a multimodality algorithm has led to significant changes in the diagnostic approach of suspected PE. While the best combination of tests for any individual patient remains the subject of controversy this article aims to rationalise the acute physician’s approach to diagnosis and use of available investigations.

scholarly journals Advances in the diagnosis of acute pulmonary embolism

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 44 ◽  
Author(s):  
Ella Ishaaya ◽  
Victor F. Tapson
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Clinical Presentation ◽  
Diagnostic Testing ◽  
Lung Imaging ◽  
Common Disease ◽  
Evidence Based ◽  
Imaging Studies ◽  
Laboratory Findings

Venous thromboembolism is a common disease which remains underdiagnosed because of nonspecific presentations which can range from asymptomatic incidental imaging findings to sudden death. Symptoms can overlap with comorbid cardiopulmonary disease, and risk factors that offer clues to the clinician are not always present. The diagnostic approach can vary depending on the specific clinical presentation, but ruling in the diagnosis nearly always depends on lung imaging. Overuse of diagnostic testing is another recognized problem; a cautious, evidence-based approach is required, although physician gestalt must be acknowledged. The following review offers an approach to the diagnosis of acute pulmonary embolism based on the assessment of symptoms, signs, risk factors, laboratory findings, and imaging studies.

scholarly journals Forty-One-Year-Old Man with Pulmonary Embolism 5 Months After COVID-19

2021 ◽  
Vol 15 ◽  
pp. 117954842098665
Author(s):  
Muhanad Taha ◽  
Paul Nguyen ◽  
Aditi Sharma ◽  
Mazen Taha ◽  
Lobelia Samavati
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Venous Thrombosis ◽  
Case Summary ◽  
One Year

Background: Hypercoagulation is one of the striking features of COVID-19. Patients hospitalized with COVID-19 are at high risk for venous thromboembolism. However, it is unknown if the risk for venous thromboembolism persists after discharge. Case Summary: We report a case with pulmonary embolism 5 months after COVID-19. No risk factors for venous thrombosis have been identified. Conclusion: In COVID-19 related hospitalization, large studies are needed to identify the risk of venous thromboembolism after discharge.

scholarly journals Importance of risk factors for the evaluation of patients with a suspected pulmonary embolism

2015 ◽  
Vol 9 (6) ◽  
pp. 2281-2284 ◽  
Author(s):  
JOACHIM GRUETTNER ◽  
TIM VIERGUTZ ◽  
MERLE BOLTE ◽  
THOMAS HENZLER ◽  
STEFAN O. SCHOENBERG ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Suspected Pulmonary Embolism

Venous Thromboembolism

2020 ◽  
Author(s):  
Samuel Z. Goldhaber
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Antithrombotic Agents ◽  
Vein Thrombosis ◽  
Recurrent Venous Thrombosis ◽  
Deep Vein ◽  
D Dimer ◽  
In Pregnancy

Venous thromboembolism, which involves venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients and is being seen with increasing frequency in outpatients. This chapter discusses the risk factors, etiology, classification, pathophysiology, natural history, prognosis, diagnosis (including venous thrombosis, recurrent venous thrombosis, and pulmonary embolism), prophylaxis, and treatment of venous thromboembolism (including the pharmacology of antithrombotic agents), as well as venous thromboembolism in pregnancy and miscellaneous thromboembolic disorders (including thrombosis of unusual sites).  This review contains 8 figures, 16 tables, and 79 references. Keywords: Venous thromboembolism, pulmonary embolism, deep vein thrombosis, embolectomy, thrombolysis, hypercoagulability, duplex ultrasonography, D-dimer, anticoagulation

Incidence and risk factors of preoperative venous thromboembolism and pulmonary embolism in patients with ovarian cancer

2020 ◽  
Vol 190 ◽  
pp. 129-134
Author(s):  
Shanhui Liang ◽  
Wei Tang ◽  
Shuang Ye ◽  
Libing Xiang ◽  
Xiaohua Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ovarian Cancer ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism

Impact of Delay in Clinical Presentation on the Diagnostic Management and Prognosis of Patients with Suspected Pulmonary Embolism

2013 ◽  
Vol 187 (12) ◽  
pp. 1369-1373 ◽  
Author(s):  
Paul L. den Exter ◽  
Josien van Es ◽  
Petra M. G. Erkens ◽  
Mark J. G. van Roosmalen ◽  
Pim van den Hoven ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Presentation ◽  
Suspected Pulmonary Embolism ◽  
Diagnostic Management

scholarly journals Ischemic Stroke in Infants and Children: Practical Management in Emergency

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Sara Ciccone ◽  
Michela Cappella ◽  
Caterina Borgna-Pignatti
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Rare Disease ◽  
Clinical Picture ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Signs And Symptoms ◽  
The Subject ◽  
Underlying Diseases ◽  
In Infants And Children

Stroke is a rare disease in children, with an estimated incidence 13/100000 and a significant impact on morbidity and mortality. Clinical presentation and risk factors, present in almost half of pediatric patients, are not the same as in adults. The diagnosis of stroke in children is often delayed because signs and symptoms can be subtle and nonspecific. History and clinical examination should exclude underlying diseases or predisposing factors. Neuroimaging is crucial in defining diagnosis. Other tests might be necessary, according to the clinical picture. We present here the most recent practical directions on how to diagnose and manage arterial stroke in children, according to different international guidelines on the subject.

scholarly journals Association between cardiovascular risk-factors and venous thromboembolism in a large longitudinal study of French women

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
C. J. MacDonald ◽  
A. L. Madika ◽  
M. Lajous ◽  
M. Canonico ◽  
A. Fournier ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Pulmonary Embolism ◽  
Cardiovascular Risk ◽  
Venous Thromboembolism ◽  
Cardiovascular Risk Factors ◽  
Arterial Disease ◽  
Population Based ◽  
Cox Models ◽  
Vein Thrombosis

Abstract Background Previous studies have shown conflicting results regarding the influence of cardiovascular risk-factors on venous thromboembolism. This study aimed to determine if these risk-factors, i.e. physical activity, smoking, hypertension, dyslipidaemia, and diabetes, were associated with the risk of venous thromboembolism, and to determine if these associations were confounded by BMI. Methods We used data from the E3N cohort study, a French prospective population-based study initiated in 1990, consisting of 98,995 women born between 1925 and 1950. From the women in the study we included those who did not have prevalent arterial disease or venous thromboembolism at baseline; thus 91,707 women were included in the study. Venous thromboembolism cases were self-reported during follow-up, and verified via specific mailings to medical practitioners or via drug reimbursements for anti-thrombotic medications. Hypertension, diabetes and dyslipidaemia were self-reported validated against drug reimbursements or specific questionnaires. Physical activity, and smoking were based on self-reports. Cox-models, adjusted for BMI and other potential risk-factors were used to determine hazard ratios for incident venous thromboembolism. Results During 1,897,960 person-years (PY), 1, 649 first incident episodes of thrombosis were identified at an incidence rate of 0.9 per 1000 PY. This included 505 cases of pulmonary embolism and 1144 cases of deep vein thrombosis with no evidence of pulmonary embolism. Hypertension, dyslipidaemia, diabetes, smoking and physical activity were not associated with the overall risk of thrombosis after adjustment for BMI. Conclusions Traditional cardiovascular risk factors were not associated with the risk of venous thromboembolism after adjustment for BMI. Hypertension, dyslipidaemia and diabetes may not be risk-factors for venous thromboembolism.

scholarly journals Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: a narrative review

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yasser Sakr ◽  
Manuela Giovini ◽  
Marc Leone ◽  
Giacinto Pizzilli ◽  
Andreas Kortgen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Hospital Discharge ◽  
Current Data ◽  
Bleeding Events ◽  
Therapeutic Implications ◽  
Therapeutic Anticoagulation ◽  
Life Threatening ◽  
Prophylactic Anticoagulation

Abstract Background Preliminary reports have described significant procoagulant events in patients with coronavirus disease-2019 (COVID-19), including life-threatening pulmonary embolism (PE). Main text We review the current data on the epidemiology, the possible underlying pathophysiologic mechanisms, and the therapeutic implications of PE in relation to COVID-19. The incidence of PE is reported to be around 2.6–8.9% of COVID-19 in hospitalized patients and up to one-third of those requiring intensive care unit (ICU) admission, despite standard prophylactic anticoagulation. This may be explained by direct and indirect pathologic consequences of COVID-19, complement activation, cytokine release, endothelial dysfunction, and interactions between different types of blood cells. Conclusion Thromboprophylaxis should be started in all patients with suspected or confirmed COVID-19 admitted to the hospital. The use of an intermediate therapeutic dose of low molecular weight (LMWH) or unfractionated heparin can be considered on an individual basis in patients with multiple risk factors for venous thromboembolism, including critically ill patients admitted to the ICU. Decisions about extending prophylaxis with LMWH after hospital discharge should be made after balancing the reduced risk of venous thromboembolism (VTE) with the risk of increased bleeding events and should be continued for 7–14 days after hospital discharge or in the pre-hospital phase in case of pre-existing or persisting VTE risk factors. Therapeutic anticoagulation is the cornerstone in the management of patients with PE. Selection of an appropriate agent and correct dosing requires consideration of underlying comorbidities.

scholarly journals Risk of venous thromboembolism associated with Janus kinase inhibitors for rheumatoid arthritis: case presentation and literature review

2021 ◽  
Author(s):  
Shunsuke Mori ◽  
Fumihiko Ogata ◽  
Ryusuke Tsunoda
Keyword(s):  
Rheumatoid Arthritis ◽  
Diabetes Mellitus ◽  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Disease Activity ◽  
Janus Kinase ◽  
Advanced Age ◽  
Jak Inhibitors ◽  
Increased Risk

AbstractJanus kinase (JAK) inhibitors have been developed as disease-modifying antirheumatic drugs. Despite the positive therapeutic impacts of JAK inhibitors, concerns have been raised regarding the risk of venous thromboembolism (VTE), such as deep vein thrombosis (DVT) and pulmonary embolism (PE). A recent post hoc safety analysis of placebo-controlled trials of JAK inhibitors in rheumatoid arthritis (RA) reported an imbalance in the incidence of VTE for a 4-mg daily dose of baricitinib versus placebo. In a recent postmarketing surveillance trial for RA, a significantly higher incidence of PE was reported in treatment with tofacitinib (10 mg twice daily) compared with tofacitinib 5 mg or tumor necrosis factor inhibitors. We also experienced a case of massive PE occurring 3 months after starting baricitinib (4 mg once daily) for multiple biologic-resistant RA. Nevertheless, the evidence to support the role of JAK inhibitors in VTE risk remains insufficient. There are a number of predisposing conditions and risk factors for VTE. In addition to the known risk factors that can provoke VTE, advanced age, obesity, diabetes mellitus, hypertension, hyperlipidemia, and smoking can also contribute to its development. Greater VTE risk is noted in patients with chronic inflammatory conditions, particularly RA patients with uncontrolled disease activity and any comorbidity. Prior to the initiation of JAK inhibitors, clinicians should consider both the number and strength of VTE risk factors for each patient. In addition, clinicians should advise patients to seek prompt medical help if they develop clinical signs and symptoms that suggest VTE/PE. Key Points• Patients with rheumatoid arthritis (RA) are at increased risk of venous thromboembolism (VTE), especially those with uncontrolled, high disease activity and those with comorbidities.• In addition to the well-known risk factors that provoke VTE events, advanced age and cardiovascular risk factors, such as obesity, diabetes mellitus, hypertension, hyperlipidemia, and smoking, should be considered risk factors for VTE.• Although a signal of VTE/pulmonary embolism (PE) risk with JAK inhibitors has been noted in RA patients who are already at high risk, the evidence is currently insufficient to support the increased risk of VTE during RA treatment with JAK inhibitors.• If there are no suitable alternatives, clinicians should prescribe JAK inhibitors with caution, considering both the strength of individual risk factors and the cumulative weight of all risk factors for each patient.

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