Anticoagulant treatment for subsegmental pulmonary embolism

Yoo, Hugo Hyung Bok; Queluz, Thaís Helena Abrahão Thomaz; Dib, Regina El

doi:10.1002/14651858.cd010222.pub3

Cited by 44 publications

(15 citation statements)

References 39 publications

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“…Incidental and isolated subsegmental PE should generally be managed in the same manner as symptomatic and non-subsegmental PE [43]. This hypothesis, however, should be assessed in prospective clinical trials [44]. By contrast, patients diagnosed with acute symptomatic PE, concomitant DVT was significantly associated with an increased risk of death within 30 days of PE diagnosis [40,45].…”

Section: Discussionmentioning

confidence: 99%

Asthma–Chronic Obstructive Pulmonary Disease Overlap Syndrome Associated with Risk of Pulmonary Embolism

2016

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PurposeWe conducted a cohort study to clarify this relationship between asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) and pulmonary embolism (PE).MethodsFrom the National Health Insurance Research Database of Taiwan, we identified patients who had a diagnosis of asthma and a diagnosis of COPD (defined as ACOS) and concurrent treatment between January 1999 and December 2009 (ACOS cohort: n = 14,150; non-ACOS cohort: n = 55,876). Cox proportional hazards regression analysis was performed to determine the adjusted hazard ratios (aHRs) for PE of the ACOS cohort compared with the non-ACOS cohort.ResultsComparing the ACOS cohort with the non-ACOS cohort, the aHR of PE was 2.08 (95% confidence intervals [CIs]: 1.56–2.76). The risk of PE was higher in ACOS cohort than non-ACOS cohort, regardless of age, sex, comorbidity, inhaled corticosteroids (ICSs) and oral steroids (OSs) used. For ages ranging from 20 to 65 years, the aHR of PE was 2.53 (95% CI: 1.44–4.44) in the ACOS cohort. ACOS patients using ICSs (aHR: 1.97, 95% CI: 1.29–3.01) or OSs (aHR: 1.97, 95% CI: 1.46–2.65), the risk of PE was higher than in the non-ACOS cohort. The risk of PE increased with the number of outpatient visits and hospitalizations necessitated, ranging from 2.32 (95% CI: 1.54–3.52) in patients having 3–9 visits to 4.20 (95% CI: 2.74–6.44) for those having >9 visits.ConclusionsACOS is associated with increased risk of PE, particularly patients with a high frequency of AE—even in young adults or people without comorbidities.

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Section: Discussionmentioning

confidence: 99%

Asthma–Chronic Obstructive Pulmonary Disease Overlap Syndrome Associated with Risk of Pulmonary Embolism

2016

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“…The significance of detecting subsegmental PE (SSPE) has been an ongoing debate for more than a decade[ 21 ]. An isolated SSPE could be a symptom of a thrombotic state, and may require treatment[ 22 ]. Recently Mehta et al[ 23 ] have shown that withholding anticoagulation in patients with a single SSPE and negative bilateral lower extremity venous duplex ultrasound exams was a safe and effective strategy.…”

Section: Treatment For Subsegmental Pe Remains a Conundrummentioning

confidence: 99%

Magnetic resonance angiography for the primary diagnosis of pulmonary embolism: A review from the international workshop for pulmonary functional imaging

Tsuchiya¹,

Ej²,

Ohno³

et al. 2018

WJR

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Pulmonary contrast enhanced magnetic resonance angiography (CE-MRA) is useful for the primary diagnosis of pulmonary embolism (PE). Many sites have chosen not to use CE-MRA as a first line of diagnostic tool for PE because of the speed and higher efficacy of computerized tomographic angiography (CTA). In this review, we discuss the strengths and weaknesses of CE-MRA and the appropriate imaging scenarios for the primary diagnosis of PE derived from our unique multi-institutional experience in this area. The optimal patient for this test has a low to intermediate suspicion for PE based on clinical decision rules. Patients in extremis are not candidates for this test. Younger women (< 35 years of age) and patients with iodinated contrast allergies are best served by using this modality We discuss the history of the use of this test, recent technical innovations, artifacts, direct and indirect findings for PE, ancillary findings, and the effectiveness (patient outcomes) of CE-MRA for the exclusion of PE. Current outcomes data shows that CE-MRA and NM V/Q scans are effective alternative tests to CTA for the primary diagnosis of PE.

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“…Additionally, the paucity of dyspnea despite profound hypoxemia in COVID-19 makes it difficult to identify a high-risk patient clinically. This clinical picture mirrors patients with peripheral subsegmental pulmonary emboli who show minimal or no symptoms that precludes early diagnosis, 20 but risk rapid decline especially with endotracheal intubation.…”

Section: Clinical Trajectory In Severe Covid-19 ‘Pneumonia’ Reflects mentioning

confidence: 62%

Rethinking COVID‐19 ‘pneumonia’ – is this primarily a vaso‐occlusive disease, and can early anticoagulation save the ventilator famine?

et al. 2020

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Anticoagulant treatment for subsegmental pulmonary embolism

Abstract: Editorial group: Cochrane Vascular Group. Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 2, 2020.

Cited by 44 publications

References 39 publications

Asthma–Chronic Obstructive Pulmonary Disease Overlap Syndrome Associated with Risk of Pulmonary Embolism

Asthma–Chronic Obstructive Pulmonary Disease Overlap Syndrome Associated with Risk of Pulmonary Embolism

Magnetic resonance angiography for the primary diagnosis of pulmonary embolism: A review from the international workshop for pulmonary functional imaging

Rethinking COVID‐19 ‘pneumonia’ – is this primarily a vaso‐occlusive disease, and can early anticoagulation save the ventilator famine?

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