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Khanna L, Vargas D, Menias C‘C, Katabathina V. Oncologic Emergencies in the Chest, Abdomen, and Pelvis. Radiol Clin North Am 2023; 61:91-110. [DOI: 10.1016/j.rcl.2022.09.003] [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]
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Detection of Incidental Pulmonary Embolism on Conventional Contrast-Enhanced Chest CT: Comparison of an Artificial Intelligence Algorithm and Clinical Reports. AJR Am J Roentgenol 2022; 219:895-902. [PMID: 35822644 DOI: 10.2214/ajr.22.27895] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND. Artificial intelligence (AI) algorithms have shown strong performance for detection of pulmonary embolism (PE) on CT examinations performed using a dedicated protocol for PE detection. AI performance is less well studied for detecting PE on examinations ordered for reasons other than suspected PE (i.e., incidental PE [iPE]). OBJECTIVE. The purpose of this study was to assess the diagnostic performance of an AI algorithm for detection of iPE on conventional contrast-enhanced chest CT examinations. METHODS. This retrospective study included 2555 patients (mean age, 53.2 ± 14.5 [SD] years; 1340 women, 1215 men) who underwent 3003 conventional contrast-enhanced chest CT examinations (i.e., not using pulmonary CTA protocols) between September 2019 and February 2020. A commercial AI algorithm was applied to the images to detect acute iPE. A vendor-supplied natural language processing (NLP) algorithm was applied to the clinical reports to identify examinations interpreted as positive for iPE. For all examinations that were positive by the AI-based image review or by NLP-based report review, a multireader adjudication process was implemented to establish a reference standard for iPE. Images were also reviewed to identify explanations of AI misclassifications. RESULTS. On the basis of the adjudication process, the frequency of iPE was 1.3% (40/3003). AI detected four iPEs missed by clinical reports, and clinical reports detected seven iPEs missed by AI. AI, compared with clinical reports, exhibited significantly lower PPV (86.8% vs 97.3%, p = .03) and specificity (99.8% vs 100.0%, p = .045). Differences in sensitivity (82.5% vs 90.0%, p = .37) and NPV (99.8% vs 99.9%, p = .36) were not significant. For AI, neither sensitivity nor specificity varied significantly in association with age, sex, patient status, or cancer-related clinical scenario (all p > .05). Explanations of false-positives by AI included metastatic lymph nodes and pulmonary venous filling defect, and explanations of false-negatives by AI included surgically altered anatomy and small-caliber subsegmental vessels. CONCLUSION. AI had high NPV and moderate PPV for iPE detection, detecting some iPEs missed by radiologists. CLINICAL IMPACT. Potential applications of the AI tool include serving as a second reader to help detect additional iPEs or as a worklist triage tool to allow earlier iPE detection and intervention. Various explanations of AI misclassifications may provide targets for model improvement.
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Abstract
Introduction Objective Methods Results Conclusions
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Pulmonary embolisms in patients with COVID-19: a prevalence study in a tertiary hospital. RADIOLOGIA 2020; 63:13-21. [PMID: 33228959 PMCID: PMC7598917 DOI: 10.1016/j.rx.2020.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/29/2020] [Accepted: 09/18/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION SARS-CoV-2, the virus responsible for the current pandemic, predominantly affects the respiratory tract, and a growing number of publications report the predisposition of patients with COVID-19 to develop thrombotic phenomena. OBJECTIVE To determine the prevalence of pulmonary embolism in patients with COVID-19; to determine the possible relationship between the severity of pulmonary involvement and D-dimer levels; to analyze the location of pulmonary embolisms in patients with COVID-19 and to compare it with the location in patients without COVID-19. METHODS This retrospective study analyzed all CT angiograms of the pulmonary arteries done in patients with suspected pulmonary embolisms between March 15 and April 30, 2020 and compared them with studies done in the same period one year earlier. RESULTS We included 492 pulmonary CT angiograms (342 (69.9%) in patients with COVID-19 and 147 (30.1%) in patients without COVID-19). The prevalence of pulmonary embolisms was higher in patients with COVID-19 (26% vs. 16.3% in patients without COVID-19, p=0.0197; relative risk=1.6). The prevalence of pulmonary embolisms in the same period in 2019 was 13.2%, similar to that of the group of COVID-19-negative patients in 2020 (p=0.43). There were no significant differences in D-dimer levels or the location of pulmonary embolisms between the two groups. CT showed moderate or severe pulmonary involvement in 78.7% of the patients with COVID-19. CONCLUSIONS Patients with COVID-19 have an increased prevalence of pulmonary embolisms (26%), and most (78.7%) have moderate or severe lung involvement on CT studies. The location of pulmonary embolisms and the degree of elevation of D-dimer levels does not differ between patients with COVID-19 and those without.
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Di Nisio M, Carrier M. Incidental venous thromboembolism: is anticoagulation indicated? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:121-127. [PMID: 29222246 PMCID: PMC6142551 DOI: 10.1182/asheducation-2017.1.121] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Patients with cancer have a high risk of venous thromboembolism (VTE) and about one-half of these events are incidentally detected. The prognosis of incidental VTE appears to be similar to symptomatic events, with comparably high rates of recurrent VTE in this patient population. In the absence of major contraindications, anticoagulant treatment with low-molecular-weight heparin for 3 to 6 months is generally recommended for incidental proximal deep vein thrombosis as well as for incidental pulmonary embolism that involves multiple subsegmental or more proximal pulmonary arteries. The decision of whether to extend treatment beyond 3 to 6 months should be evaluated on a case-by-case basis after periodic reassessment of the risks factors for bleeding and recurrent VTE while also taking into account patient preferences. The clinical relevance of a single incidental subsegmental pulmonary embolism without concomitant deep vein thrombosis is uncertain and either a watchful approach or a shorter course of anticoagulation to minimize the bleeding risk may also be considered. Preliminary evidence suggests that anticoagulation treatment may be beneficial for cancer patients with incidental distal deep vein thrombosis or incidental splanchnic vein thrombosis.
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Affiliation(s)
- Marcello Di Nisio
- Department of Medicine and Ageing Sciences, G. D'Annunzio University, Chieti, Italy
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands; and
| | - Marc Carrier
- Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, Ontario, Canada
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Klok FA, Huisman MV. Management of incidental pulmonary embolism. Eur Respir J 2017; 49:49/6/1700275. [PMID: 28663318 DOI: 10.1183/13993003.00275-2017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/23/2017] [Indexed: 12/26/2022]
Abstract
Incidental pulmonary embolism (PE) is a frequent finding on routine computed tomography (CT) scans of the chest, occurring in 1.1% of coronary CT scans and 3.6% of oncological CT scans. Despite this high frequency, optimal management of incidental PE has not been addressed in clinical trials and remains the subject of debate. Although these CT scans have not been performed with a dedicated PE protocol and have suboptimal contrast enhancement, diagnosis of incidental PE has been shown to be accurate up to the segmental and subsegmental arteries. The embolic load in incidental PE is lower than that in symptomatic PE. Even so, observational studies suggest that the natural course of incidental PE is similar to that of symptomatic PE with regard to the risk of recurrent venous thrombotic disease and mortality. Interestingly, the increased use of more advanced CT technology has coincided with an increase in the rate of incidental subsegmental PE, as is the case for symptomatic subsegmental PE. Although clinical trials are lacking, and observational data are limited to cancer-associated incidental PE, the consensus is that the management of incidental PE is identical to that of symptomatic PE, including the choice of optimal drug class, outpatient treatment and total duration of treatment.
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Affiliation(s)
- Frederikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
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Viana VB, Melo ER, Terra-Filho M, Dallan LA, Gonzalez MM, Hajjar LA, Jatene FB, Cesar LA, Vianna CB. Frequency of Deep Vein Thrombosis and/or Pulmonary Embolism After Coronary Artery Bypass Grafting Investigation Regardless of Clinical Suspicion. Am J Cardiol 2017; 119:237-242. [PMID: 27823597 DOI: 10.1016/j.amjcard.2016.09.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/29/2016] [Accepted: 09/29/2016] [Indexed: 11/30/2022]
Abstract
Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and/or pulmonary embolism (PE). Many surgeons and clinicians believe that VTE after coronary artery bypass grafting (CABG) has little clinical significance because it is seldom diagnosed. This study aimed to identify VTE after CABG, independent of clinical suspicion. In this prospective, observational, single-center study, 100 patients underwent computed tomographic pulmonary angiography (multidetector-64) and lower extremity venous compressive ultrasound after elective CABG. Patients with high risk for VTE were excluded. Aspirin was maintained throughout the preoperative and postoperative periods, and early ambulation was encouraged. Postoperatively, no mechanical or heparin prophylaxis was used in any patients. At the discretion of the surgeons, 83 surgeries were on-pump, and 17 were off-pump. On average, tomography and ultrasound were performed 7 ± 3 days after CABG. Isolated PE was observed in 13 of 100 patients (13%), simultaneous PE and DVT in 8 of 100 (8%), and isolated DVT in 4 of 100 (4%), thus totaling 25/100 VTEs (25%). Of the 21 PEs, 3 of 21 (14%) involved subsegmental, 15 of 21 (71%) segmental, 1 of 21 (5%) lobar, and 2 of 21 (10%) central pulmonary arteries. Of the 12 DVTs, all were distal (below the popliteal vein), and 2 of 12 (17%) were also proximal; 5 of 12 (42%) were unilateral, of which 3 of 5 (60%) on the contralateral saphenous vein-harvested leg. No VTE caused hemodynamic instability, and none was clinically suspected. In conclusion, VTEs were frequent, some extensive proximal VTEs occurred, but most were distally localized. Many patients in this series would have been discharged without diagnosis of and treatment for PE and/or DVT.
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Affiliation(s)
- Vitor B Viana
- Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Emanoel R Melo
- Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Mario Terra-Filho
- Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Luis A Dallan
- Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Maria M Gonzalez
- Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Ludhmila A Hajjar
- Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Fabio B Jatene
- Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Luiz A Cesar
- Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Caio B Vianna
- Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil.
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Char S, Yoon HC. Improving appropriate use of pulmonary computed tomography angiography by increasing the serum D-dimer threshold and assessing clinical probability. Perm J 2015; 18:10-5. [PMID: 25662521 DOI: 10.7812/tpp/14-007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether the implementation of an increased D-dimer threshold value and clinical probability assessment increases the prevalence of pulmonary embolism (PE) in patients undergoing pulmonary computed tomography angiography (PCTA) in an Emergency Department setting. METHODS A retrospective review of all patients undergoing PCTA during 2 separate 12-month intervals, 1 before the implementation of an increased D-dimer threshold and recommendation for formal clinical probability assessment and the other after regional implementation. The primary outcome measure was the prevalence of acute PE in each of the samples. RESULTS After the implementation of the increased D-dimer threshold and recommendation for formal clinical probability assessment, the prevalence of PE detected by PCTA increased from 4.7% to 11.7% (p < 0.001). Among all PCTAs performed after the new guidelines were promulgated, 8.6% were still performed on patients who had serum D-dimer values lower than the threshold of 1.0 µg/mL. Despite the recommendation for formal clinical probability assessment before ordering a PCTA, only 4% of patients had a formal clinical probability assessment recorded in their electronic medical record. CONCLUSION The implementation of an increased D-dimer threshold value increased the prevalence of PE in patients undergoing PCTA in an Emergency Department setting, but more consistent application of clinical probability assessment remains an elusive target.
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Affiliation(s)
- Sydney Char
- Summer Research Assistant in Diagnostic Imaging. She is studying Biomedical Engineering at Tufts University in Medford, MA.
| | - Hyo-Chun Yoon
- Assistant Chief of Diagnostic Imaging at the Moanalua Medical Center in Honolulu, HI.
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Abstract
Clinically unsuspected pulmonary embolism (UPE) is frequently diagnosed in cancer patients undergoing routine computed tomography scans for staging purposes or treatment response evaluation. The reported incidence of UPE ranges from 1% to 5% which probably represents an underestimation. A significant proportion of cancer patients with UPE actually do have pulmonary embolism (PE) related symptoms. However, these can erroneously be attributed to the cancer itself or to cancer therapy leading to a delayed or missed diagnosis. The incidence of UPE is likely to increase further with the improvements of imaging techniques. Radiologic features of UPE appear similar to symptomatic PE with nearly half of the UPE located in central pulmonary arteries and one third involving both lungs. UPE in cancer patients is not a benign condition with rates of recurrent venous thromboembolic events, bleeding and a mortality rate comparable to cancer patients with symptomatic PE. Current guidelines suggest that UPE should receive similar initial and long-term anticoagulant treatment as for symptomatic PE. However, direct evidence regarding the treatment of UPE is scarce and treatment indications are largely derived from studies performed in cancer patients with symptomatic venous thromboembolism. Selected subgroups of cancer patients with UPE such as those with sub-segmental UPE may be treated conservatively by withholding anticoagulation and avoiding the associated bleeding risk, although this requires further evaluation.
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Affiliation(s)
- Nick van Es
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands; Equal contributors
| | - Suzanne M Bleker
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands; Equal contributors
| | - Marcello Di Nisio
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands; Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti, Italy.
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Bach AG, Schmoll HJ, Beckel C, Behrmann C, Spielmann RP, Wienke A, Abbas J, Surov A. Pulmonary embolism in oncologic patients: frequency and embolus burden of symptomatic and unsuspected events. Acta Radiol 2014; 55:45-53. [PMID: 23864061 DOI: 10.1177/0284185113491569] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary embolism (PE) is a common cause of morbidity and mortality in oncologic patients. Furthermore, PE is an unsuspected finding in many cases. PURPOSE To determine the frequency and embolus burden of PE in a consecutive oncologic patient group including symptomatic as well as incidental and initially unreported events. MATERIAL AND METHODS In a retrospective, single-center study from June 2005 to January 2010 all patients with an oncologic disease (ICD-10 code C00 to C96) that received at least one contrast-enhanced computed tomography (CT) examination of the chest were reviewed. The study group included 3270 patients with 6780 examinations. A validated pulmonary artery obstruction index (Mastora score) was used to assess embolus burden. RESULTS PE was found in 240 of 3270 (7.3%) oncologic patients. The frequency was highly variable among different malignancies ranging from 0% to 25%. In the present study about half of all PE were unsuspected. The mean embolus burden was significantly higher in symptomatic PE than in unsuspected PE (P <0.001). The risk of developing a PE was 1.5 times higher in patients with metastases compared to patients without metastases (P <0.005). Age and sex had no influence on PE risk and embolus burden. CONCLUSION PE is a frequent unsuspected finding in staging examinations: particularly in patients with malignancies of the ovary, brain, and pancreas, and in patients with metastases. Therefore, the status of the pulmonary vasculature should be assessed in every staging examination that includes the chest. The effect of therapeutic actions on PE events and the unsuspected finding of PE in follow-up CT examinations require further prospective studies.
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Affiliation(s)
- Andreas Gunter Bach
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Hans-Joachim Schmoll
- Department of Oncology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Christoph Beckel
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Curd Behrmann
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Rolf Peter Spielmann
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Jasmin Abbas
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Alexey Surov
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Condliffe R, Elliot CA, Hughes RJ, Hurdman J, Maclean RM, Sabroe I, van Veen JJ, Kiely DG. Management dilemmas in acute pulmonary embolism. Thorax 2013; 69:174-80. [PMID: 24343784 PMCID: PMC3913120 DOI: 10.1136/thoraxjnl-2013-204667] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Physicians treating acute pulmonary embolism (PE) are faced with difficult management decisions while specific guidance from recent guidelines may be absent. Methods Fourteen clinical dilemmas were identified by physicians and haematologists with specific interests in acute and chronic PE. Current evidence was reviewed and a practical approach suggested. Results Management dilemmas discussed include: sub-massive PE, PE following recent stroke or surgery, thrombolysis dosing and use in cardiac arrest, surgical or catheter-based therapy, failure to respond to initial thrombolysis, PE in pregnancy, right atrial thrombus, role of caval filter insertion, incidental and sub-segmental PE, differentiating acute from chronic PE, early discharge and novel oral anticoagulants. Conclusion The suggested approaches are based on a review of the available evidence and guidelines and on our clinical experience. Management in an individual patient requires clinical assessment of risks and benefits and also depends on local availability of therapeutic interventions.
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Affiliation(s)
- Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, , Sheffield, UK
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Katabathina VS, Restrepo CS, Betancourt Cuellar SL, Riascos RF, Menias CO. Imaging of Oncologic Emergencies: What Every Radiologist Should Know. Radiographics 2013; 33:1533-53. [DOI: 10.1148/rg.336135508] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Refaat R, El-Shinnawy MA. Does the anatomic distribution of acute pulmonary emboli at MDCT pulmonary angiography in oncology-population differ from that in non-oncology counterpart? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Gimber LH, Leong J, Todoki L, Yoon HC. Avoiding Unnecessary Pulmonary CT Angiography by Using a Combination of Clinical Criteria and D-Dimer Thresholds. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojrad.2013.32012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther M, Kahn SR. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e419S-e496S. [PMID: 22315268 PMCID: PMC3278049 DOI: 10.1378/chest.11-2301] [Citation(s) in RCA: 2471] [Impact Index Per Article: 205.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2011] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This article addresses the treatment of VTE disease. METHODS We generated strong (Grade 1) and weak (Grade 2) recommendations based on high-quality (Grade A), moderate-quality (Grade B), and low-quality (Grade C) evidence. RESULTS For acute DVT or pulmonary embolism (PE), we recommend initial parenteral anticoagulant therapy (Grade 1B) or anticoagulation with rivaroxaban. We suggest low-molecular-weight heparin (LMWH) or fondaparinux over IV unfractionated heparin (Grade 2C) or subcutaneous unfractionated heparin (Grade 2B). We suggest thrombolytic therapy for PE with hypotension (Grade 2C). For proximal DVT or PE, we recommend treatment of 3 months over shorter periods (Grade 1B). For a first proximal DVT or PE that is provoked by surgery or by a nonsurgical transient risk factor, we recommend 3 months of therapy (Grade 1B; Grade 2B if provoked by a nonsurgical risk factor and low or moderate bleeding risk); that is unprovoked, we suggest extended therapy if bleeding risk is low or moderate (Grade 2B) and recommend 3 months of therapy if bleeding risk is high (Grade 1B); and that is associated with active cancer, we recommend extended therapy (Grade 1B; Grade 2B if high bleeding risk) and suggest LMWH over vitamin K antagonists (Grade 2B). We suggest vitamin K antagonists or LMWH over dabigatran or rivaroxaban (Grade 2B). We suggest compression stockings to prevent the postthrombotic syndrome (Grade 2B). For extensive superficial vein thrombosis, we suggest prophylactic-dose fondaparinux or LMWH over no anticoagulation (Grade 2B), and suggest fondaparinux over LMWH (Grade 2C). CONCLUSION Strong recommendations apply to most patients, whereas weak recommendations are sensitive to differences among patients, including their preferences.
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Affiliation(s)
- Clive Kearon
- Department of Medicine and Clinical Epidemiology and Biostatistics, Michael De Groote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Elie A Akl
- Department of Medicine, Family Medicine, and Social and Preventive Medicine, State University of New York at Buffalo, Buffalo, NY.
| | | | - Paolo Prandoni
- Department of Cardiothoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Henri Bounameaux
- Department of Medical Specialties, University Hospitals of Geneva, Geneva, Switzerland
| | - Samuel Z Goldhaber
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michael E Nelson
- Department of Medicine, Shawnee Mission Medical Center, Shawnee Mission, KS
| | - Philip S Wells
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Michael K Gould
- Department of Medicine and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Mark Crowther
- Department of Medicine, Michael De Groote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Susan R Kahn
- Department of Medicine and Clinical Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
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Varona Porres D, Andreu Soriano J, Pallisa Núñez E, Persiva Morenza O, Roque Pérez A. Patología vascular torácica en pacientes oncológicos. RADIOLOGIA 2011; 53:335-48. [DOI: 10.1016/j.rx.2011.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 01/28/2011] [Accepted: 01/31/2011] [Indexed: 11/15/2022]
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Varona Porres D, Andreu Soriano J, Pallisa Núñez E, Persiva Morenza O, Roque Pérez A. Thoracic vascular disease in oncologic patients. RADIOLOGIA 2011. [DOI: 10.1016/j.rxeng.2011.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Prevalence and Clinical History of Incidental, Asymptomatic Pulmonary Embolism: A Meta-Analysis. Thromb Res 2010; 125:518-22. [DOI: 10.1016/j.thromres.2010.03.016] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 03/25/2010] [Accepted: 03/28/2010] [Indexed: 11/22/2022]
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Lee EY, Kritsaneepaiboon S, Arellano CMR, Grace RF, Zurakowski D, Boiselle PM. Unsuspected Pulmonary Emboli in Pediatric Oncology Patients: Detection With MDCT. AJR Am J Roentgenol 2010; 194:1216-1222. [DOI: 10.2214/ajr.09.3463] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Edward Y. Lee
- Department of Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115
| | - Supika Kritsaneepaiboon
- Department of Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115
- Department of Radiology, Prince of Songkla University, Hat Yai, Thailand
| | | | - Rachael F. Grace
- Department of Pediatric Oncology, Division of Hematology/Oncology, Dana–Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - David Zurakowski
- Departments of Anesthesia and Surgery, Children's Hospital Boston and Harvard Medical School, Boston, MA
| | - Phillip M. Boiselle
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Biochemical markers for the diagnosis of venous thromboembolism: the past, present and future. J Thromb Thrombolysis 2010; 30:459-71. [DOI: 10.1007/s11239-010-0460-x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Oncology patients often experience urgent or emergent medical complications that are a direct or indirect result of the underlying malignant condition and are first identified or clarified on radiologic imaging studies. The aim of this review is to identify, discuss, and illustrate some of the major thoracic complications in patients with primary intrathoracic or extrathoracic neoplasms; particular focus is placed on issues in which radiologic imaging may have a significant impact on patient management, including superior vena cava (SVC) syndrome, post-obstructive pneumonia, diaphragmatic paralysis, pleural effusions, pericardial disease, tracheo-esophageal fistula, deep venous thrombosis, and pulmonary embolism.
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Affiliation(s)
- Leslie E Quint
- Department of Radiology, University of Michigan Medical Center, Box 5030, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0030, USA.
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