Venous Thromboembolism

Can D-dimer Still Rule Out PE in COVID-19 Patients?

Infectious Disease, Venous Thromboembolism

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A negative D-dimer performed similarly in predicting a 30-day risk of pulmonary embolism (PE) regardless of a patient’s COVID-19 status.

Source
Prognostic association between d-dimer thresholds and 30-day pulmonary embolism diagnosis among emergency department patients with suspected SARS-CoV-2 infection: a Canadian COVID-19 Emergency Department Rapid Response Network study. CJEM. 2023 Feb;25(2):134-142. doi: 10.1007/s43678-022-00440-8. Epub 2023 Jan 10.

AHA Statement – Surgical Embolectomy and ECMO for High-Risk PE

Critical Care, Surgery, Venous Thromboembolism

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This is a scientific statement from the American Heart Association emphasizing the need for more research on surgical embolectomy and mechanical circulatory support in the treatment of high-risk pulmonary embolism.

Source
Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: Historical Context, Current Status, and Future Directions: A Scientific Statement From the American Heart Association. Circulation. 2023;10.1161/CIR.0000000000001117. doi:10.1161/CIR.0000000000001117

Breaking NEWS – Best PE Scores | NEWS vs. PESI vs. sPESI

Venous Thromboembolism

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The National Early Warning Score (NEWS) was comparable to the validated Pulmonary Embolism Severity Index (PESI) and the simplified PESI (sPESI) in predicting 7-day ICU admission and 30-day mortality in patients with acute pulmonary embolism (PE).

Source
Use of the National Early Warning Score for predicting deterioration of patients with acute pulmonary embolism: a post-hoc analysis of the YEARS Study. Emerg Med J. 2022 Nov 7:emermed-2021-211506. doi: 10.1136/emermed-2021-211506. Epub ahead of print.

CANARY in the Cath Lab? New RCT Catheter-based Lytics for Intermediate PE

Venous Thromboembolism

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This underpowered RCT did not find a statistically significant difference between catheter-directed thrombolysis (CDT) and anticoagulation monotherapy for intermediate-high risk pulmonary embolism in its primary outcome but favored CDT in secondary endpoints, without a difference in safety.

Source
Catheter-Directed Thrombolysis vs Anticoagulation in Patients With Acute Intermediate-High-risk Pulmonary Embolism: The CANARY Randomized Clinical Trial. JAMA Cardiol. 2022 Oct 19:e223591. doi: 10.1001/jamacardio.2022.3591. Epub ahead of print.

“Adjust-Unlikely” vs. YEARS – A New Winning Strategy to Reduce CT in Suspected PE

Venous Thromboembolism

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Assessing pretest probability using a modified, age-adjusted clinical decision tool (“Adjust-Unlikely”) vs YEARS reduces CT imaging in patients with suspected pulmonary embolism (PE). “Adjust-Unlikely” missed no PEs. YEARS had a larger reduction of imaging but missed a few PEs.

Source
Comparison of YEARS and Adjust-Unlikely D-dimer Testing for Pulmonary Embolism in the Emergency Department [published online ahead of print, 2022 Nov 10]. Ann Emerg Med. 2022;S0196-0644(22)01118-0.

What is The Added Value of Hemoptysis in our Decision Rules for PE?

Venous Thromboembolism

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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.

What ECG Findings Predict Crashing in Acute PE?

Cardiology, Venous Thromboembolism

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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.

What’s the Risk of DVT or PE at 1, 2, and 3 Months After Hospital Discharge?

Venous Thromboembolism

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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.

PE? Check… But What’s Next? Ideal Follow-up Post-PE

Venous Thromboembolism

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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.

Prevalence and Significance of Incidental Findings on CTPA

Imaging, Venous Thromboembolism

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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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