Venous Thromboembolism

Anchoring – Does Information from Triage Bias Our Workup?

Education, Practice of EM, Venous Thromboembolism

We’re trying something new! Watch quick videos, with my personal take on the articles we cover each week and more! Here’s the JournalFeed YouTube channel link. ~Clay

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Veterans Affairs (VA) patients with known congestive heart failure (CHF) presenting for shortness of breath as a chief complaint were less likely to receive testing for venous thromboembolism (VTE) when triage reported CHF.

Source
Evidence for Anchoring Bias During Physician Decision-Making. JAMA Intern Med. 2023 Aug 1;183(8):818-823. doi: 10.1001/jamainternmed.2023.2366.

DOACs and Diapers? Direct Oral Anticoagulants in Pediatrics

Pediatrics, Pharmacy/Pharmacology, Venous Thromboembolism

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Treatment with direct oral anticoagulants (DOACs) in pediatric patients appears to reduce venous thromboembolism (VTE) recurrence compared to standard of care, with no difference in major bleeding or serious adverse events. Prophylaxis with DOACs was comparable to standard of care and was associated with a nonsignificant reduction in VTE.

Source
Efficacy and safety of direct oral anticoagulants in the pediatric population: a systematic review and a meta-analysis. J Thromb Haemost. 2023 Jul 20:S1538-7836(23)00573-1. doi: 10.1016/j.jtha.2023.07.011. Epub ahead of print.

Subsegmental PE – Hold the Anticoagulation?

Venous Thromboembolism

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Structured surveillance without anticoagulation of patients with isolated subsegmental pulmonary embolism (ssPE) rarely occurs in community practice. After applying CHEST guidelines, ~5% of patients with isolated subsegmental PE are eligible for surveillance.

Source
Prevalence of and Eligibility for Surveillance Without Anticoagulation Among Adults With Lower-Risk Acute Subsegmental Pulmonary Embolism. JAMA Netw Open. 2023;6(8):e2326898. Published 2023 Aug 1. doi:10.1001/jamanetworkopen.2023.26898

Point | Counterpoint – Lytics + Heparin or Heparin Alone for Intermediate Risk PE?

Pharmacy/Pharmacology, Venous Thromboembolism

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There is practice variation in the treatment of patients with intermediate-risk pulmonary embolism (PE). The treatment threshold for which fibrinolytics should be added to standard anticoagulation in hemodynamically stable patients at risk for decompensation has been a focus of PE research for the last decade.

Source
Treatment of Intermediate-Risk Pulmonary Embolism. N Engl J Med. 2023 Jul 13;389(2):184-187. doi: 10.1056/NEJMclde2301330.

How Accurate Is Gestalt Alone for PE?

Venous Thromboembolism

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In this individual patient data meta-analysis, researchers found that a positive clinician gestalt was associated with a three times higher rate of pulmonary embolism (PE) compared to negative gestalt.

Source
Accuracy of the Physicians’ Intuitive Risk Estimation in the Diagnostic Management of Pulmonary Embolism: An Individual Patient Data Meta-Analysis. J Thromb Haemost. 2023 May 30:S1538-7836(23)00438-5. doi: 10.1016/j.jtha.2023.05.023. Epub ahead of print.

More Evidence that PERC Works!

Venous Thromboembolism

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Among patients in the RIETE database with confirmed pulmonary embolism (PE), there was a low failure rate when pulmonary embolism rule-out criteria (PERC) was applied in this retrospective cohort. PERC-negative patients who had PEs were less likely to have proximal PEs, and their rates of cardiopulmonary complications were lower when compared to PERC-positive patients.

Source
Safety of the pulmonary embolism rule-out criteria rule: Findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry. Acad Emerg Med. 2023 Apr 24. doi: 10.1111/acem.14744. Epub ahead of print.

What’s the Risk of VTE After Minor Surgery?

Venous Thromboembolism

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It’s use-it-or-lose-it time. Use your CME money to make your life easier and keep up!

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Some “minor” surgical procedures still carry an increased risk of venous thromboembolism postoperatively.  

Source
The risk of venous thromboembolism after minor surgical procedures: A population-based case-control study. J Thromb Haemost. 2023 Apr;21(4):975-982. doi: 10.1016/j.jtha.2022.11.035. Epub 2022 Dec 22.

PE-SARD – Big Fail Predicting Bleeding Risk with PE

Venous Thromboembolism

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PE-SARD failed to accurately predict risk of major or clinically relevant bleeding in patients ≥65 years with acute PE at 7 days or on longer follow-up.

Source
Prediction of very early major bleeding risk in acute pulmonary embolism: an independent external validation of the PE-SARD Bleeding Score. J Thromb Haemost. 2023 May 4;S1538-7836(23)00347-1. doi: 10.1016/j.jtha.2023.04.025. Online ahead of print.

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