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Removing the “hemoptysis” item from PERC, YEARS, and PEGeD clinical decision tools (CDTs) did not significantly increase diagnostic failure in a cohort of patients at low risk for acute pulmonary embolism (PE).
Source
Evaluation of the “hemoptysis” item in clinical decision rules for the diagnosis of pulmonary embolism in the emergency department. Acad Emerg Med. 2022 Jul 30. doi: 10.1111/acem.14574.
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In patients with acute pulmonary embolism, only supraventricular tachycardia was an independent predictor of clinical deterioration; however, other ECG findings (below) were associated with abnormal RV function on echo.
Source
Electrocardiographic findings associated with early clinical deterioration in acute pulmonary embolism. Acad Emerg Med. 2022 Jun 24. doi: 10.1111/acem.14554. Online ahead of print.
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Risk for venous thromboembolism (VTE) was highest during hospitalization, but the risk remained elevated 3-fold at 3 months post-discharge.
Source
Venous Thrombosis Risk during and after Medical and Surgical Hospitalizations: The Medical Inpatient Thrombosis and Hemostasis (MITH) Study. J Thromb Haemost. 2022 Apr 15. doi: 10.1111/jth.15729. Online ahead of print.
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The European Society of Cardiology (ESC) has generated a position detailing optimal follow-up of patients following acute pulmonary embolism (PE). They advocate for a holistic approach with consideration of both short- and long-term events encountered by patients diagnosed with acute PE.
Source
Optimal follow-up after acute pulmonary embolism: a position paper of the European Society of Cardiology Working Group on Pulmonary Circulation and Right Ventricular Function, in collaboration with the European Society of Cardiology Working Group on Ather. Eur Heart J. 2022 Jan 25;43(3):183-189. doi: 10.1093/eurheartj/ehab816.
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Computed tomography pulmonary angiography (CTPA) yields an alternative diagnosis to pulmonary embolism (PE) in ~40% of patients with a negative PE study. Alternative diagnoses are more likely to occur in patients with increased age and in patients referred from the hospital setting (ICU or inpatient unit).
Source
Prevalence and significance of incidental findings on computed tomography pulmonary angiograms: A retrospective cohort study. Am J Emerg Med. 2022 Apr;54:232-237. doi: 10.1016/j.ajem.2022.01.064.
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Among patients with symptomatic PE who are low risk by sPESI, the addition of right ventricular assessment predictors (echo, CT, troponin, and BNP) significantly improved prognostication for clinical deterioration within 5 days.
Source
Can right ventricular assessments improve triaging of low risk pulmonary embolism? Acad Emerg Med. 2022 Mar 15. doi: 10.1111/acem.14484. Online ahead of print.
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This is a spoon-feed version of the management of massive and submassive PE in children.
Source
Acute Management of High-Risk and Intermediate-Risk Pulmonary Embolism in Children: A Review. Chest. 2022 Mar;161(3):791-802. doi: 10.1016/j.chest.2021.09.019. Epub 2021 Sep 26.
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Elevated heart rate is associated with increased risk of mortality for patients with acute symptomatic pulmonary embolism. Be wary of patients with acute pulmonary embolism who are tachycardic.
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Apixaban and rivaroxaban are two of the most prescribed direct oral anticoagulants (DOACs), but there are limited head-to-head comparisons of the medications. This study finds apixaban is associated with lower rates of VTE recurrence, GI bleeds and ICH compared to rivaroxaban.
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In PERC positive patients, use of YEARS with age-adjusted D-dimer was noninferior to an age-adjusted D-dimer strategy alone.
