Silent Pulmonary Embolism in Patients with Deep Venous Thrombosis: A Systematic Review

Stein, Paul D.; Matta, Fadi; Musani, Muzammil H.; Diaczok, Benjamin

doi:10.1016/j.amjmed.2009.09.037

Cited by 174 publications

(120 citation statements)

References 30 publications

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“…11,24 Cases of DVT were also classified into symptomatic and asymptomatic subgroups (criteria: tenderness on palpation, swelling, pain).…”

Section: Doppler Ultrasonography and Diagnosis Of Pementioning

confidence: 99%

D-dimer plasma level: a reliable marker for venous thromboembolism after elective craniotomy

Prell¹,

Rachinger²,

Smaczny³

et al. 2013

JNS

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Object The incidence of deep venous thrombosis (DVT) after craniotomy is reported to be as high as 50%. In outpatients, D-dimer levels of more than 0.5 mg/L indicate venous thromboembolism (VTE, which subsumes DVT and pulmonary embolism [PE]) with a sensitivity of 99.4% and a specificity of 38.2%. However, D-dimer levels are believed to be unreliable in postoperative patients. The authors undertook the present study to test the hypothesis that D-dimer levels would be systematically raised in a postoperative population and to define a feasible threshold for identification of VTE. Methods Doppler ultrasonography of the lower extremity was performed pre- and postoperatively to evaluate for DVT in 101 patients who underwent elective craniotomy. D-dimer levels were assessed preoperatively and on the 3rd, 7th, and 10th days after surgery. Statistical analysis was carried out to define a feasible threshold for D-dimer levels. Results D-dimer plasma levels were found to be systematically raised postoperatively, and they differed between patients with and without VTE in a highly significant way. On the 3rd day after surgery, D-dimer levels of more than 2 mg/L indicated VTE with a sensitivity of 95.3% and a specificity of 74.1%, allowing for the definition of a feasible threshold. D-dimer levels of more than 4 mg/L were observed in all patients who had PE during the postoperative period (n = 9). Ventilation time and duration of surgery were identified as highly significant risk factors for the development of VTE. Conclusions Using a threshold of 2 mg/L, D-dimer levels will indicate VTE with a high degree of sensitivity and specificity in patients who have undergone craniotomy. Pulmonary embolism seems to be indicated by even higher D-dimer levels. Given that the development of D-dimer plasma levels in the postoperative period follows a principle that can be predicted and that deviations from it indicate VTE, this principle might be applicable to other types of surgery.

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“…11,24 Cases of DVT were also classified into symptomatic and asymptomatic subgroups (criteria: tenderness on palpation, swelling, pain).…”

Section: Doppler Ultrasonography and Diagnosis Of Pementioning

confidence: 99%

D-dimer plasma level: a reliable marker for venous thromboembolism after elective craniotomy

Prell¹,

Rachinger²,

Smaczny³

et al. 2013

JNS

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“…Patients in both groups received anticoagulation treatment, which in most cases was adequate [24]. However, most patients were discharged with VKA and only a minority continued LMWH after discharge.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcomes of Patients with Clinically Unsuspected Pulmonary Embolism versus Patients with Clinically Suspected Pulmonary Embolism

Shteinberg¹,

Segal-Trabelsy

Adir³

et al. 2012

Respiration

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Background: The routine use of multidetector computed tomography has led to increased detection of unsuspected pulmonary embolism (UPE), with questionable benefit for diagnosis and treatment. Objective: The purpose of this work was to compare the clinical characteristics and prognosis of patients with UPE to patients with suspected PE (SPE). Methods: We retrospectively reviewed the charts of patients diagnosed with PE in a community-based university hospital between the years 2002 and 2007. UPE was defined as PE detected on CT scans performed for indications other than suspicion of PE. We compared patients with UPE to patients with SPE for differences in clinical features, electrocardiogram, imaging and echocardiographic findings. We also assessed the long-term outcomes using electronic patient records. Results: Of 500 patients with PE, 408 had SPE and 92 had UPE. Patients with UPE were similar to patients with SPE regarding age and sex distribution. Malignancy was more prevalent in UPE patients (39 vs. 23%, p < 0.0068). UPE patients had significantly less tachypnea (37 vs. 57%, p = 0.0005), dyspnea (47 vs. 87%, p < 0.0001), chest pain (19 vs. 42%, p < 0.0001) and hypoxemia (36 vs. 55%, p = 0.0011). Mortality was higher in UPE patients (70.3 vs. 53%, p = 0.0029). The hazard ratio after adjustment for confounders including age, sex and malignancy was 1.546 (95% CI: 1.139–2.099, p = 0.0052). Conclusions: We suggest that UPE is more prevalent in patients with a malignancy and is associated with higher mortality despite a less severe clinical presentation. UPE may be a marker of poor prognosis.

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“…It is difficult to diagnose PE because of nonspecific signs and symptoms [15][16][17][18]23,24]. CTEPH is rare in the general population, and only from 0.5% to 5% of the patients after acute PE develop pulmonary hypertension [20,21].…”

Section: B Amputation Of Left Segmental Pulmonary Arteries (Red Arrows)mentioning

confidence: 99%

A 39-year-old woman with atypical variant of Klippel-Trénaunay syndrome and progressive thromboembolic pulmonary hypertension, successfully treated by pulmonary thromboendarterectomy (RCD code: II-1A.5)

Poręba

Misztal

Biederman

et al. 2013

Journal of Rare Cardiovascular Diseases

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We present a case of 39-year old female with Klippel-Trenaunay syndrome (KTS) complicated by chronic thromboembolic pulmonary hypertension (CTEPH). Our patient was operated in adolescence by vascular surgeons and severe varicosities of her leg were excised. After second pregnancy she manifested pulmonary embolism (PE) and was treated with vitamin K antagonists (VKA) and implantation of vena cava filter. Despite chronic VKA therapy she developed pulmonary embolism again. We present our TTE studies, X-ray and CT scans confirming diagnosis of pulmonary hypertension. Because of worsening of her cardiopulmonary status she was send to Cardiac Surgery Department and underwent pulmonary thromboendarterectomy. Extensive quantities of chronic thromboembolic material were cut out from both pulmonary arteries. At one year follow-up her functional status returned to NYHA class I. Control TTE demonstrated normal diameter and function of her right cardiac chambers. We conclude that vascular anomalies existing in KTS although present locally are responsible for general hypercoagulability. We also wonder what should be proper treatment and which diagnostic tests should be perform to prevent from severe thromboembolic pulmonary hypertension. JRCD 2013; 1 (2): 61-68

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Silent Pulmonary Embolism in Patients with Deep Venous Thrombosis: A Systematic Review

Cited by 174 publications

References 30 publications

D-dimer plasma level: a reliable marker for venous thromboembolism after elective craniotomy

D-dimer plasma level: a reliable marker for venous thromboembolism after elective craniotomy

Clinical Characteristics and Outcomes of Patients with Clinically Unsuspected Pulmonary Embolism versus Patients with Clinically Suspected Pulmonary Embolism

A 39-year-old woman with atypical variant of Klippel-Trénaunay syndrome and progressive thromboembolic pulmonary hypertension, successfully treated by pulmonary thromboendarterectomy (RCD code: II-1A.5)

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