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Outpatient management of acute pulmonary embolism

Fay Crawford, Alina Andras, Karen Welch, Karen Sheares, David Keeling, Francesca M Chappell
BACKGROUND: Pulmonary embolism (PE) can occur when a thrombus (blood clot) travels through the veins and lodges in the arteries of the lungs, producing an obstruction. People who are thought to be at risk include those with cancer, people who have had a recent surgical procedure or have experienced long periods of immobilisation and women who are pregnant. The clinical presentation can vary, but unexplained respiratory symptoms such as difficulty breathing, chest pain and an increased respiratory rate are common...
2016: Cochrane Database of Systematic Reviews
Paul L den Exter, Wendy Zondag, Frederikus A Klok, Rolf E Brouwer, Janneke Dolsma, Michiel Eijsvogel, Laura M Faber, Marijke van Gerwen, Marco J Grootenboers, Roxane Heller-Baan, Marcel M Hovens, Gé J P M Jonkers, Klaas W van Kralingen, Christian F Melissant, Henny Peltenburg, Judith P Post, Marcel A van de Ree, Tom Vlasveld, Mariëlle J de Vreede, Menno V Huisman
RATIONALE: Outpatient treatment of pulmonary embolism (PE) may lead to improved patient satisfaction and reduced health care costs. However, trials to assess its safety and the optimal method for patient selection are scarce. OBJECTIVES: To validate the utility and safety of selecting PE patients for outpatient treatment by the Hestia criteria , and to compare the safety of the Hestia criteria alone with the Hestia criteria combined with NT-proBNP testing. METHODS: We performed a randomized non-inferiority trial in 17 Dutch hospitals...
March 31, 2016: American Journal of Respiratory and Critical Care Medicine
Joshua D Lenchus
INTRODUCTION: Patients experience numerous transitions, including changes in clinical status, pharmacologic treatment and prophylaxis, and progression through the physical locations of their healthcare setting as they advance through a venous thromboembolism (VTE) clinical experience. This review provides an overview of these transitions and highlights how they can impact clinical care. METHODS: Major public resources (PubMed, MEDLINE, and Google Scholar) were searched using various combinations of the terms: "venous thromboembolism", "deep vein thromboses", "pulmonary embolism", "transitions in care", and "hospital protocols" to identify narrative reviews, professional guidelines, or primary manuscripts reporting protocol development strategies and/or clinical data, published in English from 2010 through January 2015...
January 2016: Advances in Therapy
Rachel Limbrey, Luke Howard
Pulmonary embolism (PE) is a serious and costly disease for patients and healthcare systems. Guidelines emphasise the importance of differentiating between patients who are at high risk of mortality (those with shock and/or hypotension), who may be candidates for thrombolytic therapy or surgery, and those with less severe presentations. Recent clinical studies and guidelines have focused particularly on risk stratification of intermediate-risk patients. Although the use of thrombolysis has been investigated in these patients, anticoagulation remains the standard treatment approach...
September 2015: European Respiratory Review: An Official Journal of the European Respiratory Society
T van der Hulle, C E A Dronkers, F A Klok, M V Huisman
Due to the nonspecific symptoms of the condition, a diagnosis of acute pulmonary embolism (PE) is frequently considered. However, PE will only be confirmed in 10-20% of patients. Because the imaging test of choice, computed tomography pulmonary angiography (CTPA), is costly and associated with radiation exposure and other complications, a validated diagnostic algorithm consisting of a clinical decision rule and D-dimer test should be used to safely exclude PE in 20-30% of patients without the need for CTPA...
January 2016: Journal of Internal Medicine
Fahad M Al-Hameed, Hasan M Al-Dorzi, Abdulkarim M Al-Momen, Farjah H Algahtani, Hazzaa A Al-Zahrani, Khalid A Al-Saleh, Mohammed A Al-Sheef, Tarek M Owaidah, Waleed Alhazzani, Ignacio Neumann, Wojtek Wiercioch, Jan Brozek, Holger Schunemann, Elie A Akl
Venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) is commonly encountered in daily clinical practice. After diagnosis, its management frequently carries significant challenges to the clinical practitioner. Treatment of VTE with the inappropriate modality and/or in the inappropriate setting may lead to serious complications and have life-threatening consequences. As a result of an initiative of the Ministry of Health of the Kingdom of Saudi Arabia, an expert panel led by the Saudi Association for Venous Thrombo-Embolism (a subsidiary of the Saudi Thoracic Society) and the Saudi Scientific Hematology Society with the methodological support of the McMaster University Guideline working group, this clinical practice guideline was produced to assist health care providers in VTE management...
August 2015: Saudi Medical Journal
Anurag Bajaj, Parul Rathor, Vishal Sehgal, Besher Kabak, Ajay Shetty, Ossama Al Masalmeh, Srikanth Hosur
BACKGROUND: Various biomarkers have been evaluated to risk stratify patients with acute pulmonary embolism (PE). We aimed to summarize the available evidence to compare the prognostic value of three most widely studied biomarkers in normotensive patients with acute PE. METHOD: A systematic literature review of database, including Pubmed, EMBASE and Cochrane, was done. Studies were included if those were done on patients with acute PE and serum troponin or brain natriuretic peptide and N-terminal proBNP (BNP/NT-proBNP) or Heart-type fatty acid-binding protein (H-FABP) assay was done...
October 2015: Lung
A Payerols-Ternisien, A Meusy, A Terminet, D Pontal, A Bourdin, M Vergés, M Sebbane, V Georgesu, P Aubas, I Quéré, G Mercier, J-P Galanaud
BACKGROUND: In France, initial management of pulmonary embolism (PE) is performed in the hospital setting. The latest international guidelines suggest that PE at low risk of mortality can be treated in the ambulatory care setting. This means that ambulatory care pathways and general practitioner (GP) opinions concerning such a change in practice need to be determined. OBJECTIVES: To determine: (1) rate of patients eligible for an ambulatory management of their PE and reasons for hospitalization of PE at low risk of mortality; (2) acceptability for GPs of PE home care and patient's desired care pathway...
July 2015: Journal des Maladies Vasculaires
Patrick Mismetti, Laurent Bertoletti
The initial management or venous thromboembolism (VTE) corresponds to the first 3 months of treatment. Pulmonary embolism (PE) are mostly hospitalized. Serious PE associated with hemodynamic instability has to be admitted in intensive care unit due to the need for fibrinolytics. PE without any risk factor for VTE recurrences or death could be followed as outpatient. Conversely, deep vein thrombosis (DVT), including proximal DVT are not hospitalized with the xception of patients with serious risk factors. The therapeutic strategy is identical between DVT and PE treatment with an acute phase with either parenteral anticoagulants, especially low molecular weight heparins or fondaparinux, or by an intensive dose of direct oral anticoagulant such as rivaroxaban or apixaban...
February 2015: La Revue du Praticien
David R Vinson, Carrieann E Drenten, Jie Huang, J Eileen Morley, Megan L Anderson, Mary E Reed, Daniel K Nishijima, Vincent Liu
RATIONALE: Studies of adults presenting to the emergency department (ED) with acute pulmonary embolism (PE) suggest that those who are low risk on the PE Severity Index (classes I and II) can be managed safely without hospitalization. However, the impact of relative contraindications to home management on outcomes has not been described. OBJECTIVES: To compare 5-day and 30-day adverse event rates among low-risk ED patients with acute PE without and with outpatient ineligibility criteria...
May 2015: Annals of the American Thoracic Society
Laura Falconieri, Lynda Thomson, Glenn Oettinger, Robert Pugliese, Michael Palladino, Taki Galanis, Geno Merli
INTRODUCTION: Patients presenting to the emergency department (ED) with an acute uncomplicated deep vein thrombosis (DVT) may be eligible for outpatient treatment. This study aims to establish a transition of care program in the ED for patients with DVT presenting with an acute uncomplicated DVT. METHODS: This article specifies the transition of care program for DVT patients in the ED. Data was collected on patients admitted and discharged from the ED who had an acute DVT both prior to the initiation of facilitating anticoagulation for safer transitions (FAST) and after initiation of FAST...
October 2014: Hospital Practice (Minneapolis)
Vicky Tagalakis, Valérie Patenaude, Susan R Kahn, Samy Suissa
BACKGROUND: Few studies have assessed treatment patterns of acute venous thromboembolism (VTE) in a real-world population. We aimed to describe anticoagulant treatment patterns for acute VTE using healthcare databases of Québec, Canada. METHODS: We used linked healthcare databases of the province of Québec, Canada to identify all incident cases of deep vein thrombosis (DVT) and pulmonary embolism (PE) between 2000 and 2009. We formed two patient cohorts, one with definite cases (definite VTE cohort, N=40,776) and the other including cases with definite or probable VTE (any VTE cohort, N=54,803) that were followed until death, end of health coverage, or end of study (December 31, 2009)...
October 2014: Thrombosis Research
J Kalný, L Tomášková, J Pažin
INTRODUCTION: A new consensus on the management of superficial thrombophlebitis (STP) from the Central European Vascular Forum (CEVF) for the diagnosis and treatment of STP recommends anticoagulation treatment either with Fondaparinux 2.5 mg for at least 45 days or with low molecular weight heparin (LMWH) for 4 weeks in patients with thrombosis of GSV/SSV proven by duplex ultrasonography (DUS) and with thrombus length exceeding 5 cm. The dosage and duration of anticoagulation treatment depend on the associated diseases and other risk factors for TVE...
May 2014: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Marc Righini, Josien Van Es, Paul L Den Exter, Pierre-Marie Roy, Franck Verschuren, Alexandre Ghuysen, Olivier T Rutschmann, Olivier Sanchez, Morgan Jaffrelot, Albert Trinh-Duc, Catherine Le Gall, Farès Moustafa, Alessandra Principe, Anja A Van Houten, Marije Ten Wolde, Renée A Douma, Germa Hazelaar, Petra M G Erkens, Klaas W Van Kralingen, Marco J J H Grootenboers, Marc F Durian, Y Whitney Cheung, Guy Meyer, Henri Bounameaux, Menno V Huisman, Pieter W Kamphuisen, Grégoire Le Gal
IMPORTANCE: D-dimer measurement is an important step in the diagnostic strategy of clinically suspected acute pulmonary embolism (PE), but its clinical usefulness is limited in elderly patients. OBJECTIVE: To prospectively validate whether an age-adjusted D-dimer cutoff, defined as age × 10 in patients 50 years or older, is associated with an increased diagnostic yield of D-dimer in elderly patients with suspected PE. DESIGN, SETTINGS, AND PATIENTS: A multicenter, multinational, prospective management outcome study in 19 centers in Belgium, France, the Netherlands, and Switzerland between January 1, 2010, and February 28, 2013...
March 19, 2014: JAMA: the Journal of the American Medical Association
Carme Font, Alberto Carmona-Bayonas, Aranzazu Fernández-Martinez, Carmen Beato, Andrés Vargas, Pere Gascon, Remedios Otero
The purpose of this prospective cohort study was to assess the feasibility of outpatient treatment in patients with cancer and objectively confirmed pulmonary embolism (PE), and to compare the performance of the different prognostic scales available in this setting. Patients were selected for outpatient management according to a set of exclusion criteria. Outcomes at 30 and 90 days of follow-up included thromboembolic recurrences, major bleeding, and all-cause death. The performance of 4 prognostic scales (Pulmonary Embolism Severity Index, Geneva Prognostic Score, POMPE-C, and Registro Informatizado de Enfermedad Tromboembólica [RIETE registry]) was evaluated...
March 1, 2014: Journal of the National Comprehensive Cancer Network: JNCCN
K Mehmet Burgazlı, Mehmet Bilgin, Ethem Kavukçu, M Metin Altay, H Turhan Ozkan, Uğur Coşkun, Hakan Akdere, A Kubilay Ertan
Deep vein thrombosis (DVT) is a common condition in which the approach to its diagnosis has evolved over the years. Currently, an algorithm strategy combining pre-test probability, D-Dimer testing and compression ultrasound imaging allows for safe and convenient investigation of suspected lower-extremity thrombosis. Patients with low pre-test probability and a negative D-Dimer test result can have proximal DVT excluded without the need for diagnostic imaging. The mainstay of treatment of DVT is anticoagulation therapy, whereas interventions such as thrombolysis and placement of inferior vena cava filters are reserved for special situations...
2011: Journal of the Turkish German Gynecological Association
Philip S Wells, Melissa A Forgie, Marc A Rodger
IMPORTANCE: Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common, potentially lethal condition with acute morbidity. OBJECTIVE: To review the etiology of VTE and the 3 phases of VTE treatment: acute (first 5-10 days), long-term (from end of acute treatment to 3-6 months), and extended (beyond 3-6 months). EVIDENCE REVIEW: Cochrane reviews, meta-analyses, and randomized controlled trials, as well as other clinical trials for topics not covered by the former, were reviewed...
February 19, 2014: JAMA: the Journal of the American Medical Association
Davide Imberti, Raffaella Benedetti
Traditional anticoagulants, such as low-molecular-weight heparin and vitamin K antagonists, have been the mainstay for the treatment of venous thromboembolism (VTE) in the hospital setting and after discharge. These anticoagulants are effective but are associated with some limitations that may lead to their underuse. Based on the results of the EINSTEIN clinical trial program, the oral, direct factor Xa inhibitor rivaroxaban is approved for the treatment of acute deep vein thrombosis (DVT) and pulmonary embolism (PE) and for the prevention of recurrent VTE...
May 2015: Clinical and Applied Thrombosis/hemostasis
Siavash Piran, Grégoire Le Gal, Philip S Wells, Esteban Gandara, Marc Righini, Marc A Rodger, Marc Carrier
BACKGROUND: Patients with acute deep vein thrombus (DVT) can safely be treated as outpatients. However the role of outpatient treatment in patients diagnosed with a pulmonary embolism (PE) is controversial. We sought to determine the safety of outpatient management of patients with acute symptomatic PE. MATERIALS AND METHODS: A systematic literature search strategy was conducted using MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and all EBM Reviews...
November 2013: Thrombosis Research
Sérgio Nuno Craveiro Barra, Luís Paiva, Rui Providência, Andreia Fernandes, António Leitão Marques
BACKGROUND: Although most patients with acute pulmonary embolism (PE) remain hospitalized during initial therapy, some may be suitable for partial or complete outpatient management, which may have a significant impact on healthcare costs. HYPOTHESIS: This article reviews the state-of-the-art data regarding recognition of very-low-risk PE patients who are potentially eligible for outpatient treatment, along with the safety, management, and cost-effectiveness of this strategy...
September 2013: Clinical Cardiology
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