Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa1462
F. García, G. Díaz, M. T. Río, Z. Vasquez, Elena Canal, E. Aguilar, Joaquin Costa, C. Matesanz, Jose Maria Serra Diaz, A. Abad
{"title":"Incidental pulmonary embolism. Incidence, clinical-radiological features and survival","authors":"F. García, G. Díaz, M. T. Río, Z. Vasquez, Elena Canal, E. Aguilar, Joaquin Costa, C. Matesanz, Jose Maria Serra Diaz, A. Abad","doi":"10.1183/13993003.congress-2019.pa1462","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa1462","url":null,"abstract":"","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79804104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa3648
Clara Martin Ontiyuelo, Oswaldo Antonio Caguana Vélez, A. Herranz blasco, A. Sancho Muñoz, L. Molina Ferragut, Raúl Millán Segovia, A. Vázquez Sanchez, O. Pallàs Villaronga, M. Mellado Joan, Fernando Fernández Alarza, C. Jiménez Martínez, J. R. Masclans Enviz, Cristina Estirado Vera, D. Rodriguez Chiaradia
Introduction: In Patients with Mental Disorders (MD) the risk of venous thromboembolic disease has increased. There is little information regarding these patients during acute pulmonary embolism (PE). Objectives and Methods: This was a retrospective observational cohort study performed in a tertiary hospital in Spain. All patients with a primary diagnosis of PE between October 2015-September 2017 were included. The objective of the study was to compare the clinical presentation and the treatment of patients diagnosed of PE with and without MD. Results: One hundred fifty-three consecutive patients were included. Thirty-six (23.6%) had MD [depression 8(22%), anxiety 12(33%), schizophrenia 1(4%), bipolar 1(4%); more than one MD 14 (37%)]. Patients with MD were older compared to patients without MD (mean±SD, 75 ±9 vs 69 ±8 years, p=0.008) and mainly women (80% vs 56%, p=0.007). There were no significant differences in risk factors, comorbidities or clinical presentation. High levels of pro-BNP were showed in patients with MD (5499 ± 3120 vs 1764 ± 2692 pg/ml, p=0.01). Although the treatment was more conservative in patients with MD (97% of patients treated with low molecular weight heparin vs. 82% in the other group, p=0.040), hospital stay was longer in the MD group (11.9 ±6 vs 7.7 ±7 days, p=0.025). Among patients treated with psychotropic drugs, only patients in treatment with antipsychotics (n=9, 25%) were found to have a higher mortality at 90 days (p=0.044). Conclusions: Although conservative treatment of pulmonary embolism was predominant in the context of mental disorder, this was associated with a longer hospital stay. Patients on antipsychotic therapy may represent a potential higher risk population
在精神障碍(MD)患者中，静脉血栓栓塞性疾病的风险增加。关于这些患者在急性肺栓塞(PE)期间的信息很少。目的和方法:这是一项在西班牙一家三级医院进行的回顾性观察队列研究。所有在2015年10月至2017年9月期间初步诊断为PE的患者均被纳入研究。本研究的目的是比较PE合并和不合并MD患者的临床表现和治疗方法。结果:153例连续患者被纳入研究。抑郁症8例(22%)，焦虑症12例(33%)，精神分裂症1例(4%)，双相情感障碍1例(4%);多于一个MD 14(37%)]。与非MD患者相比，MD患者年龄较大(平均±SD, 75±9岁vs 69±8岁，p=0.008)，主要为女性(80% vs 56%， p=0.007)。在危险因素、合并症或临床表现方面没有显著差异。MD患者中前bnp水平较高(5499±3120 vs 1764±2692 pg/ml, p=0.01)。虽然MD患者的治疗更为保守(97%的患者接受低分子肝素治疗，而另一组为82%，p=0.040)，但MD组的住院时间更长(11.9±6天对7.7±7天，p=0.025)。在接受精神药物治疗的患者中，只有接受抗精神病药物治疗的患者(n= 9.25%)在90天死亡率较高(p=0.044)。结论:尽管肺栓塞的保守治疗在精神障碍患者中占主导地位，但这与较长的住院时间有关。接受抗精神病药物治疗的患者可能是潜在的高危人群
{"title":"Presentation and clinical evolution of Pulmonary Embolism in patients with Mental Disorders","authors":"Clara Martin Ontiyuelo, Oswaldo Antonio Caguana Vélez, A. Herranz blasco, A. Sancho Muñoz, L. Molina Ferragut, Raúl Millán Segovia, A. Vázquez Sanchez, O. Pallàs Villaronga, M. Mellado Joan, Fernando Fernández Alarza, C. Jiménez Martínez, J. R. Masclans Enviz, Cristina Estirado Vera, D. Rodriguez Chiaradia","doi":"10.1183/13993003.congress-2019.pa3648","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3648","url":null,"abstract":"Introduction: In Patients with Mental Disorders (MD) the risk of venous thromboembolic disease has increased. There is little information regarding these patients during acute pulmonary embolism (PE). Objectives and Methods: This was a retrospective observational cohort study performed in a tertiary hospital in Spain. All patients with a primary diagnosis of PE between October 2015-September 2017 were included. The objective of the study was to compare the clinical presentation and the treatment of patients diagnosed of PE with and without MD. Results: One hundred fifty-three consecutive patients were included. Thirty-six (23.6%) had MD [depression 8(22%), anxiety 12(33%), schizophrenia 1(4%), bipolar 1(4%); more than one MD 14 (37%)]. Patients with MD were older compared to patients without MD (mean±SD, 75 ±9 vs 69 ±8 years, p=0.008) and mainly women (80% vs 56%, p=0.007). There were no significant differences in risk factors, comorbidities or clinical presentation. High levels of pro-BNP were showed in patients with MD (5499 ± 3120 vs 1764 ± 2692 pg/ml, p=0.01). Although the treatment was more conservative in patients with MD (97% of patients treated with low molecular weight heparin vs. 82% in the other group, p=0.040), hospital stay was longer in the MD group (11.9 ±6 vs 7.7 ±7 days, p=0.025). Among patients treated with psychotropic drugs, only patients in treatment with antipsychotics (n=9, 25%) were found to have a higher mortality at 90 days (p=0.044). Conclusions: Although conservative treatment of pulmonary embolism was predominant in the context of mental disorder, this was associated with a longer hospital stay. Patients on antipsychotic therapy may represent a potential higher risk population","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85227809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa3644
Koral Fernandez De Roitegui Perez, J. Beristain, Igor Murga Arizabaleta, Cristina Bermudez Ampudia, A. Maestre, F. Bragado, R. Otero, M. Peris, Juan Jose Lopez Núlez, P. Verhamme, M. Monreal, Riete
Introduction: Despite the fact that the Sincope is an alarming symptom that always forces us to suspect significant cardiac dysfunction, the most recommended Clinical Scales for the prognostic evaluation of the PE do not include it as a risk parameter, for the refusal on the part of the classic studies to observe an association with the clinical outcome. Among patients who, due to their clinical profile of Low Risk, would be candidates for extrahospital management, its prognostic significance is especially necessary to clarify. Objective: Considere if the presence of Sincope is associated with mortality in a large cohort of patients with PE and a low risk clinical profile according to the sPESI scale. Material and Methods: Patients included in the RIETE Registry until March 2017 and who presented a score of 0 on the sPESI scale. The Student and Mann-Whitney tests were used to compare the continuous variables, and the Chi-square test for qualitative ones. Univariate logistic regression analyzes were performed and a predictive model was constructed using multivariate logistic regression with the selected variables. Conclusion: In patients with a low risk clinical profile according to the sPESI scale, the presence of Sincope increases significantly the probability of short-term death. When making decisions about the initial outpatient management of PE its presence should be taken into account.
{"title":"Sincope is a risk marker in Pulmonary Embolism (PE) with a low risk clinical profile (sPESI:0)","authors":"Koral Fernandez De Roitegui Perez, J. Beristain, Igor Murga Arizabaleta, Cristina Bermudez Ampudia, A. Maestre, F. Bragado, R. Otero, M. Peris, Juan Jose Lopez Núlez, P. Verhamme, M. Monreal, Riete","doi":"10.1183/13993003.congress-2019.pa3644","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3644","url":null,"abstract":"Introduction: Despite the fact that the Sincope is an alarming symptom that always forces us to suspect significant cardiac dysfunction, the most recommended Clinical Scales for the prognostic evaluation of the PE do not include it as a risk parameter, for the refusal on the part of the classic studies to observe an association with the clinical outcome. Among patients who, due to their clinical profile of Low Risk, would be candidates for extrahospital management, its prognostic significance is especially necessary to clarify. Objective: Considere if the presence of Sincope is associated with mortality in a large cohort of patients with PE and a low risk clinical profile according to the sPESI scale. Material and Methods: Patients included in the RIETE Registry until March 2017 and who presented a score of 0 on the sPESI scale. The Student and Mann-Whitney tests were used to compare the continuous variables, and the Chi-square test for qualitative ones. Univariate logistic regression analyzes were performed and a predictive model was constructed using multivariate logistic regression with the selected variables. Conclusion: In patients with a low risk clinical profile according to the sPESI scale, the presence of Sincope increases significantly the probability of short-term death. When making decisions about the initial outpatient management of PE its presence should be taken into account.","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78299903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa3646
K. Solverson, Christopher J. Humphreys, Zhiying Liang, P. Boiteau, Andre Freland, E. Herget, James Andruwchow, N. Fine, D. Helmersen, J. Weatherald
Introduction: Normotensive acute pulmonary embolism (aPE) has a wide spectrum of outcomes. The best method to identify patients at higher-risk remains unclear. Aims and Objectives: 1) develop a unique prognostic model for adverse outcomes in normotensive aPE, 2) validate the Bova score in a North American population. Methods: This was a multi-centre retrospective cohort of all aPE admitted from emergency departments in Calgary, Canada between 2012-2017. Logistic regression models with bootstrapping for internal validation were used to predict the composite primary outcome of in-hospital death or hemodynamic decompensation. Results: 2067 patients with normotensive aPE were assessed. A primary outcome occurred in 32 patients (1.5%). Stratified by simplified pulmonary embolism severity index (sPESI), 21.2% were low-risk (0% event rate) and 78.8% were high-risk (2.0% event rate). The multivariable model in sPESI high-risk patients (n=1179) retained high-sensitivity troponin ≥50 pg/ml, CT right-left ventricular diameter ratio ≥1.5, systolic blood pressure Conclusions: Our novel risk score discriminated normotensive aPE patients at high risk of in-hospital adverse events better than the Bova score. Further validation of our score is warranted.
{"title":"Refining risk in normotensive acute pulmonary embolism","authors":"K. Solverson, Christopher J. Humphreys, Zhiying Liang, P. Boiteau, Andre Freland, E. Herget, James Andruwchow, N. Fine, D. Helmersen, J. Weatherald","doi":"10.1183/13993003.congress-2019.pa3646","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3646","url":null,"abstract":"Introduction: Normotensive acute pulmonary embolism (aPE) has a wide spectrum of outcomes. The best method to identify patients at higher-risk remains unclear. Aims and Objectives: 1) develop a unique prognostic model for adverse outcomes in normotensive aPE, 2) validate the Bova score in a North American population. Methods: This was a multi-centre retrospective cohort of all aPE admitted from emergency departments in Calgary, Canada between 2012-2017. Logistic regression models with bootstrapping for internal validation were used to predict the composite primary outcome of in-hospital death or hemodynamic decompensation. Results: 2067 patients with normotensive aPE were assessed. A primary outcome occurred in 32 patients (1.5%). Stratified by simplified pulmonary embolism severity index (sPESI), 21.2% were low-risk (0% event rate) and 78.8% were high-risk (2.0% event rate). The multivariable model in sPESI high-risk patients (n=1179) retained high-sensitivity troponin ≥50 pg/ml, CT right-left ventricular diameter ratio ≥1.5, systolic blood pressure Conclusions: Our novel risk score discriminated normotensive aPE patients at high risk of in-hospital adverse events better than the Bova score. Further validation of our score is warranted.","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84442181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa3643
Diana Paulina Chiluiza Reyes, E. Barbero, A. Quezada, E. Mercedes, F. León, D. Jiménez
Introduction: The simplified Pulmonary Embolism Severity Index (PESI) score has been validated to identify low risk patients with acute symptomatic pulmonary embolism (PE). Aim: To evaluate if the modification in the cut-off value of the heart rate in the sPESI score increases its sensitivity without affecting its clinical utility. Material and Methods: We used the data set of the multicentric study PROTECT, which analysed a variety of prognostic tools in 848 normotensive patients with acute symptomatic PE from 12 different Spanish hospitals. The heart rate cut-off value was modified (positive if ≥100/bpm). The primary efficacy outcome was all-cause mortality during the first 30 days of treatment. The secondary efficacy outcome was a composite of complicated clinical course elements, defined as all-cause mortality, hemodynamic shock or non-fatal thromboembolism recurrence during the first 30 days of treatment. Results: The modified simplified PESI score identified 249 low risk patients (29%, confidence interval [CI] 95%, 26-33%) compared to 37% detected with the original sPESI score. The sensitivity of the modified sPESI for all-cause mortality, PE mortality and complicated clinical course was 100% (CI 95%, 89-100%), 100% (CI 95%, 68-99%) and 97%(CI 95%, 88-99%) respectively, compared to 97%(CI 95%, 85-100%), 91% (CI 95%, 57-100%) and 92% (CI 95%, 82-97%) of the original score. Conclusions: The modification in the cut-off value of the heart rate in the sPESI score diminished its clinical utility but at the same time it increased its sensitivity to identify normotensive patients with PE and low mortality and short-term complications risk.
{"title":"Modification of the simplified PESI score to identify low risk patients with acute symptomatic pulmonary embolism","authors":"Diana Paulina Chiluiza Reyes, E. Barbero, A. Quezada, E. Mercedes, F. León, D. Jiménez","doi":"10.1183/13993003.congress-2019.pa3643","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3643","url":null,"abstract":"Introduction: The simplified Pulmonary Embolism Severity Index (PESI) score has been validated to identify low risk patients with acute symptomatic pulmonary embolism (PE). Aim: To evaluate if the modification in the cut-off value of the heart rate in the sPESI score increases its sensitivity without affecting its clinical utility. Material and Methods: We used the data set of the multicentric study PROTECT, which analysed a variety of prognostic tools in 848 normotensive patients with acute symptomatic PE from 12 different Spanish hospitals. The heart rate cut-off value was modified (positive if ≥100/bpm). The primary efficacy outcome was all-cause mortality during the first 30 days of treatment. The secondary efficacy outcome was a composite of complicated clinical course elements, defined as all-cause mortality, hemodynamic shock or non-fatal thromboembolism recurrence during the first 30 days of treatment. Results: The modified simplified PESI score identified 249 low risk patients (29%, confidence interval [CI] 95%, 26-33%) compared to 37% detected with the original sPESI score. The sensitivity of the modified sPESI for all-cause mortality, PE mortality and complicated clinical course was 100% (CI 95%, 89-100%), 100% (CI 95%, 68-99%) and 97%(CI 95%, 88-99%) respectively, compared to 97%(CI 95%, 85-100%), 91% (CI 95%, 57-100%) and 92% (CI 95%, 82-97%) of the original score. Conclusions: The modification in the cut-off value of the heart rate in the sPESI score diminished its clinical utility but at the same time it increased its sensitivity to identify normotensive patients with PE and low mortality and short-term complications risk.","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"89 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84445120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa3640
A. Zahid, A. Azam, Q. Abdullah, I. Hamigi, A. Kodamanchile, S. Ekhelikar, M. Ganaie
{"title":"Streamlining diagnostic work-up of pulmonary embolism: Comparing YEARS algorithm with original and simplified Well’s scores","authors":"A. Zahid, A. Azam, Q. Abdullah, I. Hamigi, A. Kodamanchile, S. Ekhelikar, M. Ganaie","doi":"10.1183/13993003.congress-2019.pa3640","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3640","url":null,"abstract":"","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83618471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa3641
H. L. Ang, Hann Hsiang Tan, A. Ionescu
Introduction: An elevated D-dimer results in an extensive pulmonary embolism (PE) workup, subjecting patients to radiation, potentially harmful side effects from IV contrast and anticoagulation treatment. The PERC rule1 was developed to risk stratify low-risk patients (Wells score ≤2). If PERC score is 0, the pre-test probability would be so low that the risks involved in a PE workup outweigh the benefits1. This is yet to be tested in a two-tier Wells model (Wells score ≤4). Purpose: To assess the role of the PERC rule in safely reducing D-dimer and CTPA requests in a two-tier Wells model. Methods: We performed a retrospective analysis by applying the PERC rule in Wells score ≤4 patients who had a D-dimer test upon presentation to the Emergency Department of Royal Gwent Hospital, from July 2018 to December 2018. Results: 430 patients were included in this study. 141 patients had PERC=0. 27 of the PERC=0 patients had a CTPA scan and amongst those, 2 patients had confirmed PE. Our pre-test probability of PE in PERC=0 patients is 1.4%. By implementing the PERC rule, we could reduce the number of D-dimers ordered by 32.3% and CTPAs by 21.0%. Conclusion: Our pre-test probability of PE in patients with PERC=0 is 1.4%, below the recommended threshold of 1.8% (p=0.367)1. The use of the PERC rule could improve the use of CTPA in the diagnosis of PE. Reference: 1. Kline J, Mitchell A, Kabrhel C, Richman P, Courtney D. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. Journal of Thrombosis and Haemostasis. 2004;2(8):1247-1255.
d -二聚体升高可导致广泛的肺栓塞(PE)检查，使患者遭受放射，静脉造影剂和抗凝治疗的潜在有害副作用。PERC规则1用于对低危患者(Wells评分≤2)进行风险分层。如果PERC得分为0，则测试前概率很低，PE检查的风险大于收益1。这还需要在两层井模型(井评分≤4)中进行测试。目的:评估PERC规则在两层井模型中安全减少d -二聚体和CTPA请求方面的作用。方法:我们对2018年7月至2018年12月在皇家格温特医院急诊科就诊时进行d -二聚体检测的Wells评分≤4例患者应用PERC规则进行回顾性分析。结果:430例患者纳入本研究。141例患者PERC=0。27例PERC=0患者进行CTPA扫描，其中2例确诊PE。PERC=0患者PE的预测概率为1.4%。通过实施PERC规则，我们可以将d -二聚体的订购数量减少32.3%，ctpa减少21.0%。结论:PERC=0患者PE的预测概率为1.4%，低于1.8%的推荐阈值(p=0.367)1。PERC规则的应用可以提高CTPA在PE诊断中的应用。参考:1。李建军，李建军，李建军，等。急诊疑似肺栓塞患者的临床诊断。血栓与止血杂志，2004;2(8):1247-1255。
{"title":"Can implementation of the pulmonary embolism rule-out criteria (PERC) safely reduce D-dimer and CTPA requests in a two-tier Wells model?","authors":"H. L. Ang, Hann Hsiang Tan, A. Ionescu","doi":"10.1183/13993003.congress-2019.pa3641","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3641","url":null,"abstract":"Introduction: An elevated D-dimer results in an extensive pulmonary embolism (PE) workup, subjecting patients to radiation, potentially harmful side effects from IV contrast and anticoagulation treatment. The PERC rule1 was developed to risk stratify low-risk patients (Wells score ≤2). If PERC score is 0, the pre-test probability would be so low that the risks involved in a PE workup outweigh the benefits1. This is yet to be tested in a two-tier Wells model (Wells score ≤4). Purpose: To assess the role of the PERC rule in safely reducing D-dimer and CTPA requests in a two-tier Wells model. Methods: We performed a retrospective analysis by applying the PERC rule in Wells score ≤4 patients who had a D-dimer test upon presentation to the Emergency Department of Royal Gwent Hospital, from July 2018 to December 2018. Results: 430 patients were included in this study. 141 patients had PERC=0. 27 of the PERC=0 patients had a CTPA scan and amongst those, 2 patients had confirmed PE. Our pre-test probability of PE in PERC=0 patients is 1.4%. By implementing the PERC rule, we could reduce the number of D-dimers ordered by 32.3% and CTPAs by 21.0%. Conclusion: Our pre-test probability of PE in patients with PERC=0 is 1.4%, below the recommended threshold of 1.8% (p=0.367)1. The use of the PERC rule could improve the use of CTPA in the diagnosis of PE. Reference: 1. Kline J, Mitchell A, Kabrhel C, Richman P, Courtney D. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. Journal of Thrombosis and Haemostasis. 2004;2(8):1247-1255.","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"118 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77242847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa3653
N. Hill, N. Bascon, N. Barnes, B. Madden
Introduction: The role of thrombolysis in the management of patients with haemodynamic compromise in the presence of pulmonary embolism (PE) is recognised although it is unclear whether there is an indication for concomitant use of advanced pulmonary vasodilator therapy. Aims: To assess the potential benefit of sildenafil on outcome when administered acutely with, or without thrombolysis, to patients with large PE. Method: We performed a retrospective review of the outcome of 20 consecutive patients (9 male, 11 female) who presented with acute right heart strain on echocardiographic assessment, computed tomography or biochemical markers (beta natriuretic peptide), in association with large PE, between January 2015–June 2017, who received sildenafil (25mg TDS) at the time of presentation, with or without thrombolysis. Results: Sildenafil was tolerated without complication in 19 patients. There were 2 deaths due to malignancy at 10, and 18 months, and no deaths directly attributable to thromboembolic disease. Of those with calculable pulmonary arterial systolic pressures (PASP) (n=12), the average reduction in PASP at 3-6 months and 12-24 months was -22.04mmHg, and -17.25mmHg respectively. Those receiving sildenafil alone had a greater average reduction in PASP at short and long term follow up (-24.13mmHg, and -25.44mmHg respectively) compared with those also receiving thrombolysis due to haemodynamic compromise (-17.88mmHg, and -1.67mmHg respectively). Our experience suggests that sildenafil can be used safely in this patient group with good haemodynamic outcome, although larger randomised trials are necessary to support this.
{"title":"Should thrombolysis and sildenafil be given in the acute management of patients with large pulmonary embolism? An assessment of the short and long-term outcomes","authors":"N. Hill, N. Bascon, N. Barnes, B. Madden","doi":"10.1183/13993003.congress-2019.pa3653","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3653","url":null,"abstract":"Introduction: The role of thrombolysis in the management of patients with haemodynamic compromise in the presence of pulmonary embolism (PE) is recognised although it is unclear whether there is an indication for concomitant use of advanced pulmonary vasodilator therapy. Aims: To assess the potential benefit of sildenafil on outcome when administered acutely with, or without thrombolysis, to patients with large PE. Method: We performed a retrospective review of the outcome of 20 consecutive patients (9 male, 11 female) who presented with acute right heart strain on echocardiographic assessment, computed tomography or biochemical markers (beta natriuretic peptide), in association with large PE, between January 2015–June 2017, who received sildenafil (25mg TDS) at the time of presentation, with or without thrombolysis. Results: Sildenafil was tolerated without complication in 19 patients. There were 2 deaths due to malignancy at 10, and 18 months, and no deaths directly attributable to thromboembolic disease. Of those with calculable pulmonary arterial systolic pressures (PASP) (n=12), the average reduction in PASP at 3-6 months and 12-24 months was -22.04mmHg, and -17.25mmHg respectively. Those receiving sildenafil alone had a greater average reduction in PASP at short and long term follow up (-24.13mmHg, and -25.44mmHg respectively) compared with those also receiving thrombolysis due to haemodynamic compromise (-17.88mmHg, and -1.67mmHg respectively). Our experience suggests that sildenafil can be used safely in this patient group with good haemodynamic outcome, although larger randomised trials are necessary to support this.","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"82 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72642177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa3639
A. Zahid, A. Azam, Q. Abdullah, I. Hamigi, A. Kodamanchile, S. Ekhelikar, M. Ganaie
{"title":"Incorporating age adjusted d-dimer limit in place of differential cut-off in YEARS algorithm. Does it help to reduce CTPA burden?","authors":"A. Zahid, A. Azam, Q. Abdullah, I. Hamigi, A. Kodamanchile, S. Ekhelikar, M. Ganaie","doi":"10.1183/13993003.congress-2019.pa3639","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3639","url":null,"abstract":"","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80073920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa1465
Leyre Chasco Eguilaz, Aitor Ballaz Quincoces, A. U. Echeverría, Amaia Aramburu Ojembarrena, Txomin Zabala Hernandez, Amaia Artaraz Ereño, Olaia Bronte Moreno, Patrizia García Hontoria, Ana Jodar Samper
{"title":"Thromboprophylaxis (TP) in Pulmonology department in Galdakao-Usansolo Hospital","authors":"Leyre Chasco Eguilaz, Aitor Ballaz Quincoces, A. U. Echeverría, Amaia Aramburu Ojembarrena, Txomin Zabala Hernandez, Amaia Artaraz Ereño, Olaia Bronte Moreno, Patrizia García Hontoria, Ana Jodar Samper","doi":"10.1183/13993003.congress-2019.pa1465","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa1465","url":null,"abstract":"","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77719595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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