Sep 15 2020
VTE Week | Outpatient PE Treatment in the DOAC Era
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In this systematic review, outpatient treatment of patients with pulmonary embolism deemed low risk by a clinical decision tool demonstrated a low incidence of mortality, recurrent venous thromboembolism, or major bleeding at 90 days. There was no association between direct oral anticoagulant use and rates of adverse outcomes.
Sep 14 2020
VTE Week | Why Clinicians Don’t Follow PE Decision Tools
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Use of evidence-based decision tools when evaluating a patient for acute pulmonary embolism are fraught with barriers at both the provider and organizational level. This study used implementation science methods to explore some of the barriers and facilitators to the uptake of these tools in clinical practice.
Jun 29 2020
Does Syncope in PE Mean Increased Mortality?
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PE with syncope is associated with increased risk of short-term mortality, which is explained by the increase in hemodynamic instability seen in these patients as well.
May 15 2020
Should We Rethink Pregnancy-Adapted YEARS Criteria?
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Had the pregnancy-adapted YEARS algorithm been applied in the DiPEP population, it would have missed a significant number of PEs. But there are several limitations to this study.
Feb 17 2020
Clinical Pre-test Prob vs. Age-adjusted D-dimer for DVT – The Meta Analysis
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In the diagnosis of deep venous thrombosis, both age-adjusted D-dimer and D-dimer adjusted by clinical pre-test probability were found to be similar (read: not statistically different) in sensitivity, specificity, negative predictive value, and utility in this meta-analysis.
Jan 30 2020
Is It Time to Adjust D-dimer Thresholds to Our Clinical Pretest Probability?
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style="white-space:pre-wrap;">Using the Wells Score to categorize patients as low, moderate or high clinical pretest probability in conjunction with adjusted positive D-dimer thresholds at >1000 ng/mL for a low or >500 ng/mL for a moderate Wells Score, the authors reduced diagnostic chest imaging in the ED with no incidence of missed venous thromboembolism at 90 days.
Jan 15 2020
Arrest from PE – Do Lytics Help?
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For patients with out-of-hospital cardiac arrest and PE, 30-day survival was greater in those who received thrombolytic therapy than those who did not, but there was no significant improvement in neurologically intact survival.
Jan 14 2020
Thrombolytics for PE – Systemic vs. Catheter-Directed
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style="white-space:pre-wrap;">In high-risk PE, systemic thrombolysis was more commonly used than catheter-directed thrombolysis (CDT). Systemic vs CDT had greater in-hospital mortality and readmission, but results were confounded. CDT may have lower bleeding risk. There was no difference in plain CDT vs ultrasound-facilitated CDT.
Dec 27 2019
Interventional Therapies for Acute PE – What We Know and What We Don’t
Cardiology, Critical Care, Hematology/Oncology, Imaging, Pain/Sedation/Procedure, Pharmacy/Pharmacology, Pulmonary/Allergy, Venous Thromboembolism
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Emergency medicine docs should understand risk stratification of patients with acute PE as well as the risks, benefits, and gaps in evidence associated with interventional therapies.
Oct 31 2019
FOCUS for Unstable PE
Focused cardiac ultrasound (FOCUS) is sensitive for detecting the presence of PE in those with a HR > 100bpm or systolic blood pressure <90 and highly sensitive for detection of PE in patients with a HR > 110bpm.