pulmonary embolism (PE)
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Etiology
- source
- majority of clinically significant pulmonary emboli arise from deep venous thromboses (DVT) in the iliac artery - femoral artery system
- post surgically, the pelvic venous complex is a source of pulmonary emboli
- predisposing factors
- venous disease of the lower extremities
- carcinoma
- heart failure
- postoperative risk of PE elevated for >= 12 weeks after any surgery
- risk of PE 6-12 weeks after surgery markedly < 1-6 weeks
- risk highest for orthopedic & vascular surgery[90]
- recent pelvic or lower abdominal surgery
- prolonged immobilization, includes sitting[24]
- pregnancy
- estrogen therapy
- fracture of hip or leg
- chronic lung disease
- hypercoagulable states
- atrial fibrillation
- beta-thalassemia
- trauma
- hospitalization for autoimmune disease (HR=10)[25]
Epidemiology
- cause of death in 5-15% of hospitalized patients in US
- detected in 25-30% of routine autopsies
- prevalence of 1% in hospitalized patients
Pathology
- venous thromboembolism
- pulmonary vascular occlusion
- right heart failure
- hypotension
- cerebrovascular ischemia[56]
Clinical manifestations
- pulmonary embolism is generally asymptomatic
- dyspnea (clinical predictor of delayed diagnosis)[77]
- pleuritic chest pain or chest pressure
- apprehension
- cough
- lower extremity edema, leg pain
- tachypnea
- tachycardia
- hemoptysis (clinical predictor of delayed diagnosis)[77]
- accentuation of the pulmonic component of the 2nd heart sound (P2)
- monophonic wheeze, inspiratory & expiratory wheeze
- crackles
- lungs may be clear to auscultation
- fever
- cyanosis
- S4 heart sound
- syncope[8] 9-35%[56][57]
- hypotension[26]
Diagnostic criteria
- use Wells score first prior to PERC (MKSAP19)[4]
- use Wells score first prior to PERC (MKSAP19)
- if Wells score indicates moderate probability of pulmonary embolism. do not use Pulmonary Embolism Rule-Out Criteria[4]
- use Wells score first prior to PERC (MKSAP19)
- Pulmonary Embolism Rule-Out Criteria (PERC) for low risk:[68]
- oxygen saturation > 94%
- heart rate < 100 beats/minute
- age < 50 years
- no unilateral leg swelling
- no hemoptysis
- no recent trauma or surgery
- no prior PE or deep venous thrombosis
- no exogenous estrogen use
- Intermediate risk: right ventricular dysfunction[91]
- High risk: intensive care & reperfusion therapy[91]
Laboratory
- if Pulmonary Embolism Rule-Out Criteria (PERC) of zero, no further testing[4]
- use Wells score first prior to PERC (MKSAP19)[4]
- if Wells score indicates moderate probability of pulmonary embolism, do not use Pulmonary Embolism Rule-Out Criteria[4]
- use Wells score first prior to PERC (MKSAP19)[4]
- pulse oximetry*: low SaO2 (hypoxia)
- arterial blood gas (ABG)* if needed
- hypoxia
- increased P(A-a)O2 gradient correlates with severity
- 20% of patients with PE show normal P(A-a)O2 gradient
- pCO2 is generally diminished
- plasma D-dimer# may be elevated in pulmonary embolism
- increased D-dimers have no positive predictive value
- normal D-dimer excludes PE in < 30% of suspected cases
- negative D-dimer & low clinical probability excludes pulmonary embolism[10][14][17][32]
- elevated plasma D-dimer has very low specificity (11%) in hospitalized patients[67]
- Wells score in combination with plasma d-dimer testing can rule out pulmonary embolism in hemodynamically stable patients who present several days after onset of symptoms suggestive of PE[35]
- Wells score outperforms Geneva scores in ruling out pulmonary embolism in the primary care setting[49]
- YEARS clinical decision rule with plasma d-dimer can eliminate need for computed-tomography pulmonary angiography in 48% of patients vs 34% of patients using Wells score with a fixed cutoff plasma d-dimer of 500 ng/mL[62]
- meta-analysis recommends adjusted D-dimer or YEARS criteria to rule out pulmonary embolism[93]
- D-dimer 3-4 weeks after cessation of warfarin is predictive of thromboembolic recurrence[4]
- -D-dimer adjusted for clinical probability[85]
- < 1000 ng/mL for low-risk patients
- serum chemistries
- serum LDH: increased
- serum bilirubin: increased (normal with MI)
- serum AST may be normal (elevated with MI)
- prostate-specific antigen (PSA) unprovoked PE in men
- serum Ca+2 & serum albumin
- troponin I in serum
- N-terminal pro-BNP in serum
- complete blood count (CBC) leukocytosis
- serum troponin I:
- increase suggests right ventricular strain
- Pap Smear vs HPV DNA for unprovoked venous thromboembolism in women[45]
- most patients with venous thromboembolism do not require
- thrombophilia testing, since results will not affect management[4][65]
- extensive screening for cancer[4]
- see ARUP consult[86]
* a normal pO2 or SaO2 does not rule out PE
# a low pretest probability & Pulmonary Embolism Rule-Out Criteria (PERC) rules out pulmonary embolism, plasma D-dimer & imaging not needed; with a high pretest probability, omit plasma D-dimer, go direct to pulmonary CT angiography or ventilation-perfusion scan if contraindicated or unavailable[50]
Diagnostic procedures
- electrocardiogram
- sinus tachycardia
- infrequent changes: (15%)
- S in lead I
- Q in lead III &/or aVF
- ST segment elevation in leads III &/or aVF[4]
- T wave inversion in lead III, aVF
- right axis deviation
- incomplete right bundle branch block
- inverted T waves in right precordial leads (40%)
- T wave inversions in V2 & V3 more likely unstable angina[87]
- consider use of Pulmonary Embolism Severity Index (PESI) to estimate risk[79]
Radiology
- obtain imaging if D-dimer is positive or Wells score >4[4]
- do not delay treatment for diagnostic testing in symptomatic patients with high pretest probability (Wells score >6)
- chest X-ray: PA & lateral
- normal in 30% of patients
- Hampton's hump on lateral view
- elevated hemidiaphragm may be seen (40%)
- enlarged pulmonary artery (20%)
- pulmonary embolism unlikely if multifocal pulmonary opacities on chest X-ray[104] ***
- evaluation for DVT by Doppler ultrasonography
- 1st diagnostic imaging test in pregnancy[4]
- combined thoracic, cardiac, & lower-extremity ultrasound may reduce need for CT angiography[39]
- point-of-care (bedside) lung & venous ultrasound increases diagnostic performance of Wells criteria for PE[58]
- pulmonary CT angiography unnecessary if DVT has been diagnosed because treatments are the same[4]
- ventilation-perfusion scan (VQ scan) showing VQ mismatch[23]
- administer unfractionated heparin prior to VQ scan (see above)
- method of choice in the evaluation of chronic thromboembolic pulmonary hypertension[4][34]
- preferred method in patients with risk of acute kidney injury
- preexisting kidney disease (chronic renal failure)
- diabetes mellitus
- hypovolemia
- free urinary light chains of multiple myeloma[4]
- method of choice in pregnant patients because of lower radiation exposure than CT angiography[4]
- pulmonary CT angiography (spiral CT) detects emboli[12]
- preferred method of diagnosis in patients with intermediate (moderate) to high-probability pulmonary embolism[4][33]
- detects emboli in main, lobar or segmental arteries but not subsegmental arteries
- 2nd generation helical CT may be better [14]t
- indicated in patients with abnormal D-dimer &/or high clinical suspicion[17]
- pulmonary CT angiography 83% sensitivity[18]
- false positives 26%[48]
- may preclude need for ultrasound of lower extremity to rule out DVT[20]
- more than twice as likely to find an incidental nodule or adenopathy as it is to find PE[21]
- reserve for patients with indeterminate findings on ventilation-perfusion scan (VQ scan)[21]
- can not rule out PE in patients with high pre-test probability[72]
- pulmonary CT angiography for confirmation of abnormal VQ scan[4][15]
- mammography for unprovoked venous thromboembolism in women[45]
- echocardiography
- may show non-collapsing inferior vena cava[100]
- may show right ventricular dilation with septal bowing & preserved ejection fraction[100]
- clot in right atrium (case report)[40]
- CT of abdomen not helpful for detection of cancer in unprovoked venous thromboembolism[45]
*** ARDS more likely if multifocal pulmonary opacities on chest X-ray[104]
Complications
- pulmonary infarction (< 10%)
- recurrent pulmonary embolism (8%)
- for subsegmental pulmonary embolism, recurrent venous thromboembolism within 90 days if not anticoagulated is 3.1% (1.8% if < 65 & 5.5% if > 65 years)[92]
- secondary pulmonary hypertension (0.5-4%) occurs within 2 years[13]
- acute cor pulmonale with obstructive shock occurs when > 65% of vasculature is obstructed by pulmonary embolism
- otherwise unlikely to result in congestive heart failure
- occult malignancy (8% over two years)
- mortality
- 7% when diagnosed at presentation
- highest in first 24 hours
- 30-day mortality 1.7% low-risk, 5.0% submassive, 23% massive PE[99]
- heparin-induced thrombocytopenia
- risk factors[25]
- oxygen saturation <90% on room air
- systolic blood pressure <100 mm Hg
- chest pain requiring opioids
- active bleeding, or were at high risk for hemorrhage
- recent stroke
- gastrointestinal bleeding
- platelet count >75,000/mm3
- older age
- malignant neoplasm (cancer)
- elevated N-terminal pro-BNP in serum
- elevated serum troponin
- hemodynamic instability, serum troponin elevation, & right ventricular dysfunction more common with saddle emboli than with more distal thrombi, but outcomes are similar[66]
- presence of patent foramen ovale may increase risk of embolic stroke in patients with pulmonary embolism[81]
- diagnostic delays worsen prognosis[77]
- 1/3 of patients with initial unprovoked venous thromboembolism who discontinue anticoagulation may experience recurrence within 10 years[84]
Differential diagnosis
- asthma
- bronchopneumonia
- pleurisy
- pericarditis
- pneumothorax
- myocardial infarction
- acute pancreatitis
- perforated peptic ulcer
- fat embolism following long-bone fracture[4]
- pulmonary hypertension*
* if chronic, echocardiography is the first diagnostic test to confirm pulmonary hypertension[100]
Management
Unstable patients
- infuse unfractionated heparin if
- symptomatic patient with high test probability of pulmonary embolism[100]
- high risk of bleeding[100]
- emergent surgery
- pulmomary embolectomy or thrombolytic therapy is likely (diagnostic imaging pending)[4]
- systemic thrombolytic therapy
- indications:
- contraindications: high risk of bleeding
- thrombolytic agent
- pulmonary embolectomy (clot extraction)
- indications
- patients with angiographically-proven pulmonary emboli
- patients who remain in shock despite thrombolytic therapy & supportive care, or
- patients in whom thrombolytic therapy is contraindicated
- use unfractionated heparin if high risk of bleeding[100]
- case fatality rate is not age-dependent[37]
- may improve outcomes relative to anticoagulation[95]
- indications
- intravenous catheter-directed thrombolysis for intermediate & high-risk pulmonary embolism[101]
- lower mortality than systemic thrombolytic therapy or anticoagulation alone
- not recommended[100] without mention of ref[101]
- vena cava filter (see below)
- associated with a reduced in-hospital all-cause case fatality rate in unstable adults with pulmonary embolism, regardless of age[38]
- benefit &/or optimal use unclear[55]
- follow with anticoagulation[89]
Stable patients
- supportive therapy
- subsegmental pulmonary embolism may not need anticoagulation[74]
- chronic thromboembolic pulmonary hypertension with proximal thromboembolism may benefit from pulmonary thromboendarterectomy
- Pulmonary Embolism Severity Index (PESI) score < 86, low risk echocardiography & negative lower extremity ultrasound may be treated as outpatient[76][105]
- anticoagulation
- therapeutic anticoagulation within 24 hours to prevent progression[4]
- do not delay treatment for diagnostic testing in symptomatic patients with high pretest probability (Wells score >6)
- unfractionated heparin IV to maintain aPTT 60-90 sec
- preferred if reversal of anticoagulation is needed
- high risk of bleeding[100]
- emergent surgery
- pulmomary embolectomy or thrombolytic therapy is likely[4]
- preferred if patient with brain tumor[4]
- easier to dose in patients with renal insufficiency[4]
- preferred if reversal of anticoagulation is needed
- LMW heparin for intermediate-risk pulmonary embolism (PE)
- patients with metastatic cancer should receive long-term treatment with LMW heparin vs LMW heparin with transition to direct oral anticoagulant (avoid warfarin with metastatic cancer)
- duration prior to oral anticoagulation:
- enoxaparin
- dalteparin 200 units/kg SQ QD
- tinzaparin 175 units/kg SQ QD
- fondaparinux
- warfarin (begin concurrently with heparin or LMW heparin)
- bolus, 10 mg QD for 1-2 days
- begin at 2.5 mg QD
- adjust dose to achieve INR of 2.0-3.0 (>= 5 days)
- overlap continued heparin >= 5 days with INR > 2 for 24 hours[4]
- maintain INR 2.0-3.0 for at least 3 months[4][19]
- if INR becomes subtherapeutic in the 1st month following pulmonary embolism, add LMW heparin until INR is stable in the therapeutic range[4]
- use LMW heparin rather than warfarin in patients with underlying malignancy (had been "generally accepted")[52][63], but warfarin &
- direct-acting oral anticoagulants equally effective[42]
- hemorrhage may be more common with rivaroxaban than with dalteparin[73]
- see special case of antiphospholipid antibody syndrome
- American College of Chest Physicians recommends use of newer anticoagulants vs warfarin in patients with or without cancer[42][52][96]
- see special case of antiphospholipid antibody syndrome
- rivaroxaban may be an option[27]
- no need for bridging LMW heparin[4][61]
- NICE confirms rivaroxaban is an option for initial treatment of pulomonary embolism
- low risk of recurrent PE or bleeding while treated with rivaroxaban[47] (low = 0 in study)
- apixaban may be an option
- no need for bridging LMW heparin[4]
- rivaroxaban & apixaban probably confer the lowest risks for major bleeding[41]
- dabigatran is an option [NGC (NICE)]
- requires bridging with LMW heparin[4]
- edoxaban is an option
- requires bridging with LMW heparin[4]
- direct oral anticoagulants comparable to warfarin in patients with cancer-related venous thromboembolism[42]
- empiric anticoagulation prior to confirmation if high-probability of PE[4]
- duration of anticoagulation
- 1st episode of thromboembolism with reversible risk factors: 3 months
- 6 weeks if < 21 years[94]
- 1st episode of idiopathic thromboembolism
- life-long therapy[4][40][46]
- continued anticoagulation reduces composite outcome of recurrent recurrent venous thrombosis & serious bleeding[46]
- recurrent episodes of thromboembolism or 1st episode with hypercoagulable state: 12 months to life-long therapy[4]
- HERDOO2 score may be useful in women to assess need for long-term anticoagulation
- 1st episode of thromboembolism with reversible risk factors: 3 months
- American College of Chest Physicians recommends use aspirin after stopping anticoagulation[52]
- rivaroxaban 10 or 20 mg QD more effective in preventing recurrent thromboembolism than aspirin with no difference in bleeding (RR= 1.5%, 1.2%, & 4.4%, respectively)[59]
- no clear evidence of benefit for anticoagulation in subsegmental pulmonary embolism[69]
- therapeutic anticoagulation within 24 hours to prevent progression[4]
- inferior vena cava interruption, i.e. Greenfield filter should be considered in the following settings:
- anticoagulation is contraindicated
- major bleeding from arteriovenous malformation or other cause
- unless contraindicated, heparin therapy should be continued to prevent extension of a pre-existing clot
- no benefit over anticoagulation alone[44]
- documented recurrent thromboembolic events in patients who are adequately anticoagulated
- massive or submassive pulmonary emboli with hemodynamic compromise, especially if the is evidence of residual thrombus in a lower extremity[88]
- patients with compromised cardiac or pulmonary function who might not survive a recurrent event
- patients undergoing pulmonary embolectomy
- patients with paradoxic emboli via a patent foramen ovale
- septic pulmonary emboli from lower extremities or pelvic veins
- anticoagulation is contraindicated
- graduated compression stockings only if post-thrombotic syndrome[52]
- routine screening for potentially treatable carcinomas[64]
- low risk patients may be treated as outpatient[4][25][28][71][89]
- no cardiopulmonary distress
- supplemental oxygen not needed
- intravenous medications not needed
- no cormobidities that require inpatient management[4]
- low risk of recurrence
- supportive/sufficient home environment
Prognosis
- after 1 year, exercise limitation due to deconditioning
- not due to persistent physiological abnormalities[60]
- good prognosis = age < 80 years, no significant comorbidity, stable vital signs - can be managed as outpatient[4]
- cardiopulmonary rehabilitation improves exercise capacity & quality of life[103] .
Prevention
More general terms
More specific terms
Additional terms
- clinical decision rules for pulmonary embolism
- deep vein thrombosis (DVT)
- Greenfield filter; umbrella; inferior vena cava filter; IVC filter
- hypercoagulability
- Prospective Investigation Of Pulmonary Embolism Diagnosis (PIOPED) study
- thrombolysis for pulmonary embolism
References
- ↑ Manual of Medical Therapeutics, 28th edition, Ewald & McKenzie (eds) Little, Brown & Co, 1995, pg 247-49
- ↑ DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 242-243
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 775-78
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30 4.31 4.32 4.33 4.34 4.35 4.36 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2012, 2015, 2018, 2022
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 5.0 5.1 5.2 Journal Watch 21(6):48, 2001 Merli G et al Subcutaneous enoxaparin once or twice daily compared with intravenous unfractionated heparin for treatment of venous thromboembolic disease. Ann Intern Med 134:191, 2001 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11177331
- ↑ Goldhaber SZ & Mmorpurgo M Diagnosis, treatment, and prevention of pulmonary embolism. Report of the WHO/International Society and Federation of Cardiology Task Force. JAMA 268:1727, 1992 PMID: https://www.ncbi.nlm.nih.gov/pubmed/1527883
- ↑ Kinasewitz GT Thrombophlebitis and pulmonary embolism in the elderly patient. Clin Chest Med 14:523, 1993 PMID: https://www.ncbi.nlm.nih.gov/pubmed/8222567
- ↑ 8.0 8.1 Wilk JS et al Unexplained syncope: when to suspect pulmonary thromboembolism. Geriatrics 50:46, 1995 PMID: https://www.ncbi.nlm.nih.gov/pubmed/7557491
- ↑ Fedullo PF et al Chronic thromboembolic pulmonary hypertension. N Engl J Med 345:1465, 2001 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11794196
- ↑ 10.0 10.1 Journal Watch 22(17):134, 2002 Kriup MJ et al Use of a clinical decision rule in combination with D-dimer concentration in diagnostic workup of patients with suspected pulmonary embolism: a prospective management study. Arch Intern Med 162:1631, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12123408
- ↑ Journal Watch 22(21):160, 2002 Konstantinides S et al Importance of cardiac troponins I and T in risk stratification of patients with acute pulmonary embolism. Circulation 106:1263, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12208803
- ↑ 12.0 12.1 Journal Watch 23(4):33, 2003 Musset D et al Diagnostic strategy for patients with suspected pulmonary embolism: a prospective multicentre outcome study. Lancet 360:1914, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12493257
- ↑ 13.0 13.1 Journal Watch 24(13):103, 2004 Pengo V, Lensing AW, Prins MH, Marchiori A, Davidson BL, Tiozzo F, Albanese P, Biasiolo A, Pegoraro C, Iliceto S, Prandoni P; Thromboembolic Pulmonary Hypertension Study Group. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med. 2004 May 27;350(22):2257-64. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15163775
- ↑ 14.0 14.1 Journal Watch 25(10):77, 2005 Perrier A, Roy PM, Sanchez O, Le Gal G, Meyer G, Gourdier AL, Furber A, Revel MP, Howarth N, Davido A, Bounameaux H. Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med. 2005 Apr 28;352(17):1760-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15858185
- ↑ 15.0 15.1 Roy PM, Colombet I, Durieux P, Chatellier G, Sors H, Meyer G. Systematic review and meta-analysis of strategies for the diagnosis of suspected pulmonary embolism. BMJ. 2005 Jul 30;331(7511):259. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16052017
- ↑ Huisman, MV et al, Writing Group and Investigators of the Christopher Study Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography JAMA 2006;295:172
- ↑ 17.0 17.1 17.2 van Belle A, Buller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW, Kramer MH, Kruip MJ, Kwakkel-van Erp JM, Leebeek FW, Nijkeuter M, Prins MH, Sohne M, Tick LW; Christopher Study Investigators. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006 Jan 11;295(2):172-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16403929
Hull RD. Diagnosing pulmonary embolism with improved certainty and simplicity. JAMA. 2006 Jan 11;295(2):213-5. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16403934
Le Gal G, Righini M, Roy PM, Sanchez O, Aujesky D, Bounameaux H, Perrier A. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006 Feb 7;144(3):165-71. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16461960
Le Gal G, Righini M, Roy PM, Sanchez O, Aujesky D, Perrier A, Bounameaux H. Value of D-dimer testing for the exclusion of pulmonary embolism in patients with previous venous thromboembolism. Arch Intern Med. 2006 Jan 23;166(2):176-80. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16432085
Moores LK. Diagnosis and management of pulmonary embolism: are we moving toward an outcome standard? Arch Intern Med. 2006 Jan 23;166(2):147-8. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16432080
Rodger MA, Bredeson CN, Jones G, Rasuli P, Raymond F, Clement AM, Karovitch A, Brunette H, Makropoulos D, Reardon M, Stiell I, Nair R, Wells PS. The bedside investigation of pulmonary embolism diagnosis study: a double-blind randomized controlled trial comparing combinations of 3 bedside tests vs ventilation-perfusion scan for the initial investigation of suspected pulmonary embolism. Arch Intern Med. 2006 Jan 23;166(2):181-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16432086
Aujesky D, Obrosky DS, Stone RA, Auble TE, Perrier A, Cornuz J, Roy PM, Fine MJ. A prediction rule to identify low-risk patients with pulmonary embolism. Arch Intern Med. 2006 Jan 23;166(2):169-75. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16432084
Roy PM, Meyer G, Vielle B, Le Gall C, Verschuren F, Carpentier F, Leveau P, Furber A; EMDEPU Study Group. Appropriateness of diagnostic management and outcomes of suspected pulmonary embolism. Ann Intern Med. 2006 Feb 7;144(3):157-64. Summary for patients in: Ann Intern Med. 2006 Feb 7;144(3):I24. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16461959 - ↑ 18.0 18.1 Stein PD et al, Mulitdetector computed tomography for acute pulmonary embolism N Engl J Med 2006; 354;2317 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16738268
Perrier A & Bounameaux H Accuracy of outcome in suspected pulmonary embolism N Engl J Med 2006; 354:2383 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16738276 - ↑ 19.0 19.1 Campbell IA et al, Anticoagulation for three vs six months in patients with deep vein thrombosis or pulmonary embolism, or both: randomised trial. BMJ 2007, 334:674 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17289685
- ↑ 20.0 20.1 Righini M et al, Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: A randomized non-inferiority trial. Lancet 2008, 371:1343 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18424324
- ↑ 21.0 21.1 21.2 Hall WB et al The Prevalence of Clinically Relevant Incidental Findings on Chest Computed Tomographic Angiograms Ordered to Diagnose Pulmonary Embolism Arch Intern Med. 2009;169(21):1961-1965 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19933956 <Internet> http://archinte.ama-assn.org/cgi/content/short/169/21/1961?home
- ↑ Jaff MR et al Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension: A Scientific Statement From the American Heart Association. Circulation March 21, 2011 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21422387
Prescriber's Letter 18(4): 2011 COMMENTARY: Duration of Anticoagulation After Venous Thromboembolism GUIDELINES: Antithrombotic Therapy for Venous Thromboembolic Disease (June 2008) GUIDELINES: Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension (March 2011) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=270409&pb=PRL (subscription needed) http://www.prescribersletter.com - ↑ 23.0 23.1 Salaun P-Y et al. Noninvasive diagnosis of pulmonary embolism. Chest 2011 Jun; 139:1294 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20724733
- ↑ 24.0 24.1 Kabrhel C et al Physical inactivity and idiopathic pulmonary embolism in women: Prospective study. BMJ 2011 Jul 4; 343:d3867 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21727169
Douketis JD and Iorio A. The association between venous thromboembolism and physical inactivity in everyday life. BMJ 2011 Jul 4; 343:d3865 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21727168 - ↑ 25.0 25.1 25.2 25.3 Aujesky D et al. Outpatient versus inpatient treatment for patients with acute pulmonary embolism: An international, open-label, randomised, non-inferiority trial. Lancet 2011 Jul 2; 378:41. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21703676
Zoller B et al Risk of pulmonary embolism in patients with autoimmune disorders: a nationwide follow-up study from Sweden The Lancet, Early Online Publication, 26 November 2011 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22119579 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61306-8/fulltext - ↑ 26.0 26.1 Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
- ↑ 27.0 27.1 Buller HR et al. for the EINSTEIN-PE Investigators. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med 2012 Mar 26 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22449293
- ↑ 28.0 28.1 Vinson DR et al. Can selected patients with newly diagnosed pulmonary embolism be safely treated without hospitalization? A systematic review. Ann Emerg Med 2012 Nov; 60:651. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22944455
- ↑ 29.0 29.1 Sharifi M et al. Moderate pulmonary embolism treated with thrombolysis (from the "MOPETT" trial). Am J Cardiol 2013 Jan 15; 111:273. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23102885
- ↑ 30.0 30.1 Guyatt GH et al Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines CHEST February 2012 vol. 141 no. 2 suppl 7S-47S <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22315257 <Internet> http://chestjournal.chestpubs.org/content/141/2_suppl/7S.full
- ↑ Todd JL, Tapson VF. Thrombolytic therapy for acute pulmonary embolism: a critical appraisal. Chest. 2009 May;135(5):1321-9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19420199
- ↑ 32.0 32.1 Moores LK, King CS, Holley AB. Current approach to the diagnosis of acute nonmassive pulmonary embolism. Chest. 2011 Aug;140(2):509-18. doi:http://dx.doi.org/ 10.1378/chest.10-2468. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21813530
- ↑ 33.0 33.1 Agnelli G, Becattini C. Acute pulmonary embolism. N Engl J Med. 2010 Jul 15;363(3):266-74. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20592294
- ↑ 34.0 34.1 Fedullo P, Kerr KM, Kim NH, Auger WR. Chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med. 2011 Jun 15;183(12):1605-13. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21330453
- ↑ 35.0 35.1 den Exter PL et al. Impact of delay in clinical presentation on the diagnostic management and prognosis of patients with suspected pulmonary embolism. Am J Respir Crit Care Med 2013 Jun 15; 187:1369 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23590273
- ↑ 36.0 36.1 Meyer G et al. Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 2014 Apr 10; 370:1402. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24716681 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1302097
- ↑ 37.0 37.1 Stein PD, Matta F. Pulmonary embolectomy in elderly patients. Am J Med. 2014 Apr;127(4):348-50. Epub 2013 Dec 11. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24333199
- ↑ 38.0 38.1 Stein PD, Matta F. Vena cava filters in unstable elderly patients with acute pulmonary embolism. Am J Med. 2014 Mar;127(3):222-5. Epub 2013 Nov 23. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24280176
Stein PD, Dalen JE, Matta F. Underuse of vena cava filters in unstable patients with acute pulmonary embolism. Am J Med. 2014 Jan;127(1):6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24239441 - ↑ 39.0 39.1 Koenig S et al. Ultrasound assessment of pulmonary embolism in patients receiving CT pulmonary angiography. Chest 2014 Apr; 145:818. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24178672
Nazerian P et al. Accuracy of point-of-care multiorgan ultrasonography for the diagnosis of pulmonary embolism Chest. 2014 May;145(5):950-7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24092475 - ↑ 40.0 40.1 40.2 Kabrhel C Case 29-2014 - A 60-Year-Old Woman with Syncope. N Engl J Med 2014; 371:1143-1150. September 18, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25229919 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcpc1403307
- ↑ 41.0 41.1 Castellucci LA et al. Clinical and safety outcomes associated with treatment of acute venous thromboembolism: A systematic review and meta-analysis. JAMA. 2014 Sep 17;312(11):1122-35 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25226478
- ↑ 42.0 42.1 42.2 42.3 Vedovati MC et al. Direct oral anticoagulants in patients with VTE and cancer: A systematic review and meta-analysis. Chest 2015 Feb; 147:475. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25211264
Raskob GE, van Es N, Verhamme P et al Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism. N Engl J Med. 2018 Feb 15;378(7):615-624, Epub 2017 Dec 12. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29231094 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1711948 - ↑ The NNT: Anticoagulation Given for Acute Venous Thromboembolism (Deep Venous Thrombosis and Pulmonary Embolism). http://www.thennt.com/nnt/anticoagulation-for-venous-thromboembolism/
Cundiff DK et al. Anticoagulants vs non-steroidal anti-inflammatories or placebo for treatment of venous thromboembolism. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD003746. PMID: https://www.ncbi.nlm.nih.gov/pubmed/1643746 - ↑ 44.0 44.1 Mismetti P et al Effect of a Retrievable Inferior Vena Cava Filter Plus Anticoagulation vs Anticoagulation Alone on Risk of Recurrent Pulmonary Embolism. A Randomized Clinical Trial. JAMA. 2015;313(16):1627-1635 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25919526 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2279714
- ↑ 45.0 45.1 45.2 45.3 Carrier M et al Screening for Occult Cancer in Unprovoked Venous Thromboembolism. N Engl J Med. June 22, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26095467 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1506623
- ↑ 46.0 46.1 46.2 Couturaud F et al. Six months vs extended oral anticoagulation after a first episode of pulmonary embolism: The PADIS-PE randomized clinical trial. JAMA 2015 Jul 7; 314:31 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26151264 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2382981
Kearon C, Akl EA, Comerota AJ et al Antithrombotic Therapy for VTE Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2_suppl):e419S-e494S PMID: https://www.ncbi.nlm.nih.gov/pubmed/22315268
corresponding NGC guideline updated Sept 2016 - ↑ 47.0 47.1 Beam DM et al. Immediate discharge and home treatment with rivaroxaban of low-risk venous thromboembolism diagnosed in two U.S. emergency departments: A one-year preplanned analysis. Acad Emerg Med 2015 Jul; 22:788 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26113241
- ↑ 48.0 48.1 Hutchinson BD et al. Overdiagnosis of pulmonary embolism by pulmonary CT angiography. AJR Am J Roentgenol 2015 Aug; 205:271 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26204274
- ↑ 49.0 49.1 Hendriksen JMT et al Diagnostic prediction models for suspected pulmonary embolism: systematic review and independent external validation in primary care. BMJ 2015;351:h4438 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26349907 <Internet> http://www.bmj.com/content/351/bmj.h4438
Dachs RJ Predicting pulmonary embolus in primary care. BMJ 2015;351:h4594 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26351275 <Internet> http://www.bmj.com/content/351/bmj.h4594 - ↑ 50.0 50.1 Raja AS et al Evaluation of Patients With Suspected Acute Pulmonary Embolism: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med. Published online 29 September 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26414967 <Internet> http://annals.org/article.aspx?articleid=2443959
- ↑ Masotti L, Ray P, Righini M, et al. Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation. Vascular Health Risk Mgmt. 2008;4(3):629-636 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18827912
Masotti L, Righini M, Vuilleumier N et al Prognostic stratification of acute pulmonary embolism: focus on clinical aspects, imaging, and biomarkers. Vasc Health Risk Manag. 2009;5(4):567-75. Epub 2009 Jul 14. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19649307 - ↑ 52.0 52.1 52.2 52.3 52.4 Kearon C et al Antithrombotic Therapy for VTE Disease: CHEST Guideline. Chest. January 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26867832 <Internet> http://journal.publications.chestnet.org/article.aspx?articleid=2479255
- ↑ Marshall PS, Mathews KS, Siegel MD Diagnosis and management of life-threatening pulmonary embolism. J Intensive Care Med. 2011 Sep-Oct;26(5):275-94. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21606060
- ↑ Rosenfield K, Ghoshhajra BB, Dudzinski DM, Stone JR. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 9-2016. A 29-Year-Old Man with Dyspnea and Chest Pain. N Engl J Med. 2016 Mar 24;374(12):1178-88. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27007962 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcpc1512452
- ↑ 55.0 55.1 Bikdeli B, Wang Y, Minges KE et al Vena Caval Filter Utilization and Outcomes in Pulmonary Embolism: Medicare Hospitalizations From 1999 to 2010. J Am Coll Cardiol. 2016 Mar 8;67(9):1027-35. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26940921
Bikdeli B, Wang Y, Jimenez D et al. Association of inferior vena cava filter use with mortality rates in older adults with acute pulmonary embolism. JAMA Intern Med 2018 Dec 10; PMID: https://www.ncbi.nlm.nih.gov/pubmed/30535318 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2717952 - ↑ 56.0 56.1 56.2 Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
- ↑ 57.0 57.1 Duplyakov D, Kurakina E, Pavlova T, Khokhlunov S, Surkova E. Value of syncope in patients with high-to-intermediate risk pulmonary artery embolism. Eur Heart J Acute Cardiovasc Care. 2015 Aug;4(4):353-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24619817
- ↑ 58.0 58.1 Nazerian P, Vanni S, Volpicelli G et al Accuracy of point-of-care multiorgan ultrasonography for the diagnosis of pulmonary embolism. Chest. 2014 May;145(5):950-7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24092475
- ↑ 59.0 59.1 Weitz JI, Lensing AW, Prins MH, et al. Rivaroxaban or aspirin for extended treatment of venous thromboembolism. N Engl J Med 2017 Mar 18; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28316279 Free Article <Internet> http://www.nejm.org/doi/10.1056/NEJMoa1700518
Crowther MA, Cuker A. Reduced-intensity rivaroxaban for the prevention of recurrent venous thromboembolism. N Engl J Med 2017 Mar 18; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28316277 Free Article <Internet> http://www.nejm.org/doi/10.1056/NEJMe1701628 - ↑ 60.0 60.1 Kahn SR, Hirsch AM, Akaberi A et al. Functional and exercise limitations after a first episode of pulmonary embolism: Results of the ELOPE prospective cohort study. Chest 2017 May; 151:1058 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27932051
Kahn SR, Akaberi A, Granton JT et al Quality of Life, Dyspnea and Functional Exercise Capacity Following a First Episode of Pulmonary Embolism: Results of the ELOPE Cohort Study. Am J Med. 2017 Apr 8. pii: S0002-9343(17)30361-3. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28400247 - ↑ 61.0 61.1 Johnson SA, Eleazer GP, Rondina MT. Pathogenesis, diagnosis, and treatment of venous thromboembolism in older adults. J Am Geriatr Soc. 2016;64(9):1869-1878 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27556937
- ↑ 62.0 62.1 Van der Hulle T, Cheung WY, Kooij S, et al Simplified Diagnostic Management of Suspected Pulmonary Embolism (the YEARS Study): A Prospective, Multicentre, Cohort Study. Lancet 2017;May 23 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28549662 <Internet> http://www.acc.org/latest-in-cardiology/journal-scans/2017/06/02/10/46/simplified-diagnostic-management-of-suspected-pulmonary-embolism
- ↑ 63.0 63.1 NEJM Knowledge+ Question of the Week. Sept 12, 2017 https://knowledgeplus.nejm.org/question-of-week/178/
Lee AYY et al. Tinzaparin vs warfarin for treatment of acute venous thromboembolism in patients with active cancer: A randomized clinical trial. JAMA 2015 Aug 18; 314:677. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26284719
Lee AY, Levine MN, Baker RI et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003 Jul 11; 349:146 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/12853587 Free Article <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa025313 - ↑ 64.0 64.1 van Es N, Le Gal G, Otten HM et al. Screening for occult cancer in patients with unprovoked venous thromboembolism: A systematic review and meta-analysis of individual patient data. Ann Intern Med 2017 Aug 22; PMID: https://www.ncbi.nlm.nih.gov/pubmed/28828492
Merli G, Weitz H. Venous thrombosis and cancer: What would Dr. Trousseau teach today? Ann Intern Med 2017 Aug 22; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28828491 - ↑ 65.0 65.1 Connors JM Thrombophilia Testing and Venous Thrombosis. N Engl J Med 2017; 377:1177-1187. September 21, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28930509 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMra1700365
- ↑ 66.0 66.1 Alkinj B, Pannu BS, Apala DR, Kotecha A, Kashyap R, Iyer VN. Saddle vs nonsaddle pulmonary embolism: Clinical presentation, hemodynamics, management, and outcomes. Mayo Clin Proc 2017 Oct; 92:1511. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28890217
- ↑ 67.0 67.1 Bass AR, Fields KG, Goto R, Turissini G, Dey S, Russell LA. Clinical decision rules for pulmonary embolism in hospitalized patients: A systematic literature review and meta-analysis. Thromb Haemost 2017 Nov; 117:2176 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29044295 https://www.thieme-connect.de/DOI/DOI?10.1160/TH17-06-0395
- ↑ 68.0 68.1 Freund Y, Cachanado M, Aubry A et al. Effect of the pulmonary embolism rule-out criteria on subsequent thromboembolic events among low-risk emergency department patients: The PROPER randomized clinical trial. JAMA 2018 Feb 13; 319:559. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29450523 https://jamanetwork.com/journals/jama/fullarticle/2672630
Kline JA. Utility of a clinical prediction rule to exclude pulmonary embolism among low-risk emergency department patients reason to PERC up. JAMA 2018 Feb 13; 319:551. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29450510 https://jamanetwork.com/journals/jama/article-abstract/2672615 - ↑ 69.0 69.1 Bariteau A, Stewart LK, Emmett TW, Kline JA. Systematic review and meta-analysis of outcomes of patients with subsegmental pulmonary embolism with and without anticoagulation treatment. Acad Emerg Med 2018 Mar 2; PMID: https://www.ncbi.nlm.nih.gov/pubmed/29498138 https://onlinelibrary.wiley.com/doi/abs/10.1111/acem.13399
- ↑ 70.0 70.1 Roncon L, Zuin M, Casazza F, Becattini C, Bilato C, Zonzin P. Impact of syncope and pre-syncope on short-term mortality in patients with acute pulmonary embolism. Eur J Intern Med 2018 Apr 11; PMID: https://www.ncbi.nlm.nih.gov/pubmed/29655808 https://www.ejinme.com/article/S0953-6205(18)30141-9/fulltext
- ↑ 71.0 71.1 Frank Peacock W, Coleman CI, Diercks DB et al Emergency department discharge of pulmonary embolus patients. Acad Emerg Med 2018 May 14; PMID: https://www.ncbi.nlm.nih.gov/pubmed/29757489 https://onlinelibrary.wiley.com/doi/abs/10.1111/acem.13451
- ↑ 72.0 72.1 Belzile D, Jacquet S, Bertoletti L et al Outcomes following a negative computed tomography pulmonary angiography according to pulmonary embolism prevalence: a meta-analysis of the management outcome studies. J Thromb Haemost. 2018 Jun;16(6):1107-1120. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29645405
- ↑ 73.0 73.1 Young AM, Marshall A, Thirlwall J et al. Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: Results of a randomized trial (SELECT-D). J Clin Oncol 2018 Jul 10; 36:2017 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29746227
- ↑ 74.0 74.1 Raslan IA, Chong J, Gallix B et al Rates of Overtreatment and Treatment-Related Adverse Effects Among Patients With Subsegmental Pulmonary Embolism. JAMA Intern Med. Published online July 30, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30073241 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2687988
- ↑ 75.0 75.1 Darwish OS, Mahayni A, Patel M, Amin A. Cardiac troponins in low-risk pulmonary embolism patients: A systematic review and meta-analysis. J Hosp Med 2018 Apr 25; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/29694453
Darwish OS, Mahayni A, Patel M, Amin A. ERRATUM TO: Cardiac Troponins in Low-Risk Pulmonary Embolism Patients: A Systematic Review and Meta-Analysis. J Hosp Med. 2018 Jul;13(7):509. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29964275 - ↑ 76.0 76.1 Bledsoe JR, Woller SC, Stevens SM et al. Management of low-risk pulmonary embolism patients without hospitalization: The Low-Risk Pulmonary Embolism Prospective Management Study. Chest 2018 Aug; 154:249. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29410163 https://journal.chestnet.org/article/S0012-3692(18)30231-9/fulltext
Goldhaber SZ. Cautionary notes about outpatient treatment of acute pulmonary embolism. Chest 2018 Aug; 154:233. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30080496 https://journal.chestnet.org/article/S0012-3692(18)30272-1/fulltext - ↑ 77.0 77.1 77.2 77.3 Goyard C, Cote B, Looten V et al. Determinants and prognostic implication of diagnostic delay in patients with a first episode of pulmonary embolism. Thromb Res 2018 Aug 26; PMID: https://www.ncbi.nlm.nih.gov/pubmed/30190113 https://www.thrombosisresearch.com/article/S0049-3848(18)30475-4/fulltext
- ↑ Vinson DR, Mark DG, Chettipally UK et al Increasing Safe Outpatient Management of Emergency Department Patients With Pulmonary Embolism: A Controlled Pragmatic Trial. Ann Intern Med. 2018. Nov 13. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30422263 <Internet> http://annals.org/aim/article-abstract/2714293/increasing-safe-outpatient-management-emergency-department-patients-pulmonary-embolism-controlled
Stein PD, Hughes MJ Mounting Evidence for Safe Home Treatment of Selected Patients With Acute Pulmonary Embolism. Ann Intern Med. 2018. Nv 13. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30422280 <Internet> http://annals.org/aim/article-abstract/2714294/mounting-evidence-safe-home-treatment-selected-patients-acute-pulmonary-embolism - ↑ 79.0 79.1 Aleva FE, Voets LWLM, Simons SO et al Prevalence and Localization of Pulmonary Embolism in Unexplained Acute Exacerbations of COPD: A Systematic Review and Meta-analysis. Chest. 2017 Mar;151(3):544-554. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27522956
- ↑ Konstantinides SV, Torbicki A, Agnelli G et al 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014 Nov 14;35(43):3033-69, 3069a-3069k. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25173341
- ↑ 81.0 81.1 Le Moigne E, Timsit S, Ben Salem D et al Patent Foramen Ovale and Ischemic Stroke in Patients With Pulmonary Embolism: A Prospective Cohort Study. Ann Intern Med. 2019. May 7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31060047 https://annals.org/aim/article-abstract/2732836/patent-foramen-ovale-ischemic-stroke-patients-pulmonary-embolism-prospective-cohort
Schmidt MR, Sondergaard L. Patent Foramen Ovale: A Villain in Pulmonary Embolism? Ann Intern Med. 2019. May 7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31060049 https://annals.org/aim/article-abstract/2732838/patent-foramen-ovale-villain-pulmonary-embolism - ↑ 82.0 82.1 Kearon C, Parpia S, Spencer FA et al. Long-term risk of recurrence in patients with a first unprovoked venous thromboembolism managed according to D-dimer results: A cohort study. J Thromb Haemost 2019 Apr 29; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31033194 https://onlinelibrary.wiley.com/doi/abs/10.1111/jth.14458
- ↑ Aujesky D Pulmonary Embolism Severity Index (PESI) https://www.mdcalc.com/pulmonary-embolism-severity-index-pesi
- ↑ 84.0 84.1 Khan F, Rahman A, Carrier M et al Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event: systematic review and meta-analysis. BMJ 2019;366:l4363 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31340984 https://www.bmj.com/content/366/bmj.l4363
Bikdeli B et al Minimizing recurrent venous thromboembolism. BMJ 2019;366:l4686 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31345836 https://www.bmj.com/content/366/bmj.l4686 - ↑ 85.0 85.1 Kearon C et sl Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability. N Engl J Med 2019; 381:2125-2134, Nov 28 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31774957 https://www.nejm.org/doi/full/10.1056/NEJMoa1909159
- ↑ 86.0 86.1 ARUP Consult: Venous Thromboembolism The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/venous-thromboembolism
- ↑ 87.0 87.1 NEJM Knowledge+ Question of the Week. June 2, 2020 https://knowledgeplus.nejm.org/question-of-week/52/
- ↑ 88.0 88.1 Ahmed O et al. Meta-analysis of the usefulness of inferior vena cava filters in massive and submassive pulmonary embolism. Am J Cardiol 2020 Aug 1; 128:54 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32650924 https://www.ajconline.org/article/S0002-9149(20)30459-8/fulltext
- ↑ 89.0 89.1 89.2 Ortel TL et al American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Advances. 4(19). 2020 Oct 13 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33007077 https://ashpublications.org/bloodadvances/article/4/19/4693/463998
- ↑ 90.0 90.1 Caron A, Depas N, Chazard E. Risk of Pulmonary Embolism More Than 6 Weeks After Surgery Among Cancer-Free Middle-aged Patients. JAMA Surgery. December 1, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31596449 PMCID: PMC6802263 Free PMC article https://edhub.ama-assn.org/jn-learning/module/2752278
- ↑ 91.0 91.1 91.2 91.3 Klok FA, Toenges G, Mavromanoli A et al. Early switch to oral anticoagulation in patients with acute intermediate-risk pulmonary embolism (PEITHO-2): A multinational, multicentre, single-arm, phase 4 trial. Lancet Haematol 2021 Sep; 8:e627. August 4 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34363769 https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(21)00203-9/fulltext
- ↑ 92.0 92.1 Le Gal G, Kovacs MJ, Bertoletti L et al. Risk for recurrent venous thromboembolism in patients with subsegmental pulmonary embolism managed without anticoagulation: A multicenter prospective cohort study. Ann Intern Med 2021 Nov 23; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34807722 https://www.acpjournals.org/doi/10.7326/M21-2981
- ↑ 93.0 93.1 Stals MAM, Takada T, Kraaijpoel N et al. Safety and efficiency of diagnostic strategies for ruling out pulmonary embolism in clinically relevant patient subgroups: A systematic review and individual-patient data meta-analysis. Ann Intern Med 2021 Dec 14; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34904857 https://www.acpjournals.org/doi/10.7326/M21-2625
- ↑ 94.0 94.1 Goldenberg NA et al. Effect of anticoagulant therapy for 6 weeks vs 3 months on recurrence and bleeding events in patients younger than 21 years of age with provoked venous thromboembolism: The Kids-DOTT randomized clinical trial. JAMA 2022 Jan 11; 327:129 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35015038 PMCID: PMC8753509 (available on 2022-07-11) https://jamanetwork.com/journals/jama/fullarticle/2787908
- ↑ 95.0 95.1 Sadeghipour P, Jenab Y, Moosavi J et al Catheter-Directed Thrombolysis vs Anticoagulation in Patients With Acute Intermediate-High-risk Pulmonary Embolism, The CANARY Randomized Clinical Trial. JAMA Cardiol. 2022;7(12):1189-1197 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36260302 PMCID: PMC9582964 (available on 2023-10-19) https://jamanetwork.com/journals/jamacardiology/fullarticle/2797198
- ↑ 96.0 96.1 Stevens SM, Woller SC, Baumann Kreuziger L et al. Executive summary: Antithrombotic therapy for VTE disease: Second update of the CHEST guideline and expert panel report. Chest. 2021;160:2247-2259. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34352279 https://journal.chestnet.org/article/S0012-3692(21)01507-5/fulltext
- ↑ 97.0 97.1 Prandoni P, Lensing AWA, Prins MH et al. Prevalence of pulmonary embolism among patients with recent onset of dyspnea on exertion. A cross-sectional study. J Thromb Haemost 2023 Jan; 21:68-75. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36695397 https://www.jthjournal.org/article/S1538-7836(22)07202-6/fulltext
- ↑ Kahn SR, de Wit K. Pulmonary Embolism. N Engl J Med. 2022 Jul 7;387(1):45-57. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35793208 Review.
- ↑ 99.0 99.1 Becattini C et al. Contemporary management and clinical course of acute pulmonary embolism: The COPE study. Thromb Haemost 2023 Mar 20; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36758612 https://www.thieme-connect.de/products/ejournals/abstract/10.1055/a-2031-3859
- ↑ 100.0 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9 NEJM Knowledge+ Complex Medical Care
- ↑ 101.0 101.1 101.2 Planer D et al. Catheter-directed thrombolysis compared with systemic thrombolysis and anticoagulation in patients with intermediate- or high-risk pulmonary embolism: Systematic review and network meta-analysis. CMAJ 2023 Jun 19; 195:E833. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37336568 PMCID: PMC10281204 Free PMC article https://www.cmaj.ca/content/195/24/E833
- ↑ Lim W, Le Gal G, Bates SM, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. Blood Adv. 2018;2:3226-3256. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30482764
- ↑ 103.0 103.1 Jervan O et al. The effects of exercise training in patients with persistent dyspnea following pulmonary embolism: A randomized controlled trial. Chest 2023 Oct; 164:981 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37149257 Free article https://journal.chestnet.org/article/S0012-3692(23)00643-8/fulltext
- ↑ 104.0 104.1 104.2 NEJM Knowledge+ Question of the Week. Jan 16, 2024 https://knowledgeplus.nejm.org/question-of-week/1875/
Gorman EA, O'Kane CM, McAuley DF. Acute respiratory distress syndrome in adults: diagnosis, outcomes, long-term sequelae, and management. Lancet. 2022 Oct 1;400(10358):1157-1170. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36070788 Review. - ↑ 105.0 105.1 Luijten D, Douillet D, Luijken K et al. Safety of treating acute pulmonary embolism at home: An individual patient data meta-analysis. Eur Heart J 2024 Jul 12; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38993086 Free article. https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehae378/7712560