Update on diagnosis and anticoagulant therapy for venous thromboembolism

Stevens, Hannah; Tran, Huyen

doi:10.1111/imj.14063

Cited by 11 publications

(7 citation statements)

References 70 publications

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“…DVT was diagnosed with ultrasound with Doppler, and PE was diagnosed with a CT scan performed in a PE specific protocol. Both these modalities are standard for establishing a VTE diagnosis [27, 28].…”

Section: Discussionmentioning

confidence: 99%

Incidence of Venous Thromboembolism Following Major Emergency Abdominal Surgery

et al. 2019

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Background In a retrospective cohort study, we looked at the incidence and risk factors of developing in‐hospital venous thromboembolism (VTE) after major emergency abdominal surgery and the risk factors for developing a venous thrombosis. Methods Data were extracted through medical records from all patients undergoing major emergency abdominal surgery at a Danish University Hospital from 2010 until 2016. The primary outcome was the incidence of venous thrombosis developed in the time from surgery until discharge from hospital. The secondary outcomes were 30‐day mortality and postoperative complications. Multivariate logistic analyses were used for confounder control. Results In total, 1179 patients who underwent major emergency abdominal surgery during 2010–2016 were included. Thirteen patients developed a postoperative venous thromboembolism (1.1%) while hospitalized. Eight patients developed a pulmonary embolism all verified by CT scan and five patients developed a deep venous thrombosis verified by ultrasound scan. Patients diagnosed with a VTE were significantly longer in hospital with a length of stay of 34 versus 14 days, P < 0.001, and they suffered significantly more surgical complications (69.2% vs. 30.4%, P = 0.007). Thirty‐day mortality was equal in patients with and without a venous thrombosis. In a multivariate analysis adjusting for gender, ASA group, BMI, type of surgery, dalteparin dose and treatment with anticoagulants, we found that a dalteparin dose ≥5000 IU was associated with the risk of postoperative surgical complications (odds ratio 1.55, 95% CI 1.11–2.16, P = 0.009). Conclusion In this study, we found a low incidence of venous thrombosis among patients undergoing major emergency abdominal surgery, comparable to the incidence after elective surgery.

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Section: Discussionmentioning

confidence: 99%

Incidence of Venous Thromboembolism Following Major Emergency Abdominal Surgery

et al. 2019

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“…Thus, these data suggest that the PERC may not be a beneficial diagnostic step when evaluating acutely and/or chronically ill hospitalized patients with risk factors and/or symptoms suggestive of PE (eg, age ≥50 years, recent surgery or trauma, SaO 2 <95%, and tachycardia). 15,[37][38][39] Additional prospective research with a larger sample of heterogeneous inpatients being evaluated for PE diagnosis is needed to appraise the clinical utility of the PERC in the hospitalized patient population.…”

Section: Use Of a Validated Clinical Decision Rulementioning

confidence: 99%

Adherence to Best Practice Advice for Diagnosis of Pulmonary Embolism

Prentice

Wipke‐Tevis²

2022

Clin Nurse Spec

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This study evaluated clinician adherence to the American College of Physicians Best Practice Advice for diagnosis of pulmonary embolism. Design:A prospective, single-center, descriptive design was utilized. Methods:A heterogeneous sample of 111 hemodynamically stable adult inpatients with a computed tomography pulmonary angiogram ordered was consented. Electronic medical records were reviewed for demographic and clinical variables to determine adherence. The 6 individual best practice statements and the overall adherence were evaluated by taking the sum of "yes" answers divided by the sample size. Results:Overall adherence was 0%. Partial adherence was observed with clinician-recorded clinical decisions rules and obtaining D-dimer (3.6% [4/111] and 10.2% [9/88], respectively) of low/ intermediate probability scorers. Age adjustment of D-dimer was not recorded. Computed tomography pulmonary angiogram was the first diagnostic test in 89.7% (79/88) in low/intermediate probability patients. Conclusion: In hemodynamically stable, hospitalized adults, adherence to best practice guidelines for diagnosis of pulmonary embolism was minimal. Clinical utility of the guidelines in hospitalized adults needs further evaluation. Systems problems (eg, lack of standardized orders, age-adjusted D-dimer values, information technology support) likely contributed to poor guideline adherence.

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“…There is a wealth of literature about tools to assess whether to test for venous thromboembolism and whether to admit. These are discussed in detail in two recent articles from Internal Medicine Journal . I must confess that I do not consciously use any of them, relying on clinical ‘gestalt’ after years of practising in the field.…”

Section: Playing Patientmentioning

confidence: 99%

Pleurisy and pulmonary embolism: physician sees through patient eyes

Cochrane

2020

Internal Medicine Journal

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As a respiratory physician personally affected by pulmonary thromboembolism, I bring a unique perspective to managing this condition. It has made me realise that sometimes we do not see in detail the ways our colleagues practise, even working alongside them, although general management principles are the same. While banned from work, but permitted 'as much paperwork as I like' (the sole compromise that would ensure this patient's adherence), I sought to learn from my time as patient, hoping that other clinicians might gain from my experience in both roles. When it came to deciding which insights would be most useful to impart for the benefit of our patients, the leading concepts were not novel but important to emphasise in our current medical world, which prioritises both efficiency and quality of patient care.

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Update on diagnosis and anticoagulant therapy for venous thromboembolism

Cited by 11 publications

References 70 publications

Incidence of Venous Thromboembolism Following Major Emergency Abdominal Surgery

Incidence of Venous Thromboembolism Following Major Emergency Abdominal Surgery

Adherence to Best Practice Advice for Diagnosis of Pulmonary Embolism

Pleurisy and pulmonary embolism: physician sees through patient eyes

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