Family history of venous thromboembolism predicts the diagnosis of acute pulmonary embolism in the emergency department

Introduction: Coronavirus disease 2019 (COVID-19) is a multisystem process with a growing evidence of its endotheliopathy effects, with subsequent hypercoagulability states. Case Report: WWe present an emergency department case of a COVID-19-provoked deep venous thrombosis and pulmonary embolism without a history of venous thromboembolism (VTE), with extension of the VTE despite adherence to apixaban. Conclusion: This case demonstrates the importance of further research and protocols for optimal dosage and treatment to prevent worsening VTE in COVID-19 patients.

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Association of Short-Term Mortality of Venous Thromboembolism with Family History of Venous Thromboembolism and Charlson Comorbidity Index

Thrombosis and Haemostasis ◽

10.1055/s-0038-1676347 ◽

2018 ◽

Vol 119 (01) ◽

pp. 048-055 ◽

Cited By ~ 1

Author(s):

Bengt Zöller ◽

MirNabi Pirouzifard ◽

Jan Sundquist ◽

Kristina Sundquist

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Family History ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Charlson Comorbidity Index ◽

Short Term ◽

Short Term Mortality ◽

History Of ◽

Comorbidity Index

AbstractStudies on short-term prognosis of venous thromboembolism (VTE) that take family history of VTE and Charlson Comorbidity Index (CCI) into account are sparse. The aim was to investigate the importance of family history of VTE and CCI for short-term mortality after a first episode of VTE. Using Swedish medical databases, we conducted a 90-day nationwide cohort study of 41,700 Swedish born patients with a first-time VTE (July 2005–August 2012). Patients diagnosed with VTE and prescribed anticoagulant treatment were included. Mortality hazard ratios (HRs) with 95% confidence intervals (CIs) were determined with Cox regression. Patients with first-degree (sibling/parent) family history of VTE (n = 11,405, 27.4%) had significantly lower CCI than those without family history. Independent risk factors for 90-day mortality in the adjusted model were: female sex (HR = 1.19, 95% CI: 1.09–1.29), increasing age (HR = 1.02, 95% CI: 1.01–1.02 per year), pulmonary embolism (HR = 1.21, 95% CI: 1.11–1.32) or combined pulmonary embolism and deep venous thrombosis (HR = 1.60, 95% CI: 1.27–2.01) compared with deep venous thrombosis, CCI = 1 (HR = 2.93, 95% CI: 2.32–3.72), CCI = 2 (HR = 8.65, 95% CI: 7.16–10.46) or CCI = 3 (HR = 22.25, 95% CI: 18.73–26.44) compared with CCI = 0. Having one or two or more affected first-degree relatives with VTE was associated with lower mortality, HR = 0.83 (95% CI: 0.74–0.92) and HR = 0.65 (95% CI: 0.51–0.85), respectively. The mortality rate was 0.70% in patients with a CCI of zero. In receiver operating characteristic (ROC) analysis, the area under the ROC curve for CCI was 0.84 (0.83–0.95). Family history of VTE is associated with lower mortality while CCI is a strong predictor for short-term mortality in VTE. Co-morbidities are important for risk assessment of VTE.

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Unexpected Pulmonary Embolism Late After Recovery from Mild COVID-19?

European Journal of Case Reports in Internal Medicine ◽

10.12890/2021_002854 ◽

2021 ◽

Author(s):

Doranna De Pace ◽

Sara Ariotti ◽

Simone Persampieri ◽

Giuseppe Patti ◽

Lupi Alessandro

Keyword(s):

Pulmonary Embolism ◽

Risk Factor ◽

Venous Thromboembolism ◽

Systemic Inflammation ◽

Acute Pulmonary Embolism ◽

Low Grade ◽

Increased Risk ◽

History Of ◽

Low Grade Inflammation

SARS-CoV-2 infection is associated with an increased risk of venous thromboembolism (VTE), which is common during active illness but unusual in milder cases and after healing. We describe a case of bilateral acute pulmonary embolism occurring 3 months after recovery from a paucisymptomatic SARS-CoV-2 infection. The only VTE risk factor demonstrable was a history of previous SARS-CoV-2 infection, with laboratory signs of residual low-grade inflammation. Clinicians should be aware of VTE as a potential cause of sudden dyspnoea after COVID-19 resolution, especially in the presence of persistent systemic inflammation.

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Overcoming barriers to outpatient management of emergency department patients with acute pulmonary embolism

Academic Emergency Medicine ◽

10.1111/acem.14210 ◽

2021 ◽

Author(s):

David R. Vinson ◽

Dustin G. Mark ◽

Dustin W. Ballard

Keyword(s):

Emergency Department ◽

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Outpatient Management ◽

Emergency Department Patients

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An incidental finding of testicular seminoma in the context of acute pulmonary embolism: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02925-z ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Kaitlin J. Mayne ◽

Emma Lewis ◽

Lewis Vickers

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Clinical Guidelines ◽

Acute Pulmonary Embolism ◽

Incidental Finding ◽

White Male ◽

Vena Cava ◽

Testicular Seminoma ◽

Computed Tomography Scanning ◽

The Right

Abstract Background Clinical guidelines do not recommend further investigation for occult malignancy in the scenario of unprovoked venous thromboembolism in the absence of additional clinical features suggestive of malignancy. We present the case of a young gentleman with pulmonary embolism who was diagnosed with testicular seminoma despite lack of symptoms or signs suggestive of malignancy. This is a unique case describing a scenario not well documented in existing literature where contravention of clinical guidelines had a potentially advantageous outcome for the patient. Case presentation A 37-year-old white male presented with seemingly unprovoked acute pulmonary embolism with right heart strain. He did not have any predisposing factors for venous thromboembolism and did not have any symptoms or signs suggestive of malignancy. Clinical guidelines do not recommend further investigation to screen for malignancy in this scenario. Despite this, our young, otherwise healthy patient proceeded to computed tomography scanning, resulting in the diagnosis of localized testicular seminoma. Testicular ultrasound described normal-sized testes (despite a discrete lesion in the right testis), suggesting this was not detectable by the patient or clinician on routine examination. The patient was anticoagulated and had an inferior vena cava filter inserted to facilitate orchidectomy followed by adjuvant radiotherapy. Conclusions This case highlights the importance of considering malignancy in seemingly unprovoked venous thromboembolism and the availability of guidelines to direct further investigation. Our patient’s treatment was not in line with clinical guidelines and was considered a “lucky find.”

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Familial thrombophilia associated with fibrinogen Paris V: Dusart syndrome

Blood ◽

10.1182/blood.v96.3.1191 ◽

2000 ◽

Vol 96 (3) ◽

pp. 1191-1193 ◽

Cited By ~ 15

Author(s):

Takashi Tarumi ◽

Danko Martincic ◽

Anne Thomas ◽

Robert Janco ◽

Mary Hudson ◽

...

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Early Onset ◽

Family Members ◽

Initial Presentation ◽

Pulmonary Emboli ◽

Common Cause ◽

History Of ◽

Prophylactic Anticoagulation ◽

Fibrin Clots

Abstract We report on a family with a history of venous thromboembolism associated with fibrinogen Paris V (fibrinogen A-Arg554→Cys). Ten members experienced thrombotic events, including 4 with fatal pulmonary emboli. Pulmonary embolism was the presenting feature in 4. Those with the mutation and a history of thrombosis had somewhat higher fibrinogen concentrations than those with the mutation and no thrombosis (294 ± 70 mg/dL vs 217 ± 37 mg/dL, respectively). The Paris V mutation consistently caused a prolongation of the reptilase time, and fibrin clots containing the abnormal fibrinogen were more translucent than normal clots. Given the early onset of symptoms and the initial presentation with pulmonary embolism in some family members, it was justifiable to offer prophylactic anticoagulation with warfarin to carriers of the mutation. Fibrinogen Paris V has now been reported in 4 apparently unrelated families, indicating that it is a relatively common cause of dysfibrinogenemia-associated thrombosis.

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Venous Thromboembolism: Genetics and Thrombophilias

Seminars in Respiratory and Critical Care Medicine ◽

10.1055/s-0041-1723937 ◽

2021 ◽

Vol 42 (02) ◽

pp. 271-283

Author(s):

Manila Gaddh ◽

Rachel P. Rosovsky

Keyword(s):

Clinical Practice ◽

Venous Thromboembolism ◽

Family History ◽

Morbidity And Mortality ◽

Inherited Thrombophilia ◽

Risks And Benefits ◽

Hereditary Thrombophilia ◽

The World ◽

The Future ◽

History Of

AbstractVenous thromboembolism (VTE) is a major cause of morbidity and mortality throughout the world. Up to one half of patients who present with VTE will have an underlying thrombophilic defect. This knowledge has led to a widespread practice of testing for such defects in patients who develop VTE. However, identifying a hereditary thrombophilia by itself does not necessarily change outcomes or dictate therapy. Furthermore, family history of VTE by itself can increase an asymptomatic person's VTE risk several-fold, independent of detecting a known inherited thrombophilia. In this article, we will describe the current validated hereditary thrombophilias including their history, prevalence, and association with VTE. With a focus on evaluating both risks and benefits of testing, we will also explore the controversies of why, who, and when to test as well as discuss contemporary societal guidelines. Lastly, we will share how these tests have been integrated into clinical practice and how to best utilize them in the future.

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136 Impact of Electronic Clinical Decision Support on Initial Site of Care for Emergency Department Patients With Acute Pulmonary Embolism

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2016.08.148 ◽

2016 ◽

Vol 68 (4) ◽

pp. S54 ◽

Cited By ~ 2

Author(s):

D.R. Vinson ◽

D.W. Ballard ◽

D.G. Mark ◽

D.M. Yealy ◽

M.E. Reed ◽

...

Keyword(s):

Emergency Department ◽

Pulmonary Embolism ◽

Decision Support ◽

Clinical Decision Support ◽

Acute Pulmonary Embolism ◽

Clinical Decision ◽

Emergency Department Patients ◽

Electronic Clinical Decision Support

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High incidence of patients lost to follow-up after venous thromboembolism diagnosis – Identifying an unmet need for targeted transition of care

Vascular ◽

10.1177/17085381211020969 ◽

2021 ◽

pp. 170853812110209

Author(s):

Rae S Rokosh ◽

Jack H Grazi ◽

David Ruohoniemi ◽

Eugene Yuriditsky ◽

James Horowitz ◽

...

Keyword(s):

Emergency Department ◽

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Time Of Day ◽

Transition Of Care ◽

Initial Discharge ◽

Significant Difference

Objectives Venous thromboembolism, including deep venous thrombosis and pulmonary embolism, is a major source of morbidity, mortality, and healthcare utilization. Given the prevalence of venous thromboembolism and its associated mortality, our study sought to identify factors associated with loss to follow-up in venous thromboembolism patients. Methods This is a single-center retrospective study of all consecutive admitted (inpatient) and emergency department patients diagnosed with acute venous thromboembolism via venous duplex examination and/or chest computed tomography from January 2018 to March 2019. Patients with chronic deep venous thrombosis and those diagnosed in the outpatient setting were excluded. Lost to venous thromboembolism-specific follow-up (LTFU) was defined as patients who did not follow up with vascular, cardiology, hematology, oncology, pulmonology, or primary care clinic for venous thromboembolism management at our institution within three months of initial discharge. Patients discharged to hospice or dead within 30 days of initial discharge were excluded from LTFU analysis. Statistical analysis was performed using STATA 16 (College Station, TX: StataCorp LLC) with a p-value of <0.05 set for significance. Results During the study period, 291 isolated deep venous thrombosis, 25 isolated pulmonary embolism, and 54 pulmonary embolism with associated deep venous thrombosis were identified in 370 patients. Of these patients, 129 (35%) were diagnosed in the emergency department and 241 (65%) in the inpatient setting. At discharge, 289 (78%) were on anticoagulation, 66 (18%) were not, and 15 (4%) were deceased. At the conclusion of the study, 120 patients (38%) had been LTFU, 85% of whom were discharged on anticoagulation. There was no statistically significant difference between those LTFU and those with follow-up with respect to age, gender, diagnosis time of day, venous thromboembolism anatomic location, discharge unit location, or anticoagulation choice at discharge. There was a non-significant trend toward longer inpatient length of stay among patients LTFU (16.2 days vs. 12.3 days, p = 0.07), and a significant increase in the proportion of LTFU patients discharged to a facility rather than home ( p = 0.02). On multivariate analysis, we found a 95% increase in the odds of being lost to venous thromboembolism-specific follow-up if discharged to a facility (OR 1.95, CI 1.1–3.6, p = 0.03) as opposed to home. Conclusions Our study demonstrates that over one-third of patients diagnosed with venous thromboembolism at our institution are lost to venous thromboembolism-specific follow-up, particularly those discharged to a facility. Our work suggests that significant improvement could be achieved by establishing a pathway for the targeted transition of care to a venous thromboembolism-specific follow-up clinic.

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