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Huisman MV, Tromeur C, Gal GL, Roux PYL, Righini M. Diagnostic management of acute pulmonary embolism. Presse Med 2024:104241. [PMID: 39181236 DOI: 10.1016/j.lpm.2024.104241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Abstract
Straightforward, accurate diagnostic management in patients presenting with clinically suspected pulmonary embolism (PE) is essential, since starting anticoagulant treatment may give important adverse effects of bleeding, while false exclusion of the disease may lead to recurrent VTE, with associated morbidity and mortality. In the past three decades, considerable improvement in the diagnostic management of PE has been made. Computed tomography pulmonary angiography (CTPA) has largely replaced conventional pulmonary angiography and ventilation-perfusion lung scanning as the imaging methods of choice. Several diagnostic algorithms, all able to minimize the need for radiological imaging have been developed and validated. Lastly, within the diagnostic algorithms, varying D-dimer cut-off levels have successfully been introduced to further downsize the need for radiological imaging.
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Affiliation(s)
- M V Huisman
- Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands; Dutch Thrombosis Network, Leiden, The Netherlands.
| | - C Tromeur
- Département de médecine interne, vasculaire et Pneumologie, CHU Brest; Univ Brest, INSERM U1304-GETBO, Brest, France
| | - G le Gal
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - P Y Le Roux
- Department of Nuclear Medicine, CHU Brest, Univ Brest, INSERM U1304-GETBO, Brest, France
| | - M Righini
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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2
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Lutfi A, O'Rourke E, Crowley M, Craig E, Worrall A, Kevane B, O'Shaughnessy F, Donnelly J, Cleary B, Áinle FN. VTE risk assessment, prevention and diagnosis in pregnancy. Thromb Res 2024; 235:164-174. [PMID: 38350183 DOI: 10.1016/j.thromres.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 02/15/2024]
Abstract
Venous thromboembolism (VTE) is still reported as the leading cause of direct maternal death in pregnancy in serial international reports in developed countries. VTE risk is higher during pregnancy but is further increased by additional well-characterized risk factors. International guidelines recommend that formal VTE risk assessment should be conducted at least in early pregnancy, at delivery and when risk factors change. High quality data supporting optimal VTE prevention strategies are lacking, outside the setting of prevention of VTE recurrence. Moreover, recent high-quality studies have provided much-needed data on diagnostic strategies for pulmonary embolism (PE) in pregnancy. In this review, we summarize knowledge gaps and recently published data in the prevention and diagnosis of VTE in pregnancy. Moreover, we describe ongoing high-quality randomised trials and prospective clinical management studies in this area. High quality clinical studies and trials in pregnancy can be done and must be prioritised, through international network efforts and national funding advocacy. Ultimately, translation of study results to impact upon guidelines and policy will deliver better care to and will protect the lives and health of pregnant people and those contemplating pregnancy throughout the world.
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Affiliation(s)
- Ahmed Lutfi
- Cork University Maternity Hospital, Cork, Ireland.
| | - Ellen O'Rourke
- Dept of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Eilidh Craig
- Rotunda Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Amy Worrall
- Rotunda Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Fergal O'Shaughnessy
- Rotunda Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jennifer Donnelly
- Rotunda Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brian Cleary
- Rotunda Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Fionnuala Ní Áinle
- Rotunda Hospital, Dublin, Ireland; University College Dublin, Dublin, Ireland
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3
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Kevane B, Áinle FN. Prevention, diagnosis, and management of PE and DVT in pregnant women. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:237-247. [PMID: 38066865 PMCID: PMC10727078 DOI: 10.1182/hematology.2023000476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Venous thromboembolism (VTE) is a leading cause of maternal morbidity and mortality worldwide. Despite the impact of VTE on pregnant and postpartum people and on society, guidelines addressing prevention, diagnosis, and management of VTE in pregnant and postpartum people frequently are based on recommendations from expert opinion and are extrapolated from data in nonpregnant populations. Pregnant individuals are frequently excluded from clinical trials, which is a barrier to providing safe, effective care. Anchoring to a case discussion, this review provides an update on recently published and ongoing randomized clinical trials (RCTs), prospective clinical management studies, and other research in this area. It highlights, in particular, the results of the Highlow RCT, which addresses optimal prevention of recurrence during pregnancy in people with prior VTE. Finally, we raise awareness of the impact of national and international clinical trial networks on the conduct of RCTs in pregnancy. We conclude, based on these data, that academic VTE clinical trials in pregnant women can and must be done.
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Affiliation(s)
- Barry Kevane
- Department of Hematology, Mater University Hospital, Dublin, Ireland
- Department of Hematology, Rotunda Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
- Irish Network for VTE Research, University College Dublin, Dublin, Ireland
| | - Fionnuala Ní Áinle
- Department of Hematology, Mater University Hospital, Dublin, Ireland
- Department of Hematology, Rotunda Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
- Irish Network for VTE Research, University College Dublin, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
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4
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Parks AL, Fazili M, Aston V, Porter TF, Branch DW, Woller SC, Snow GL, Stevens SM. Excluding pregnancy-associated deep vein thrombosis with whole-leg ultrasound. Res Pract Thromb Haemost 2023; 7:102202. [PMID: 37840688 PMCID: PMC10569988 DOI: 10.1016/j.rpth.2023.102202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/02/2023] [Accepted: 08/21/2023] [Indexed: 10/17/2023] Open
Abstract
Background Deep vein thrombosis (DVT) is common in pregnancy, yet data are limited on the best diagnostic strategies in pregnant patients suspected of DVT. Objectives We conducted a prospective cohort study to evaluate the rate of symptomatic DVT in the 90 days after a negative whole-leg compression ultrasound (CUS) in pregnant women presenting with DVT symptoms. Methods In this prospective cohort study, we enrolled pregnant patients suspected of DVT between 2011 and 2019 who were referred to the vascular imaging laboratory at a tertiary care center and had anticoagulation held after a negative whole-leg CUS. Primary outcome was objectively confirmed DVT or pulmonary embolism or death due to venous thromboembolism (VTE). Results Whole-leg CUS yielded normal results in 186 patients (97.9%) and identified DVT in 4 (2.1%). The mean age was 30 and 164 were White. Among the 186 patients with a negative, initial whole-leg CUS who did not receive anticoagulation, there were 2 DVT events identified over the 90-day follow-up period, for an overall rate of 1.1% (95% CI: 0.2-3.4%). The study was terminated before full planned accrual for administrative reasons. Conclusion The rate of symptomatic DVT is low in pregnant patients who have a single, negative whole-leg CUS and did not receive anticoagulation. Adequately powered studies should prospectively assess whole-leg CUS in a larger population alone and in combination with pre-test probability scores and/or D-dimer to determine its role in the evaluation of suspected DVT in pregnancy.
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Affiliation(s)
- Anna L. Parks
- Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Masarret Fazili
- Department of Medicine, Intermountain Medical Center, Intermountain Health, Salt Lake City, Utah, USA
| | - Valerie Aston
- Department of Pulmonary/Critical Care, Intermountain Medical Center, Intermountain Health, Salt Lake City, Utah, USA
| | - T. Flint Porter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Medical Center, Intermountain Health, Salt Lake City, Utah, USA
| | - D. Ware Branch
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Scott C. Woller
- Department of Medicine, Intermountain Medical Center, Intermountain Health, Salt Lake City, Utah, USA
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Gregory L. Snow
- Statistical Data Center, Intermountain Health, Salt Lake City, Utah, USA
| | - Scott M. Stevens
- Department of Medicine, Intermountain Medical Center, Intermountain Health, Salt Lake City, Utah, USA
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
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5
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Salvi A, Nitti C, Fabbri A, Groff P, Ruggiero EG, Agnelli G. Diagnosis and Treatment of Deep Vein Thrombosis in the Emergency Department: Results of an Italian Nominal Group Technique Study. Clin Appl Thromb Hemost 2021; 26:1076029620959720. [PMID: 33112649 PMCID: PMC7791439 DOI: 10.1177/1076029620959720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Early diagnosis and treatment of deep vein thrombosis (DVT) is a main issue in
the Emergency setting. With the aim of assisting clinicians in the diagnosis and
the subsequent management of DVT in the Emergency Departments, a Nominal Group
Technique (NGT) study was conducted. A panel of 5 Italian experts developed 21
consensus statements based on available evidence and their clinical experience.
The agreed consensus statements may assist clinicians in applying the results of
clinical studies and clinical experience to routine care settings, providing
guidance on all aspects of the risk assessment, prophylaxis, early diagnosis and
appropriate treatment of DVT in the EDs.
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Affiliation(s)
- Aldo Salvi
- Emergency Department, 18494"Ospedali Riuniti Ancona", Ancona, Italy
| | - Cinzia Nitti
- Emergency Department, 18494"Ospedali Riuniti Ancona", Ancona, Italy
| | - Andrea Fabbri
- Emergency Department, "Presidio ospedaliero Morgagni-Pierantoni", Forlì, Italy
| | - Paolo Groff
- Emergency Department, 18633"Azienda ospedaliera di Perugia", Perugia, Italy
| | | | - Giancarlo Agnelli
- Internal and Vascular Medicine-Stroke Unit, 9309University of Perugia, Perugia, Italy
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Mazzolai L, Ageno W, Alatri A, Bauersachs R, Becattini C, Brodmann M, Emmerich J, Konstantinides S, Meyer G, Middeldorp S, Monreal M, Righini M, Aboyans V. Second consensus document on diagnosis and management of acute deep vein thrombosis: updated document elaborated by the ESC Working Group on aorta and peripheral vascular diseases and the ESC Working Group on pulmonary circulation and right ventricular function. Eur J Prev Cardiol 2021; 29:1248-1263. [PMID: 34254133 DOI: 10.1093/eurjpc/zwab088] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/25/2021] [Accepted: 05/07/2021] [Indexed: 12/14/2022]
Abstract
This consensus document is proposed to clinicians to provide the whole spectrum of deep vein thrombosis management as an update to the 2017 consensus document. New data guiding clinicians in indicating extended anticoagulation, management of patients with cancer, and prevention and management of post-thrombotic syndrome are presented. More data on benefit and safety of non-vitamin K antagonists oral anticoagulants are highlighted, along with the arrival of new antidotes for severe bleeding management.
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Affiliation(s)
- Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Chemin de Mont-Paisible 18, CH-1011 Lausanne, Switzerland
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Via Ravasi 2, 21100 Varese, Italy
| | - Adriano Alatri
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Chemin de Mont-Paisible 18, CH-1011 Lausanne, Switzerland
| | - Rupert Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt GmbH, Grafenstraße 9, 64283 Darmstadt, Germany.,Departement of Vascular Medicine, Center for Thrombosis and Hemostasis, University Medical Center Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Cecilia Becattini
- Departement of Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Marianne Brodmann
- Département of Internal Medicine, Division of Angiology, Medical University Graz, Graz, Austria
| | - Joseph Emmerich
- Department of Vascular Medicine, Groupe Hospitalier Paris Saint-Joseph and University of Paris, Paris, France
| | - Stavros Konstantinides
- Departement of Vascular Medicine, Center for Thrombosis and Hemostasis, University Medical Center Mainz, Langenbeckstr. 1, 55131 Mainz, Germany.,Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Saskia Middeldorp
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, Spain
| | - Marc Righini
- Division of Angiology and Hemostasis, Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital and Inserm 1094, Tropical Neuroepidemiology, School of Medicine, 2 avenue martin Luther-King 87042 Limoges, France
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7
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Bistervels IM, Scheres LJJ, Spijker R, Middeldorp S, van Mens TE. Diagnostic tests for pregnancy-related deep vein thrombosis. Hippokratia 2020. [DOI: 10.1002/14651858.cd013794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ingrid M Bistervels
- Amsterdam UMC, University of Amsterdam, Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Reproduction and Development; Amsterdam Netherlands
| | - Luuk JJ Scheres
- Amsterdam UMC, University of Amsterdam, Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Reproduction and Development; Amsterdam Netherlands
- Department of Internal Medicine; Radboud UMC; Nijmegen Netherlands
| | - René Spijker
- Cochrane Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University; Utrecht Netherlands
- Amsterdam UMC, University of Amsterdam, Medical Library, Amsterdam Public Health; Amsterdam Netherlands
| | - Saskia Middeldorp
- Amsterdam UMC, University of Amsterdam, Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Reproduction and Development; Amsterdam Netherlands
| | - Thijs E van Mens
- Amsterdam UMC, University of Amsterdam, Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Reproduction and Development; Amsterdam Netherlands
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8
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O'Shaughnessy F, O'Reilly D, Ní Áinle F. Current opinion and emerging trends on the treatment, diagnosis, and prevention of pregnancy-associated venous thromboembolic disease: a review. Transl Res 2020; 225:20-32. [PMID: 32554071 DOI: 10.1016/j.trsl.2020.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/10/2020] [Accepted: 06/09/2020] [Indexed: 12/23/2022]
Abstract
Pregnancy associated venous thromboembolism (PA-VTE) is a leading cause of maternal morbidity and mortality worldwide. Despite the availability of international guidance on the prevention, diagnosis and treatment, practice differs between countries and clinical institutions. The evidence base in this area is limited due to the vulnerable population who are affected, with the majority of guidelines deriving their recommendations from experience in surgical and medical venous thromboembolic disease. This review includes best evidence in PA-VTE management, highlighting specific literature which supports current diagnosis, prevention, and treatment strategies. Additionally, we hope to demonstrate emerging trends in the field through discussion of ongoing trials designed to progress towards evidence-based practice in the context of PA-VTE.
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Affiliation(s)
- Fergal O'Shaughnessy
- Pharmacy Department, Rotunda Hospital, Dublin 1, Ireland; Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland; Department of Haematology, Mater University Hospital, Dublin 7, Ireland
| | - Daniel O'Reilly
- Department of Paediatrics, Children's Health Ireland at Tallaght, Dublin 24, Ireland; SPHERE research group, Conway Institute, University College Dublin, Dublin 4, Ireland; Department of Haematology, Mater University Hospital, Dublin 7, Ireland.
| | - Fionnuala Ní Áinle
- SPHERE research group, Conway Institute, University College Dublin, Dublin 4, Ireland; School of Medicine, University College Dublin, Dublin 4, Ireland; Department of Haematology, Rotunda Hospital, Dublin 1, Ireland; Department of Haematology, Mater University Hospital, Dublin 7, Ireland
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9
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Current Challenges in Diagnosis of Venous Thromboembolism. J Clin Med 2020; 9:jcm9113509. [PMID: 33138326 PMCID: PMC7693569 DOI: 10.3390/jcm9113509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/17/2020] [Accepted: 10/27/2020] [Indexed: 02/05/2023] Open
Abstract
In patients with suspected venous thromboembolism, the goal is to accurately and rapidly identify those with and without thrombosis. Failure to diagnose venous thromboembolism (VTE) can lead to fatal pulmonary embolism (PE), and unnecessary anticoagulation can cause avoidable bleeding. The adoption of a structured approach to VTE diagnosis, that includes clinical prediction rules, D-dimer testing and non-invasive imaging modalities, has enabled rapid, cost-effective and accurate VTE diagnosis, but problems still persist. First, with increased reliance on imaging and widespread use of sensitive multidetector computed tomography (CT) scanners, there is a potential for overdiagnosis of VTE. Second, the optimal strategy for diagnosing recurrent leg deep venous thrombosis remains unclear as is that for venous thrombosis at unusual sites. Third, the conventional diagnostic approach is inefficient in that it is unable to exclude VTE in high-risk patients. In this review, we outline pragmatic approaches for the clinician faced with difficult VTE diagnostic cases. In addition to discussing the principles of the current diagnostic framework, we explore the diagnostic approach to recurrent VTE, isolated distal deep-vein thrombosis (DVT), pregnancy associated VTE, subsegmental PE, and VTE diagnosis in complex medical patients (including those with impaired renal function).
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10
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Al Lawati K, Aljazeeri J, Bates SM, Chan WS, De Wit K. Ability of a single negative ultrasound to rule out deep vein thrombosis in pregnant women: A systematic review and meta-analysis. J Thromb Haemost 2020; 18:373-380. [PMID: 31557394 DOI: 10.1111/jth.14650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/28/2019] [Accepted: 09/19/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The diagnostic accuracy of ultrasound (US) for suspected lower extremity deep vein thrombosis (DVT) in nonpregnant patients has been well validated. However, in pregnant women with suspected DVT and an initial negative US, serial US is generally recommended. We aimed to determine the ability of single negative US to exclude DVT in symptomatic pregnant women. METHODS Two authors independently reviewed the following databases: MEDLINE, PubMed, and EMBASE from inception until February 2019. We assessed the risk of bias using the CLARITY group tool for prognostic studies and performed a random effects meta-analysis to report the pooled false negative rate of a single leg ultrasound. RESULTS Eight studies (seven prospective and one retrospective) were included. An overlap among study populations was identified in four of the manuscripts. Two authors performed data re-extraction from these hard copy research charts. Risk of bias was low for the included populations and method of measurement, and low or high for completeness of follow up. A total of 635 pregnant patients with symptoms of DVT had an initial negative US examination. Of those, six were diagnosed with DVT during repeat serial testing (0.94%) and three developed DVT or PE during 3-month follow-up after serial ultrasonography (0.47%). The pooled false-negative rate of a single ultrasound was 1.27% (95% confidence interval, 0.42-2.56), I2 = 27%. CONCLUSION The false-negative rate is low with a single US for suspected DVT in pregnancy. Our results will help inform shared decision-making around planning repeat ultrasound scans in these patients.
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Affiliation(s)
- Kumait Al Lawati
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Oman Medical Specialty Board, Muscat, Oman
| | - Jafar Aljazeeri
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Shannon M Bates
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Thrombosis and Atherosclerosis Research Institute (TaARI), Hamilton, ON, Canada
| | - Wee-Shian Chan
- Department of Medicine, University of British Colombia, Vancouver, BC, Canada
| | - Kerstin De Wit
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Thrombosis and Atherosclerosis Research Institute (TaARI), Hamilton, ON, Canada
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11
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Chan WS. Diagnosis of venous thromboembolism in pregnancy. Thromb Res 2018; 163:221-228. [DOI: 10.1016/j.thromres.2017.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/10/2017] [Accepted: 09/04/2017] [Indexed: 01/24/2023]
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12
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Mazzolai L, Aboyans V, Ageno W, Agnelli G, Alatri A, Bauersachs R, Brekelmans MPA, Büller HR, Elias A, Farge D, Konstantinides S, Palareti G, Prandoni P, Righini M, Torbicki A, Vlachopoulos C, Brodmann M. Diagnosis and management of acute deep vein thrombosis: a joint consensus document from the European Society of Cardiology working groups of aorta and peripheral vascular diseases and pulmonary circulation and right ventricular function. Eur Heart J 2017; 39:4208-4218. [DOI: 10.1093/eurheartj/ehx003] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 01/09/2017] [Indexed: 01/08/2023] Open
Affiliation(s)
- Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Ch du Mont-Paisible 18, Lausanne, Switzerland
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, and, Inserm 1098, Tropical Neuroepidemiology, School of Medicine, 2 avenue martin Luther-King, Limoges cedex, France
| | - Walter Ageno
- Department of Clinical and Experimental Medicine, University of Insubria, Via Ravasi 2, Varese, Italy
| | - Giancarlo Agnelli
- Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, S. Andrea delle Fratte, Perugia, Italy
| | - Adriano Alatri
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Ch du Mont-Paisible 18, Lausanne, Switzerland
| | - Rupert Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt GmbH, Grafenstraße 9, Darmstadt, Germany
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Langenbeckstr. 1, Mainz, Germany
| | - Marjolein P A Brekelmans
- Department of Vascular Medicine, Academic Medical Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Harry R Büller
- Department of Vascular Medicine, Academic Medical Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Antoine Elias
- Cardiology and Vascular Medicine, Toulon Hospital Centre, 54 Rue Henri Sainte-Claire Deville, Toulon, France
| | - Dominique Farge
- Assistance Publique-Hôpitaux de Paris, Saint-Louis Hospital, Internal Medicine and Vascular Disease Unit and Groupe Francophone on Thrombosis and Cancer, Paris 7 Diderot University, Sorbonne Paris Cité, 1, Avenue Claude Vellefaux, Paris, France
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Langenbeckstr. 1, Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, Greece
| | - Gualtiero Palareti
- Cardiovascular Diseases, University of Bologna, Via Albertoni 15, Bologna, Italy
| | - Paolo Prandoni
- Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Via Nicolò Giustiniani, 2, Padua, Italy
| | - Marc Righini
- Division of Angiology and Hemostasis, Department of Medical Specialties, Geneva University Hospital, Rue Gabrielle Perret-Gentil 4, Geneva, Switzerland
| | - Adam Torbicki
- Department of Pulmonary Circulation and Thromboembolic Diseases, Medical Center for Postgraduate Education, ul Plocka 26, Warszawa, Otwock, Poland
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13
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Kafeza M, Shalhoub J, Salooja N, Bingham L, Spagou K, Davies AH. A systematic review of clinical prediction scores for deep vein thrombosis. Phlebology 2016; 32:516-531. [PMID: 27885107 DOI: 10.1177/0268355516678729] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective Diagnosis of deep vein thrombosis remains a challenging problem. Various clinical prediction rules have been developed in order to improve diagnosis and decision making in relation to deep vein thrombosis. The purpose of this review is to summarise the available clinical scores and describe their applicability and limitations. Methods A systematic search of PubMed, MEDLINE and EMBASE databases was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance using the keywords: clinical score, clinical prediction rule, risk assessment, clinical probability, pretest probability, diagnostic score and medical Subject Heading terms: 'Venous Thromboembolism/diagnosis' OR 'Venous Thrombosis/diagnosis'. Both development and validation studies were eligible for inclusion. Results The search strategy returned a total of 2036 articles, of which 102 articles met a priori criteria for inclusion. Eight different diagnostic scores were identified. The development of these scores differs in respect of the population included (hospital inpatients, hospital outpatients or primary care patients), the exclusion criteria, the inclusion of distal deep vein thrombosis and the use of D-dimer. The reliability and applicability of the scores in the context of specific subgroups (inpatients, cancer patients, elderly patients and those with recurrent deep vein thrombosis) remains controversial. Conclusion Detailed knowledge of the development of the various clinical prediction scores for deep vein thrombosis is essential in understanding the power, generalisability and limitations of these clinical tools.
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Affiliation(s)
- Marina Kafeza
- 1 Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Joseph Shalhoub
- 1 Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,2 Imperial College Healthcare NHS Trust, London, UK
| | - Nina Salooja
- 2 Imperial College Healthcare NHS Trust, London, UK
| | - Lucy Bingham
- 2 Imperial College Healthcare NHS Trust, London, UK
| | - Konstantina Spagou
- 3 Computational and Systems Medicine, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alun H Davies
- 1 Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,2 Imperial College Healthcare NHS Trust, London, UK
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Hoffman R, Brenner B. Can we program VTE prevention in pregnancy? Intern Emerg Med 2015; 10:123-4. [PMID: 25633230 DOI: 10.1007/s11739-014-1184-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 12/22/2014] [Indexed: 11/24/2022]
Affiliation(s)
- Ron Hoffman
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, P.O. Box 9602, Haifa, 31096, Israel,
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