Evolution of CT findings after anticoagulant treatment for acute pulmonary embolism in patients with and without an ultimate diagnosis of CTEPH

2021 ◽  
pp. 2100699
Author(s):  
Natalia J. Braams ◽  
Gudula J. A. M. Boon ◽  
Frances S. de Man ◽  
Josien van Es ◽  
Paul L. den Exter ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Arteries ◽  
Vascular Lesions ◽  
Anticoagulant Treatment ◽  
Thrombotic Occlusion ◽  
Pulmonary Arterial ◽  
Acute Pe ◽  
Over Time

IntroductionThe pulmonary arterial morphology of patients with pulmonary embolism (PE) is diverse and it is unclear how the different vascular lesions evolve after initiation of anticoagulant treatment. A better understanding of the evolution of CTPA findings after the start of anticoagulant treatment may help to better identify those PE patients prone to develop CTEPH. We aimed to assess the evolution of various thromboembolic lesions on CTPA over time after the initiation of adequate anticoagulant treatment in individual acute PE patients with and without an ultimate diagnosis of CTEPH.MethodsWe analysed the CTPA at diagnosis of acute PE (baseline) and at follow-up in 41 patients with CTEPH and 124 patients without an ultimate diagnosis of CTEPH, all receiving anticoagulant treatment. Central and segmental pulmonary arteries were scored by expert chest radiologists as normal or affected. Lesions were further sub-classified as: 1. central thrombus, 2. total thrombotic occlusion, 3. mural thrombus, 4. web or 5. tapered pulmonary artery.ResultsCentral thrombi resolved after anticoagulant treatment, while mural thrombi and total thrombotic occlusions either resolved or evolved into webs or tapered pulmonary arteries. Only patients with an ultimate diagnosis of CTEPH exhibited webs and tapered pulmonary arteries on the baseline scan. Moreover, such lesions always persisted after follow-up.ConclusionWebs and tapered pulmonary arteries at the time of PE diagnosis strongly indicate a state of chronic PE and should raise awareness for possible CTEPH, particularly in patients with persistent dyspnea after anticoagulant treatment for acute PE.

Negative spiral CT in acute pulmonary embolism

2002 ◽  
Vol 43 (5) ◽  
pp. 486-491 ◽  
Author(s):  
T. Nilsson ◽  
A. Olausson ◽  
H. Johnsson ◽  
U. Nyman ◽  
P. Aspelin
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Arteries ◽  
Negative Contrast ◽  
Spiral Ct ◽  
Pulmonary Angiography ◽  
Diagnostic Quality ◽  
Anticoagulation Treatment ◽  
Acute Pe

Purpose: To retrospectively evaluate the clinical outcome of non-anticoagulated patients with clinically suspected acute pulmonary embolism (PE) and no symptoms or signs of deep venous thrombosis (DVT) following a negative contrast medium-enhanced spiral CT of the pulmonary arteries (s-CTPA). Material and Methods: During a 24-month period, 739 of 751 patients underwent s-CTPA with acceptable diagnostic quality for clinically suspected acute PE. All patients who had a CT study not positive for PE were followed up with a questionnaire, a telephone interview and review of all medical reports, including autopsies and death certificates for any episodes of venous thromboembolism (VTE) during a 3-month period. Results: PE was diagnosed in 158 patients. Of the remaining 581 patients with a negative s-CTPA, 45 patients were lost to follow-up. 88 patients were excluded because of anticoagulation treatment (cardiac disorder n=32, chronic VTE or acute symptomatic DVT n=31, PE diagnosed at pulmonary angiography n=1, thrombus prophylaxis during diagnostic work-up or other reasons than VTE n=24) and 7 patients undergoing lower extremity venous studies because of symptoms of DVT (all negative). Thus, 441 patients with a negative s-CTPA and no DVT symptoms, venous studies or anticoagulant treatment constituted the follow-up cohort. Four of these patients had proven VTE (all PE) during the 3-month follow-up period. Two of the PE episodes contributed to the patient's death. Conclusion: Patients with clinically suspected acute PE, no symptoms or signs of DVT and a negative single slice s-CTPA using 3–5 mm collimation, may safely be left without anticoagulation treatment unless they are critically ill, have a limited cardiopulmonary reserve and/or if a high clinical suspicion remains.

Differential effect of anticoagulant treatment on vascular morphology in patients with acute pulmonary embolism

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N.J Braams ◽  
G.J.A.M Boon ◽  
P.L Den Exter ◽  
L.J.M Kroft ◽  
L.F.M Beenen ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Arteries ◽  
Funding Source ◽  
Anticoagulant Treatment ◽  
Private Company ◽  
Total Occlusion ◽  
Almost All

Abstract Introduction Chronic thromboembolic pulmonary hypertension (CTEPH) is described as one of the most severe consequence of acute pulmonary embolism (APE). When signs of chronic PE are present on the CT pulmonary angiogram (CTPA) used to diagnose APE, the question arises whether there is underlying CTEPH. The relevance of chronic lesions, as well as the effect of anticoagulant treatment on their development is currently unknown. Purpose To investigate the effect of anticoagulant treatment on CTPA derived vascular morphological abnormalities in patients with APE. Methods We performed a case-cohort study. As cases, we selected CTEPH patients who had a prior history of a first APE episode. As cohort, we selected patients who had a follow-up CTPA performed 6 months after first episode APE in the context of a clinical trial (den Exter 2015). A baseline (i.e. at moment of APE diagnosis) CTPA and a follow-up CTPA was available for all patients. Experienced chest radiologists morphologically assessed 20 segmental pulmonary arteries per patient as “normal” or “affected” (as defined by a total occlusion by thrombus, central thrombus, mural thrombus, web or tapered pulmonary artery). Pulmonary segmental vessels of the entire cohort were merged for the analysis. All patients were treated adequately with anticoagulant treatment (vitamin K antagonists, direct oral anticoagulation or low molecular weight heparin) in the period between baseline and follow-up CTPA according to current guidelines. Results A total of 30 cases and 116 controls were included. Mean time between baseline and follow-up CTPA was 193 (62) days. At baseline CTPA, 1647 (56%) of the 2920 pulmonary segmental vessels were scored as affected. Almost all central thrombi resolved after oral anticoagulant treatment (1103/1191=93%). Webs (n=85) and tapered pulmonary arteries (n=57) did not change in morphology at follow-up (Figure 1). Most vessels containing a total occlusion by a thrombus at baseline resolved completely (156/280=56%), changed to a tapered pulmonary artery (26%) or became a web (7%). Mural thrombi either remained unchanged (16/34=47%), resolved completely (29%) or became a web (24%). Conclusion After anticoagulant treatment for APE almost all central thrombi completely resolved, whereas mural thrombi or total occlusions by thrombi either resolved or transformed to a web or tapered pulmonary artery. Interestingly, none of the webs and tapered pulmonary arteries resolved after anticoagulant treatment. Therefore, webs and tapered pulmonary arteries at the moment of APE diagnosis indicate a chronic PE state. Figure 1. Web at baseline and follow-up Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Research grant from Actelion Pharmaceuticals

Outpatient Treatment In Patients with Acute Pulmonary Embolism: The Hestia Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. LBA-1-LBA-1
Author(s):  
Wendy Zondag ◽  
Inge Mos ◽  
Dina Creemers ◽  
Lidia Hoogerbrugge ◽  
Olaf Dekkers ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Confidence Interval ◽  
Outpatient Treatment ◽  
Research Funding ◽  
Acute Pulmonary Embolism ◽  
Bleeding Event ◽  
Total Mortality ◽  
Recurrent Vte ◽  
Acute Pe

Abstract Abstract LBA-1 Introduction: Patients with pulmonary embolism (PE) are initially treated in the hospital with low molecular weight heparin (LMWH). The most recent guideline of the American College of Chest Physicians on Antithrombotic therapy 2008 reports some small studies on outpatient treatment in patients with pulmonary embolism, which suggest outpatient treatment in selected patients with PE is potentially effective and safe but firm recommendations for clinical practice are lacking. Clinicians urgently need reliable, easy-to-use selection criteria for selection of patients with pulmonary embolism eligible for outpatient treatment. Objective: To evaluate the efficacy and safety of outpatient treatment according to predefined criteria (Hestia criteria) in patients with acute PE. Patients and Methods: Open-label, single-arm, multicenter clinical trial of patients with objectively proven acute pulmonary embolism, conducted in twelve hospitals in the Netherlands from 2008 to 2010. Follow-up was completed in September 2010. Patients with acute PE were triaged with the predefined Hestia criteria for eligibility for outpatient treatment starting with therapeutic weight adjusted doses of LMWH (Nadroparin), followed by vitamin K antagonists. All patients eligible for outpatient treatment according to the Hestia criteria, were sent home either immediately or within 24 hours after PE was objectively diagnosed. Outcome: Outpatient treatment was evaluated with respect to recurrent venous thromboembolism (VTE), including PE or deep venous thrombosis (DVT), major haemorrhage and total mortality during initial LMWH treatment and 3 months follow up. We considered outpatient treatment to be effective if the upper limit of the 95% confidence interval of the incidence of recurrent VTE would not exceed 7%. Results: Of 297 included patients, who all completed follow-up, 6 patients (2.0%; 95% confidence interval [CI], 0.8–4.3) had recurrent VTE (5 PE (1.7%), 1 DVT (0.3 %)). Three patients (1.0%, 95% CI 0.2–2.9) died during three months follow-up, but none as a result of fatal PE. One patient died of fatal intracerebral haemorrhage, the other two patients died of progressive malignancy. In addition to the patient with intracranial bleeding, one other patient had a major bleeding event (0.7 %, 95% CI 0.08%-2.4%). Conclusion: Outpatient anticoagulant treatment is effective and safe for patients with pulmonary embolism who have been selected with the Hestia criteria. (Dutch Trial Register NTR1319). Disclosures: Huisman: GSK: Research Funding; Actelion: Research Funding; Bayer: Speakers Bureau; Boehringer Ingelheim: Speakers Bureau; Pfizer: Speakers Bureau.

P2772The rule-out criteria for chronic thromboembolic pulmonary hypertension can identify patients without haemodynamic abnormalities and functional limitation 3 and 12 months after acute PE

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Barco ◽  
A Mavromanoli ◽  
F A Klok ◽  
S V Konstantinides
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
High Probability ◽  
Acute Pulmonary Embolism ◽  
Functional Limitation ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Thromboembolic Pulmonary Hypertension ◽  
Acute Pe ◽  
Rule Out

Abstract Background Up to one-third of patients report persisting hemodynamic abnormalities and functional limitation over long-term follow-up after acute pulmonary embolism (PE). Purpose We tested whether a validated algorithm designed to rule-out chronic thromboembolic pulmonary hypertension (CTEPH) after acute PE can be used for identifying patients at lower risk of presenting with persisting symptoms and echocardiographic abnormalities. Methods The multicentre Follow-up of Acute Pulmonary Embolism (FOCUS) cohort study prospectively enrolled 1,100 consecutive patients diagnosed with acute symptomatic PE; two-year follow-up is ongoing. We focused on the scheduled visits for 3- and 12-month follow-up. The rule-out criteria are based on: the absence of ECG signs of right ventricular dysfunction and normal NT-proBNP/BNP values. Echocardiographic abnormalities were defined according to the presence of abnormal parameters indicating an intermediate/high probability of pulmonary hypertension as recommended by the 2015 ESC/ERS Society Guidelines on Pulmonary Hypertension. The presence of functional limitation was defined based on a World Health Organization classification grade ≥3, a Borg dyspnoea index ≥4, or a 6-minute walking distance <300 m. Results We included 323 patients (mean age 61 years, 58% men), of whom 255 have meanwhile completed a one-year follow-up. At 3- and 12-month follow-up, 194 (60%) and 155 (61%) of patients exhibited no abnormal echocardiographic findings or natriuretic peptide levels. The percentage of patients with echocardiographic abnormalities was 20.4% and 18.0%, respectively. The negative predictive value of the score for ruling out the combination of functional limitation and intermediate/high probability of pulmonary hypertension as recommended by the 2015 ESC/ERS Guidelines on Pulmonary Hypertension was 0.96 (95% CI 0.92–0.98) at 3 and 0.97 (0.92–0.99) at 12 months. The corresponding positive predictive values were 0.10 (0.06–0.17) and 0.09 (0.05–0.17), respectively. Conclusions The CTEPH rule-out criteria are capable of excluding functional limitation and evidence of (chronic) pulmonary hypertension 3 and 12 months after the diagnosis of acute PE. Acknowledgement/Funding The sponsor (University Medical Center of the Johannes Gutenberg University, Mainz) has obtained grants from Bayer Vital GmbH and Bayer Pharma AG

Thromboembolic resolution assessed by CT pulmonary angiography after treatment for acute pulmonary embolism

2015 ◽  
Vol 114 (07) ◽  
pp. 26-34 ◽  
Author(s):  
Lucia J. M. Kroft ◽  
Petra M. G. Erkens ◽  
Renée A. Douma ◽  
Inge C. M. Mos ◽  
Gé Jonkers ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Clinical Importance ◽  
Pulmonary Angiography ◽  
Ct Pulmonary Angiography ◽  
Systematic Assessment ◽  
Cardiopulmonary Complications ◽  
Recurrent Vte ◽  
Acute Pe

SummaryThe systematic assessment of residual thromboembolic obstruction after treatment for acute pulmonary embolism (PE) has been under-studied. This assessment is of potential clinical importance, should clinically suspected recurrent PE occur, or as tool for risk stratification of cardiopulmonary complications or recurrent venous thromboembolism (VTE). This study aimed to assess the rate of PE resolution and its implications for clinical outcome. In this prospective, multi-center cohort study, 157 patients with acute PE diagnosed by CT pulmonary angiography (CTPA) underwent follow-up CTPA-imaging after six months of anticoagulant treatment. Two expert thoracic radiologists independently assessed the presence of residual thromboembolic obstruction. The degree of obstruction at baseline and follow-up was calculated using the Qanadli obstruction index. All patients were followed-up for 2.5 years. At baseline, the median obstruction index was 27.5 %. After six months of treatment, complete PE resolution had occurred in 84.1 % of the patients (95 % confidence interval (CI): 77.4–89.4 %). The median obstruction index of the 25 patients with residual thrombotic obstruction was 5.0 %. During follow-up, 16 (10.2 %) patients experienced recurrent VTE. The presence of residual thromboembolic obstruction was not associated with recurrent VTE (adjusted hazard ratio: 0.92; 95 % CI: 0.2–4.1). This study indicates that the incidence of residual thrombotic obstruction following treatment for PE is considerably lower than currently anticipated. These findings, combined with the absence of a correlation between residual thrombotic obstruction and recurrent VTE, do not support the routine use of follow-up CTPA-imaging in patients treated for acute PE.

scholarly journals Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium

2019 ◽  
Vol 25 ◽  
pp. 107602961985303 ◽  
Author(s):  
Belinda Rivera-Lebron ◽  
Michael McDaniel ◽  
Kamran Ahrar ◽  
Abdulah Alrifai ◽  
David M. Dudzinski ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
International Association ◽  
Response Team ◽  
Threatening Condition ◽  
Life Threatening ◽  
Acute Pe ◽  
Careful Assessment ◽  
Pulmonary Embolism Response Team

Pulmonary embolism (PE) is a life-threatening condition and a leading cause of morbidity and mortality. There have been many advances in the field of PE in the last few years, requiring a careful assessment of their impact on patient care. However, variations in recommendations by different clinical guidelines, as well as lack of robust clinical trials, make clinical decisions challenging. The Pulmonary Embolism Response Team Consortium is an international association created to advance the diagnosis, treatment, and outcomes of patients with PE. In this consensus practice document, we provide a comprehensive review of the diagnosis, treatment, and follow-up of acute PE, including both clinical data and consensus opinion to provide guidance for clinicians caring for these patients.

scholarly journals Safety and Efficiency of the YEARS Diagnostic Algorithm for Pregnant Patients with Clinically Suspected Acute Pulmonary Embolism —the Artemis Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 419-419
Author(s):  
Liselotte M. Van Der Pol ◽  
Cecile Tromeur ◽  
Ingrid Bistervels ◽  
Thomas van Bemmel ◽  
Francis Couturaud ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pregnant Women ◽  
Failure Rate ◽  
Acute Pulmonary Embolism ◽  
Diagnostic Algorithm ◽  
Ct Scanning ◽  
Ct Scans ◽  
Acute Pe ◽  
D Dimer

Abstract Background Acute pulmonary embolism (PE) is the leading cause of maternal mortality in Western countries, accounting for 20 to 30% of all maternal deaths. Therefore, the threshold to test for PE during pregnancy is low. Because evidence regarding the safety of ruling out PE with clinical decision rules and D-dimer tests in pregnant women is unavailable, all women with a suspected PE need to undergo an imaging test, with potential harm to patient and fetus by exposure to ionizing radiation. In the present international, multicenter, prospective management study, we evaluated the safety and efficiency of the YEARS diagnostic algorithm for ruling out PE in pregnant patients with clinically suspected PE (Netherlands Trial Registry number 5913). YEARS is a simple diagnostic algorithm designed to reduce the number of required computed tomography (CT) scans in the diagnostic work-up of PE in non-pregnant patients, and was recently shown to be as safe as conventional algorithms but associated with a significant absolute 14% reduction in the number of CT scans (van der Hulle et al., Lancet 2017). Methods The Artemis study was performed in 11 Dutch hospitals, 8 French hospitals and 1 Irish hospital. Consecutive pregnant patients with suspected acute PE were included. Exclusion criteria were treatment with therapeutically dosed anticoagulants >24 hours or contraindications for CT. The YEARS algorithm was slightly adjusted for application during pregnancy (figure 1): in patients with signs of deep vein thrombosis (DVT), compression ultrasonography was obligatory before CT scanning was considered. In patients with proven DVT, anticoagulant treatment was initiated and no further diagnostic tests were undertaken. In patients with no YEARS items (Figure 1), a D-dimer threshold of <1.0 µg/ml was sufficient to rule out PE. In the remaining patients D-dimer threshold was <0.5 µg/mL. CT scanning was only performed in patients with a D-dimer level above the threshold. Anticoagulant therapy was withheld if PE was excluded. The primary safety endpoint was the occurrence of symptomatic venous thromboembolism during 3 months of follow-up, the primary efficiency endpoint was the proportion of patients in whom CTPA could be avoided. All safety endpoints were adjudicated by an independent committee. Assuming a 1.0% diagnostic failure rate and defining a maximum acceptable failure rate of 2.7%, a total study population of 472 patients was required (one-sided alpha 0.05, beta 80%). Results and conclusion: The last patient was included in May 2018. At baseline, 48% of pregnant women with suspected acute PE had no YEARS item and a D-dimer threshold of 1.0 µg/mL was applied. A total of 42% had a D-dimer level below the relevant threshold and were managed without CT scanning. Follow-up and endpoint adjudication was not completed at the abstract submission deadline; full study results will be presented at the ASH meeting. Disclosures Couturaud: Pfizer: Research Funding; Bayer: Honoraria, Other: Travel Support; AstraZeneca: Honoraria; Actelion: Other: Travel Support; Intermune: Other: Travel Support; Leo Pharma: Other: Travel Support; Daiichi Sankyo: Other: Travel Support.

Out of Hospital Treatment of Acute Pulmonary Embolism in Patients with a Low NT-ProBNP Level.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3996-3996
Author(s):  
Mariette J Agterof ◽  
Roger E.G. Schutgens ◽  
Repke J Snijder ◽  
G. Epping ◽  
Henny G Peltenburg ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Emergency Room ◽  
Acute Pulmonary Embolism ◽  
Conflicts Of Interest ◽  
Low Risk ◽  
Hospital Treatment ◽  
Serious Adverse Events ◽  
Risk Patients ◽  
Acute Pe

Abstract Abstract 3996 Poster Board III-932 Background NT-proBNP is emerging to be of great importance in risk assessment of patients with acute pulmonary embolism (PE), by identifying both high and low-risk patients. The aim of the present management study was to investigate the safety of out of hospital treatment of patients with acute PE based on a NT-proBNP < 500 pg/ml. Methods Hemodynamically stable outpatients with objectively diagnosed acute PE and a NT-proBNP level < 500 pg/ml, were considered eligible for participation in this multicenter prospective study. Patients were discharged immediately from the emergency room or within the first 24 hours of admission. The primary objective was the 10-days mortality rate. Secondary objectives were the incidence of re-admission to hospital due to PE or its treatment, the patient's satisfaction during the first ten days of treatment and the incidence of serious adverse events in a 3-month follow-up period. Results Approximately 40 percent of all patients presenting at the emergency room with acute PE fulfilled the inclusion criteria. In total, 152 patients (mean age 53.4 ± 14.3 years; 51% female) with PE were treated as outpatients. No deaths, major bleedings or recurrent venous thromboembolism occurred during the first 10 days or in a follow-up period of 3 months. Seven patients required readmission. Three patients were admitted because of complaints of their PE: two patients with anxiety and pain and one patient with dyspnoea and low oxygen saturation. There were no signs of progression of PE in these 3 patients. Four patients were re-admitted because of an illness unrelated to PE. According to the PSQ18 and anxiety score, patients were satisfied with their out of hospital treatment; they had no progression of anxiety during the first ten days of treatment. Conclusion Out of hospital treatment is safe in a group of low risk patients with non-massive PE, based on NT-proBNP levels < 500 pg/ml. Approximately 40 percent of PE-patients can be treated in an outpatient setting. Patients consider out of hospital treatment as comfortable and have no increase in anxiety scores. Disclosures: No relevant conflicts of interest to declare.

P5017Factors associated with a negative D-dimer test in patients diagnosed with acute symptomatic pulmonary embolism

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Barco ◽  
M Russo ◽  
F A Klok ◽  
S V Konstantinides
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
False Negative ◽  
Diagnostic Strategy ◽  
Inverse Association ◽  
Symptomatic Pulmonary Embolism ◽  
Post Hoc ◽  
Acute Pe ◽  
D Dimer

Abstract Background The recommended diagnostic strategy for suspected acute pulmonary embolism (PE) combines the assessment of pre-test probability, D-dimer level, and -if indicated- computed tomography pulmonary angiography. Purpose To evaluate the frequency and potential explanations for negative D-dimer tests in patients diagnosed with acute PE. Methods The multicentre Follow-up of Acute Pulmonary Embolism (FOCUS) cohort study prospectively enrolled 1,100 consecutive patients diagnosed with acute symptomatic PE; two-year follow-up is ongoing. The items of the Simplified revised Geneva Score and the D-dimer levels at diagnosis have been prospectively collected, but they did not necessarily guide management decisions. Quantitative D-dimer was measured on admission either by quantitative latex-based assays or enzyme-linked immunosorbent assays. A negative D-dimer was defined by fixed (0.50 μg/mL) or age-adjusted (age*0.01 μg/mL if age>50) cut-off. Results Using the fixed cut-off, a negative D-Dimer was detected in 17 of 773 patients with ultimately diagnosed PE (miss rate 2.2% [95% CI 1.4–3.5]); using the age-adjusted cut-off, the test was discordant with the PE diagnosis in 24 patients (3.1% [2.1–4.6]). In Figure 1, red dots indicate negative D-dimer test by fixed cut-off and blue dots indicate additional negative D-dimer tests by age-adjusted cut-off. In 448 (59%) patients post-hoc classified as PE-unlikely, 11 (2.5% [1.4–4.3]) and 14 (3.1% [1.9–5.2]) patients had a negative D-dimer using the two different cut-offs, respectively. Haemoptysis on admission, V/Q scan-based diagnosis, and chronic lung disease were associated with a discordant D-dimer, while an inverse association existed for concomitant DVT. In 7 (29%) PE cases with normal D-dimer, PE was verified to be subsegmental also in a post-hoc evaluation. Another seven (29%) patients were receiving anticoagulation at the time of D-dimer assessment. Figure 1 Conclusions Our results show that the frequency of discordance between a normal D-dimer test and the diagnosis of acute PE is low, but not negligible. One third of discordant findings were related to subsegmental PE. Physicians should be aware that the risk of obtaining a false-negative D-dimer might be higher in specific subgroups of patients. Acknowledgement/Funding The sponsor (University Medical Center of the Johannes Gutenberg University, Mainz) has obtained grants from Bayer Vital GmbH and Bayer Pharma AG

scholarly journals Clinical and anamnestic characteristics and risk factors in patients with acute pulmonary embolism among residents of Kharkiv

2021 ◽  
Vol 17 (3) ◽  
pp. 58-63
Author(s):  
V.Y. Tseluyko ◽  
L.M. Yakovleva ◽  
S.M. Sukhova ◽  
K.Yu. Kinoshenko ◽  
O.V. Radchenko ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Varicose Veins ◽  
Pulmonary Arteries ◽  
Lower Extremities ◽  
Right Ventricular Dysfunction ◽  
Early Death ◽  
City Council ◽  
Acute Pe

Background. The purpose was the analysis of the features of the course and the leading factors in the development of pulmonary embolism. Materials and methods. During the period from November 1, 2019, to December 2020, inclusive, 188 patients with acute pulmonary embolism (PE), aged 46 to 80 years old, were hospitalized at the City Clinical Hospital 8 of the Kharkiv City Council; the average age was 62.9 ± 16.7 years. In-hospital mortality was 12.2 % (23 patients). The criterion for inclusion in the study was acute PE, which was diagnosed based on the results of multislice computed tomographic angiography of the pulmonary arteries (MCT angiography of the pulmonary arteries). All patients underwent a general clinical examination, the risk and prognosis were assessed based on the generally accepted scales, standard transthoracic echocardiography (EchoCG), and Doppler ultrasound examination of the veins of the lower extremities were performed. Results. The disease was diagnosed with the same frequency in men and women; there was no difference in age. Among the most significant and important risk factors for the development of pulmonary embolism are the history of venous thrombosis/embolism and active malignant oncological disease (43 and 35 %, respectively), while the less significant ones were advanced age, varicose veins of the lower extremities and arterial hypertension 47.9, 31.4 and 52.1 %, respectively. The vast majority (57.4 %) had a combination of 2 or more risk factors. Signs of right ventricular dysfunction according to MCT angiography of the pulmonary arteries and/or echocardiography were recorded in 45.7 % of patients. A high and medium-high risk of early death associated with acute PE was found in a significant percentage (71.8 %) of patients, which required the inclusion of a thrombolytic agent in the treatment strategy.

Sign in / Sign up

Export Citation Format

Share Document