Clinical Characteristics, Management, and Outcomes of Patients Diagnosed With Acute Pulmonary Embolism in the Emergency Department

Pollack, Charles V.; Schreiber, Donald; Goldhaber, Samuel Z.; Slattery, David; Fanikos, John; O’Neil, Brian J.; Thompson, James R.; Hiestand, Brian; Briese, Beau; Pendleton, Robert C.; Miller, Chadwick D.; Kline, Jeffrey A.

doi:10.1016/j.jacc.2010.05.071

Cited by 490 publications

(372 citation statements)

References 25 publications

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“…En un 90% de los casos la sospecha de TEP se plantea en base a signos clínicos 8 , junto a la presencia de factores de riesgo, presentes en el 75%-94% de los casos 9,10 . El TEP se puede presentar con un amplio espectro clínico, desde apenas sínto-mas hasta shock o inestabilidad hemodiná-mica, variables en función de la gravedad 11 . Los síntomas más habituales son disnea, que puede ser de reposo o de esfuerzo, y dolor torácico de características pleuríti-cas.…”

Section: Tromboembolismo Pulmonarunclassified

Trombo-embolismo pulmonar: necesitamos sospecha clínica

García-Sanz¹,

Pena-Álvarez

González‐Barcala

2012

Anales Sis San Navarra

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RESuMENLa enfermedad tromboembólica venosa (ETV) es un importante problema de salud, con una incidencia anual de 1-2 casos /1.000 personas. Un tercio de los pacientes con ETV sintomática cursan con tromboembolismo pulmonar (TEP), que es frecuentemente infradiagnosticado debido a su presentación clínica variable e inespecífica. El conocimiento de los signos y síntomas de la ETV puede reducir los retrasos en el diagnóstico y, con ello, la morbimortalidad asociada. Sin embargo, el TEP se puede presentar con un amplio espectro clínico, desde apenas síntomas hasta shock o inestabilidad hemodinámica, por lo que no debemos limitar la sospecha de TEP a aquellos pacientes con presentación típica; además esta posibilidad diagnóstica debe ser considerada no sólo ante la presencia de síntomas agudos, sino también en aquellos pacientes con síntomas respiratorios de evolución prolongada.Palabras clave. Tromboembolismo pulmonar. Diagnós-tico diferencial. Síndromes clínicos. Síntomas frecuentes. Retraso diagnóstico. ABSTRACTVenous thromboembolism (VTE) is a major health problem, with an annual incidence of 1-2 per 1,000 person-years. One in three patients with symptomatic VTE presents pulmonary embolism (PE), which is often underdiagnosed due to variable and nonspecific clinical presentation. Knowing the signs and symptoms of VTE can reduce delays in diagnosis, and thus VTErelated morbidity and mortality as well. Nevertheless, PE can present a wide clinical spectrum, ranging from being asymptomatic to shock or hemodynamic instability, which is why PE suspicion should not be limited to those patients with typical presentation. Therefore, this diagnostic possibility should not only be considered for patients with acute symptoms, but also for those with persistent respiratory symptoms.

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Section: Tromboembolismo Pulmonarunclassified

Trombo-embolismo pulmonar: necesitamos sospecha clínica

García-Sanz¹,

Pena-Álvarez

González‐Barcala

2012

Anales Sis San Navarra

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“…All but one of the phase III studies with the new oral agents included both patients with deep vein thrombosis and patients with pulmonary embolism. The risk of early in-hospital death in patients with pulmonary embolism ranges from 1% to >30%, depending on clinical presentation, and is higher than in patients with deep vein thrombosis [4][5][6]. This requires the availability of efficacy and safety data for the new oral agents across the spectrum of severity of pulmonary embolism.…”

Section: Introductionmentioning

confidence: 99%

Anticoagulant treatment for acute pulmonary embolism: a pathophysiology-based clinical approach

Agnelli

Becattini

2015

Eur Respir J

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The management of patients with acute pulmonary embolism is made challenging by its wide spectrum of clinical presentation and outcome, which is mainly related to patient haemodynamic status and right ventricular overload. Mechanical embolic obstruction and neurohumorally mediated pulmonary vasoconstriction are responsible for right ventricular overload. The pathophysiology of acute pulmonary embolism is the basis for risk stratification of patients as being at high, intermediate and low risk of adverse outcomes. This risk stratification has been advocated to tailor clinical management according to the severity of pulmonary embolism.Anticoagulation is the mainstay of the treatment of acute pulmonary embolism. New direct oral anticoagulants, which are easier to use than conventional anticoagulants, have been compared with conventional anticoagulation in five randomised clinical trials including >11 000 patients with pulmonary embolism. Patients at high risk of pulmonary embolism (those with haemodynamic compromise) were excluded from these studies. Direct oral anticoagulants have been shown to be as effective and at least as safe as conventional anticoagulation in patients with pulmonary embolism without haemodynamic compromise, who are the majority of patients with this disease. Whether these agents are appropriate for the acute-phase treatment of patients at intermediate-high risk pulmonary embolism (those with both right ventricle dysfunction and injury) regardless of any risk stratification remains undefined. @ERSpublications New oral anticoagulants are efficacious and safe in haemodynamically stable patients with acute pulmonary embolism http://ow.ly/I2iP5

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“…The annual incidence is approximately 1-3 per 1000 adults in developed countries [2]. Recent studies such as COPER and EMPEROR have shown that some important prognostic risk factors associated with death from pulmonary embolism (17 %) were age (over 70 years), cancer, congestive heart failures, chronic obstructive pulmonary disease, systemic arterial hypotension, tachypnea and the mortality rate directly attributable to pulmonary embolism was only 1 % [3,4]. These prognostic risk factors are often used to identify provoked VTE [5].…”

Section: Introductionmentioning

confidence: 99%

Red Cell Distribution Width Has a Predictable Value for Differentiation of Provoked and Unprovoked Venous Thromboembolism

Ertop

Bilici

Engın

et al. 2015

Indian J Hematol Blood Transfus

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Venous thromboembolism (VTE) is generally classified as provoked or unprovoked. This dichotomy is important for following patients, mortality rate, prognosis and whether more efficient therapy is needed. In VTE patients, during initial diagnosis, it is not known exactly whether red cell distribution width (RDW) have a predictable value for this differentiation and pathogenesis. In this study, 298 patients with VTE and 197 control subjects were included. Patients with VTE were defined as provoked or unprovoked with respect to physical examination findings and laboratory values. Changes in RDW were tested between VTE patients and control subjects, provoked and unprovoked VTE patients, and separately with control subjects. RDW was found to be high in provoked and unprovoked groups compared with control group (p \ 0.001, p = 0.003 respectively). RDW was significantly high in provoked VTE patients group compared with unprovoked patients (p \ 0.001) and a cut-off value was found to be 13.6 %. In ROC analysis, sensitivity was 90.19 % and specificity was 82 % (95 % CI 85. . RDW could be used as a simple, costeffective and a reliable test independent of age in differentiation of provoked and unprovoked VTE. In order to better understand its role, prospective large homogenized population studies in different regions are necessary.

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Clinical Characteristics, Management, and Outcomes of Patients Diagnosed With Acute Pulmonary Embolism in the Emergency Department

Cited by 490 publications

References 25 publications

Trombo-embolismo pulmonar: necesitamos sospecha clínica

Trombo-embolismo pulmonar: necesitamos sospecha clínica

Anticoagulant treatment for acute pulmonary embolism: a pathophysiology-based clinical approach

Red Cell Distribution Width Has a Predictable Value for Differentiation of Provoked and Unprovoked Venous Thromboembolism

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