Sub-segmental pulmonary emboli as a marker of CT-pulmonary angiogram overuse in a single-center retrospective cohort study: A dimer a dozen?

Recently, computed tomography pulmonary angiography (CTPA) has emerged as the first line modality for the diagnosis of pulmonary embolism (PE) as it is fast, reliable and widely available [1]. However, with increasing use of CTPA, there has been an associated increase in the incidence of PE with no significant change in mortality [2]. Overuse of CTPA leads to unnecessary radiation and contrast exposure, increased costs, as well as incidental findings, raising the question of over-diagnosis of clinically insignificant PEs conferring a major burden on both patients and healthcare system (2,3).
Source: Thrombosis Research - Category: Hematology Authors: Tags: Letter to the Editors-in-Chief Source Type: research

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CONCLUSIONS: Mechanically ventilated COVID-19 patients present with an imbalance between markedly increased factor V/VIII activity and overwhelmed protein C/S pathway. Plasma D-dimer may be a useful biomarker at the bedside for suspicion of VTE. PMID: 32965009 [PubMed - as supplied by publisher]
Source: European Review for Medical and Pharmacological Sciences - Category: Drugs & Pharmacology Tags: Eur Rev Med Pharmacol Sci Source Type: research
Objective: The clinical presentation of pulmonary embolism (PE) can be various and misleading. We analysed patients with suspicion of PE and subsequently performed computed tomography pulmonary angiography (CTPA) in an emergency department of Internal Medicine, focusing on patient groups in which PE might be underestimated in the emergency setting, such as young patients and patients with low clinical probability. Material and Methods: In 2016 and 2017, all patients receiving a CTPA for the question of PE were retrospectively evaluated for clinical (age, symptoms, vital parameters) and D-Dimers. The Wells score was calcul...
Source: Medical Principles and Practice - Category: Internal Medicine Source Type: research
COVID-19 patients have a strong propensity to develop thrombosis and their respiratory symptoms often prompt clinicians to assess for the presence of a pulmonary thromboembolism (PTE) [1,2]. Prior research estimates that approximately 20% to 30% of patients with COVID-19 have a PTE demonstrated by computed tomography pulmonary angiography (CTPA) [3,4]. Some clinical decision rules such as the Pulmonary Embolism Rule-Out Criteria (PERC) and Wells' Criteria are used to assess a patient's risk of PTE.
Source: The American Journal of Emergency Medicine - Category: Emergency Medicine Authors: Source Type: research
Abstract BACKGROUND: Validated diagnostic algorithms are used to manage patients with suspected pulmonary embolism (PE). The recently published YEARS study proposed a simplified diagnostic strategy to reduce the use of computed tomography pulmonary angiography. OBJECTIVES: To externally validate this strategy in an independent cohort. METHODS: We analyzed data from three previous prospective cohort studies of outpatients with suspected PE. We retrospectively applied the YEARS algorithm. The three YEARS clinical criteria are: clinical signs of deep vein thrombosis, hemoptysis, and PE as the most likely di...
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Tags: J Thromb Haemost Source Type: research
Current guidelines recommend the use of unenhanced chest computed tomography (CT) as first-line imaging in patients suspected of having COVID-19 pneumonia, in order to assess the extent of lung damage [1,2]. Although most patients have a favorable disease course, some of them develop secondary disease worsening due to an excessive systemic inflammatory response, evidenced by high serum levels of biomarkers such as IL-6, which promotes an hypercoagulability state leading to thrombotic complications [3,4].
Source: Thrombosis Research - Category: Hematology Authors: Tags: Letter to the Editors-in-Chief Source Type: research
AbstractThe association between coronavirus disease 2019 (COVID-19) pneumonia and venous thrombotic disorders is still unclear. We assessed the association between COVID-19 infection-related pneumonia and proximal deep-vein thrombosis (DVT) in a cohort of patients admitted to our hospital during the European outbreak in the front line of Cremona, Lombardy. In a single-center cross-sectional study, all patients hospitalized for more than 5  days in Internal Medicine Department with confirmed COVID-19 pneumonia received 2-point compressive ultrasound assessment (CUS) of the leg vein system during a single day. Ninety-fo...
Source: Internal and Emergency Medicine - Category: Emergency Medicine Source Type: research
Authors: Al Oweidat K, Al Ryalat SA, Al Husban N, Alhawari H, Ghareeb R, Ribie M, Jwaied S, Al Yasjeen S, Juweid ME Abstract OBJECTIVE: To determine whether a pregnancy-adapted clinical and D-dimer-based algorithm, termed the "YEARS algorithm," can reduce the need for radiological imaging, including lung scintigraphy in pregnant women with suspected pulmonary embolism (PE). PATIENTS AND METHODS: This retrospective study included all pregnant women with suspected PE between January 2014 and September 2019 who have undergone D-dimer testing and radiological imaging (computed tomography pulmonary angiogr...
Source: Hellenic Journal of Nuclear Medicine - Category: Nuclear Medicine Tags: Hell J Nucl Med Source Type: research
CONCLUSIONS: Physiologic, hematologic and imaging data show not only the presence of a hypercoagulable phenotype in severe Covid-19 pneumonia but also markedly impaired pulmonary perfusion likely caused by pulmonary angiopathy and thrombosis. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 ( PMID: 32667207 [PubMed - as supplied by publisher]
Source: American Journal of Respiratory and Critical Care Medicine - Category: Respiratory Medicine Authors: Tags: Am J Respir Crit Care Med Source Type: research
CONCLUSIONS: Our study suggested that COVID-19 pneumonia was associated with hypercoagulable state. However, the rate of VTE in COVID-19 pneumonia patients was not significantly higher than that in CAP patients. PMID: 32628040 [PubMed - as supplied by publisher]
Source: Arteriosclerosis, Thrombosis and Vascular Biology - Category: Cardiology Authors: Tags: Arterioscler Thromb Vasc Biol Source Type: research
lou N Abstract The aim of this study was to evaluate the occurrence of pulmonary embolism in returning travelers with hypoxemic pneumonia due to COVID-19. All returning travelers to Reunion Island with hypoxemic pneumonia due to COVID-19 underwent computed tomography pulmonary angiography (CTPA) and were included in the cohort. Thirty-five patients were returning travelers with hypoxemic pneumonia due to COVID-19 and had recently returned from one of the countries most affected by the COVID-19 outbreak (mainly from France and Comoros archipelago). Five patients (14.3%) were found to have pulmonary embolism and two...
Source: The American Journal of Tropical Medicine and Hygiene - Category: Tropical Medicine Authors: Tags: Am J Trop Med Hyg Source Type: research
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