scholarly journals Thrombotic thrombocytopenia following ChAdOx1 nCov-19 vaccination

2021 ◽  
Vol 20 (3) ◽  
pp. 223-226
Author(s):  
A Jafri ◽  
◽  
A Prieto ◽  
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Medical History ◽  
Thromboembolic Events ◽  
Provisional Diagnosis ◽  
Pulmonary Angiogram ◽  
Ct Pulmonary Angiogram ◽  
Very High ◽  
D Dimer

Serious thromboembolic events with concurrent thrombocytopenia, sometimes accompanied by bleeding, have occurred very rarely following administration of the ChAdOx1 nCoV-19 vaccine. We report the case of a 59-year-old male with an unremarkable medical history who presented to the emergency department with increasing breathlessness five days after receiving the first dose of ChAdOx1 nCov-19. The patient’s blood results showed mild thrombocytopenia and a very high D-dimer, and a pulmonary embolism was confirmed through a CT pulmonary angiogram, which led to a provisional diagnosis of vaccine-induced immune thrombotic thrombocytopenia. The condition was then treated with immunoglobulin and intravenous argatroban in line with the guidance from the Expert Haematology Panel focussed on Vaccine-induced Thrombosis and Thrombocytopenia before conversion to apixaban.

Patients with markedly elevated D-dimer who do not have pulmonary embolism

2020 ◽  
pp. postgradmedj-2019-137123
Author(s):  
Jeren Lim ◽  
Calum Cardle ◽  
Chris Isles
Keyword(s):  
Pulmonary Embolism ◽  
Aortic Dissection ◽  
Inclusion Criteria ◽  
Kaplan Meier ◽  
Pulmonary Angiogram ◽  
Ct Pulmonary Angiogram ◽  
Very High ◽  
D Dimer ◽  
Active Cancer

ObjectiveTo determine the cause of a markedly raised D-dimer among patients in whom a diagnosis of pulmonary embolism (PE) has been excluded by CT pulmonary angiogram (CTPA) with particular reference to new cases of cancer and aortic dissection.MethodsOne thousand consecutive patients, suspected of PE, who had undergone CTPA and for whom a D-dimer had been requested, were seen between 2012 and 2016. Retrospectively we examined the case records of all those in the top quintile of the D-dimer distribution whose CTPA was negative for PE. D-dimer in the top quintile ranged from 7.5 to 260 times upper limit normal.ResultsEighty-five patients fulfilled our inclusion criteria. The likely causes of their very high D-dimer were infection (n=35, 41.2%), cardiovascular disease (n=12, 14.1% including two patients with previously undiagnosed aortic dissection), surgery or trauma (n=12, 14.1%), new or active cancer (n=9, 10.6% comprising six new cancers and three patients with cancers diagnosed previously that were considered to be active) and miscellaneous causes (n=17, 20.0%). Thirty-five patients (43.5%) died over a 2-year follow-up. Kaplan-Meier survival analysis showed poorer outcomes for patients with new or active cancer, when compared with those with no known cancer (p<0.001).ConclusionsWe have shown that a small proportion of patients suspected of PE whose D-dimers are markedly elevated have diagnoses we would not want to miss including previously unsuspected cancer and aortic dissection. Further studies will be required to define the optimal workup of patients with extremely high D-dimer who do not have venous thromboembolism

scholarly journals Focus Assessed Transthoracic Echocardiography (FATE) to facilitate the diagnosis of low risk Pulmonary Embolism in Emergency Department

2013 ◽  
Vol 12 (4) ◽  
pp. 459-461 ◽  
Author(s):  
RS Sazwan ◽  
YU Devi ◽  
FM Hashairi ◽  
WAR Wan Faizia
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Transthoracic Echocardiography ◽  
Gold Standard ◽  
Clinical Presentation ◽  
Medical Science ◽  
Low Risk ◽  
Pulmonary Angiogram ◽  
Ct Pulmonary Angiogram ◽  
Standard Investigation

A diagnosis of Pulmonary Embolism (PE) is difficult that may be missed because of non specific clinical presentation. However, early diagnosis is fundamental, since immediate treatment is highly effective. Thus, with the availability of ultrasound machine in Emergency Department (ED) can help Emergency Physician to diagnose PE by using Focus Assessed Transthoracic Echocardiography (FATE) to facilitate the diagnosis of PE in low risk patient before proceed with the gold standard investigation which is CT Pulmonary Angiogram (CTPA). We believed this case was likely to be repeated on some readers' clinical practice and this procedure is an appropriate option to consider in such cases. DOI: http://dx.doi.org/10.3329/bjms.v12i4.16101 Bangladesh Journal of Medical Science Vol. 12 No. 04 October ’13 Page 459-461

scholarly journals P104: Evaluating the use of the pulmonary embolism rule-out criteria in the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S93-S94
Author(s):  
S. Sharif ◽  
C. Kearon ◽  
M. Eventov ◽  
M. Li ◽  
P. Sneath ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
False Negative ◽  
False Negative Rate ◽  
Signs And Symptoms ◽  
Ct Scanning ◽  
Pulmonary Angiogram ◽  
Ct Angiogram ◽  
D Dimer ◽  
Rule Out

Introduction: Diagnosing pulmonary embolism (PE) can be challenging because the signs and symptoms are often non-specific. Studies have shown that evidence-based algorithms are not always adhered to in the Emergency Department (ED), which leads to unnecessary CT scanning. The pulmonary embolism rule-out criteria (PERC) can identify patients who can be safely discharged from the ED without further investigation for PE. The purpose of this study is to evaluate the use of the PERC rule in the ED and to compare the rates of testing for PE if the PERC rule was used. Methods: This was a health records review of ED patients investigated for PE at two emergency departments over a two-year period (April 2013-March 2015). Inclusion criteria were ED physician ordered CT pulmonary angiogram, ventilation-perfusion scan, or D-dimer for investigation of PE. Patients under the age of 18 were excluded. PE was considered to be present during the emergency department visit if PE was diagnosed on CT or VQ (subsegmental level or above), or if the patient was subsequently found to have PE or deep vein thrombosis during the next 30 days. Trained researchers extracted anonymized data. The rate of CT/VQ imaging and the negative predictive value was calculated. Results: There were 1,163 patients that were tested for PE and 1,097 patients were eligible for our analysis. Of the total, 330/1,097 (30.1%; 95%CI 27.4-32.3%) had CT/VQ imaging for PE, and 48/1,097 (4.4%; 95%CI 3.3-5.8%) patients were diagnosed with PE. 806/1,097 (73.5%; 95%CI 70.8-76.0%) were PERC positive, and of these, 44 patients had a PE (5.5%; 95%CI 4.1-7.3%). Conversely, 291/1,097 (26.5%; 95%CI 24.0-29.2%) patients were PERC negative, and of these, 4 patients had a PE (1.4%; 95%CI 0.5-3.5%). Of the PERC negative patients, 291/291 (100.0%; 95%CI 98.7-100.0%) had a D-dimer test done, and 33/291 (11.3%; 95%CI 8.2-15.5%) had a CT angiogram. If PERC was used, CT/VQ imaging would have been avoided in 33/1,097 (3%; 95%CI 2.2-4.2%) patients and the D-dimer would have been avoided in 291/1,097 (26.5%; 95%CI 24.0-29.2%) patients. Conclusion: If the PERC rule was used in all patients with suspected PE, fewer patients would have further testing. The false negative rate for the PERC rule was low.

scholarly journals LO30: Prevalence of pulmonary embolism among emergency department patients with syncope: a multicenter prospective cohort study

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S17-S17 ◽  
Author(s):  
V. Thiruganasambandamoorthy ◽  
M. L.A. Sivilotti ◽  
B. H. Rowe ◽  
A. D. McRae ◽  
M. Mukarram ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
The United States ◽  
Pulmonary Angiogram ◽  
Emergency Department Patients ◽  
Multicenter Prospective Cohort Study ◽  
Multicenter Prospective Cohort ◽  
D Dimer ◽  
Combined Data

Introduction: The prevalence of pulmonary embolism (PE) among patients with syncope is understudied. Based on a recent study with an exceptionally high PE prevalence, some advocate investigating all syncope patients for PE, including those with another clear cause for their syncope. We sought to evaluate the PE prevalence among emergency department (ED) patients with syncope. Methods: We combined data from two large prospective studies enrolling adults with syncope from 17 EDs in Canada and the United States. Each study collected the results of investigations related to PE (i.e. D-dimer or ventilation-perfusion (VQ) scan, or computed tomography pulmonary angiogram (CTPA)), and 30-day adjudicated outcomes including diagnosis of PE, arrhythmia, myocardial infarction, serious hemorrhage and/or death. Results: Of the 9,091 patients (median age 66 years, 51.9% females, 39.1% hospitalized) with 30-day follow-up, 546 (6.0%) were investigated for PE: 278 (3.1%) had D-dimer, 39 (0.4%) had VQ and 347 (3.8%) patients had CTPA performed. 30-day outcomes included: 874 (9.6%) patients with any serious outcome; 0.9% deaths; and 818 (9.0%) patients with non-PE serious outcomes. Overall, 56 patients (prevalence 0.6%; 95% CI 0.5% 0.8%) were diagnosed with PE, including 8 (0.1%) of those admitted to hospital at the index presentation. Only 11 patients (0.1%) with a non-PE serious condition had a concomitant underlying PE identified. Conclusion: The prevalence of PE is very low among ED patients with syncope, including those hospitalized following syncope. While acknowledging syncope may be caused by an underlying PE, clinicians should be cautious against indiscriminate over-investigations for PE.

scholarly journals COVID-19 CT pulmonary angiogram examinations and reported pulmonary embolism incidence: comparison between peak first wave and early second wave

2021 ◽  
Vol 76 (4) ◽  
pp. 310-312
Author(s):  
M.T. Tsakok ◽  
Z. Qamhawi ◽  
S.F. Lumley ◽  
C. Xie ◽  
P. Matthews ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Angiogram ◽  
Ct Pulmonary Angiogram ◽  
Second Wave
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