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Latest & greatest articles for pulmonary embolism
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-sided heart strain. x 3 Goldhaber, S.Z., Visani, L., and De Rosa, M. Acute pulmonaryembolism: clinical outcomes in the International Cooperative PulmonaryEmbolism Registry (ICOPER). Lancet . 1999 ; 353 : 1386–1389 | | | | | , x 4 Kearon, C., Akl, E.A., Ornelas, J. et al. Antithrombotic therapy for VTE disease: CHEST guideline expert panel report. Chest . 2016 ; 149 : 315–352 | | | | | Full-dose thrombolysis may be beneficial in hemodynamically unstable patients with pulmonaryembolism (...) , but this therapy increases the risk of major bleeding. x 4 Kearon, C., Akl, E.A., Ornelas, J. et al. Antithrombotic therapy for VTE disease: CHEST guideline expert panel report. Chest . 2016 ; 149 : 315–352 | | | | | , x 5 Meyer, G., Vicaut, E., Danays, T. et al. Fibrinolysis for patients with intermediate-risk pulmonaryembolism. N Engl J Med . 2014 ; 370 : 1402–1411 | | | , x 6 Konstantinides, S.V., Torbicki, A., Agnelli, G. et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary
-PTP and a d-dimer level of less than 1000 ng per milliliter or with a moderate C-PTP and a d-dimer level of less than 500 ng per milliliter. All other patients underwent chest imaging (usually computed tomographic pulmonary angiography). If pulmonaryembolism was not diagnosed, patients did not receive anticoagulant therapy. All patients were followed for 3 months to detect venous thromboembolism.A total of 2017 patients were enrolled and evaluated, of whom 7.4% had pulmonaryembolism on initial (...) not receive anticoagulant therapy, 1 patient (0.05%; 95% CI, 0.01 to 0.30) had venous thromboembolism. Our diagnostic strategy resulted in the use of chest imaging in 34.3% of patients, whereas a strategy in which pulmonaryembolism is considered to be ruled out with a low C-PTP and a d-dimer level of less than 500 ng per milliliter would result in the use of chest imaging in 51.9% (difference, -17.6 percentage points; 95% CI, -19.2 to -15.9).A combination of a low C-PTP and a d-dimer level of less than
Thrombolytics for Patients with Acute or Massive PulmonaryEmbolisms: Clinical Effectiveness and Guidelines Thrombolytics for Patients with Acute or Massive PulmonaryEmbolisms: Clinical Effectiveness and Guidelines | CADTH.ca Find the information you need Thrombolytics for Patients with Acute or Massive PulmonaryEmbolisms: Clinical Effectiveness and Guidelines Thrombolytics for Patients with Acute or Massive PulmonaryEmbolisms: Clinical Effectiveness and Guidelines Last updated: August 27 (...) , 2019 Project Number: RB1385-000 Product Line: Research Type: Drug Report Type: Summary of Abstracts Result type: Report Question What is the clinical effectiveness of thrombolytics for the treatment of adults with acute or emergent massive pulmonaryembolism? What are the evidence-based guidelines regarding thrombolytics in managing adult patients with acute or emergent massive pulmonaryembolism? Key Message Three systematic reviews with meta-analyses, seven meta-analyses, five randomized
Could the YEARS algorithm be used to exclude pulmonaryembolism during pregnancy? Data from the CT-PE-pregnancy study The recently proposed YEARS algorithm was shown to safely exclude pulmonaryembolism (PE) and reduce the use of computed tomography pulmonary angiography (CTPA) among pregnant women with suspected PE. Our aim was to externally validate this finding.We performed a post hoc analysis of a prospective management outcome study for PE diagnosis in pregnant women. PE was diagnosed
Hospital volume and outcomes for acute pulmonaryembolism: multinational population based cohort study. To evaluate the association between experience in the management of acute pulmonaryembolism, reflected by hospital case volume, and mortality.Multinational population based cohort study using data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry between 1 January 2001 and 31 August 2018.353 hospitals in 16 countries.39 257 consecutive patients with confirmed (...) diagnosis of acute symptomatic pulmonary embolism.Pulmonary embolism related mortality within 30 days after diagnosis of the condition.Patients with acute symptomatic pulmonaryembolism admitted to high volume hospitals (>40 pulmonaryembolisms per year) had a higher burden of comorbidities. A significant inverse association was seen between annual hospital volume and pulmonaryembolism related mortality. Admission to hospitals in the highest quarter (that is, >40 pulmonaryembolisms per year
Patent Foramen Ovale and Ischemic Stroke in Patients With PulmonaryEmbolism: A Prospective Cohort Study. Pulmonaryembolism (PE) is associated with increased risk for ischemic stroke, but the underlying mechanism remains unclear. The authors hypothesized that paradoxical embolism through patent foramen ovale (PFO) should be the main mechanism.To determine the frequency of recent ischemic stroke in patients with symptomatic PE according to whether PFO was detected.Prospective cohort study (...) was more frequent in the PFO group than in the non-PFO group (9 of 42 patients [21.4%] vs. 15 of 273 patients [5.5%]; difference in proportions, 15.9 percentage points [95% CI, 4.7 to 30.7 percentage points]).Because of inconclusive contrast TTE or MRI, 46 patients were excluded from analysis.Frequency of recent ischemic stroke in patients with symptomatic PE was higher in patients with PFO than in those without PFO. This finding supports the hypothesis that paradoxical embolism is an important
A novel electrocardiographic parameter for diagnosis of acute pulmonaryembolism: RS time: RS time in acute pulmonaryembolismPulmonaryembolism (PE) is one of the leading causes of cardiovascular mortality worldwide. Electrocardiography (ECG) may provide useful information for patients with acute PE. In this study, we aimed to investigate the diagnostic value of the QRS duration and RS time in inferolateral leads in patients admitted to the emergency department, and pre-diagnosed with acute (...) PE.We retrospectively enrolled 136 consecutive patients, admitted to the emergency department, pre-diagnosed with the clinical suspicion of acute PE, and underwent computerized tomographic pulmonary angiography (CTPA) to confirm the PE diagnosis. The study subjects were divided into two groups according to the presence or absence of PE, and the independent predictors of PE were investigated.Sixty-eight patients (50%) had PE. Patients with PE had a longer RS time. Among the ECG parameters, only RS
Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected PulmonaryEmbolism. Pulmonaryembolism is one of the leading causes of maternal death in the Western world. Because of the low specificity and sensitivity of the d-dimer test, all pregnant women with suspected pulmonaryembolism undergo computed tomographic (CT) pulmonary angiography or ventilation-perfusion scanning, both of which involve radiation exposure to the mother and fetus. Whether a pregnancy-adapted algorithm could be used (...) to safely avoid diagnostic imaging in pregnant women with suspected pulmonaryembolism is unknown.In a prospective study involving pregnant women with suspected pulmonaryembolism, we assessed three criteria from the YEARS algorithm (clinical signs of deep-vein thrombosis, hemoptysis, and pulmonaryembolism as the most likely diagnosis) and measured the d-dimer level. Pulmonaryembolism was ruled out if none of the three criteria were met and the d-dimer level was less than 1000 ng per milliliter
The Prognostic Value of Renal Function in Acute PulmonaryEmbolism-A Multi-Centre Cohort Study Haemodynamic alterations caused by acute pulmonaryembolism (PE) may affect multi-organ function including kidneys. This multi-centre, multinational cohort study aimed to validate the prognostic significance of estimated glomerular filtration rate (eGFR) and its potential additive value to the current PE risk assessment algorithms. The post hoc analysis of pooled prospective cohort studies: 2,845
Inhaled nitric oxide to treat intermediate risk pulmonaryembolism: A multicenter randomized controlled trial. To test the hypothesis that adjunctive inhaled NO would improve RV function and viability in acute PE.This was a randomized, placebo-controlled, double blind trial conducted at four academic hospitals. Eligible patients had acute PE without systemic arterial hypotension but had RV dysfunction and a treatment plan of standard anticoagulation. Subjects received either oxygen plus
% at 5 years, and 30% at 10 years. The frequency of recurrence does not appear to depend on the clinical presentation of the first event (that is, whether it was a DVT or PE), but recurrent VTE is likely to occur in the same clinical form as the first event [ ]. Diagnosis Diagnosis of pulmonaryembolism When to suspect When should I suspect pulmonaryembolism? Suspect pulmonaryembolism (PE) in a person with dyspnoea, tachypnoea, pleuritic chest pain, and/or features of deep vein thrombosis (DVT (...) of acute pulmonaryembolism: The Task Force for the Diagnosis and Management of Acute PulmonaryEmbolism of the European Society of Cardiology (ESC) [ ]. The symptoms and signs of pulmonaryembolism (PE) are based on the NICE guidelines [ ; ]. In a study identified in the ESC guideline, the clinial characteristics of people with suspected (n = 528) and confirmed (n = 1880) PE in the emergency department were [ ]: Dyspnoea — 51% and 50%, respectively. Pleuritic chest pain — 28% and 39%, respectively
Increasing Safe Outpatient Management of Emergency Department Patients With PulmonaryEmbolism: A Controlled Pragmatic Trial. Many low-risk patients with acute pulmonaryembolism (PE) in the emergency department (ED) are eligible for outpatient care but are hospitalized nonetheless. One impediment to home discharge is the difficulty of identifying which patients can safely forgo hospitalization.To evaluate the effect of an integrated electronic clinical decision support system (CDSS
Accuracy and Interobserver Reliability of the Simplified PulmonaryEmbolism Severity Index Versus the Hestia Criteria for Patients With PulmonaryEmbolism The objective was to assess and compare the accuracy and interobserver reliability of the simplified PulmonaryEmbolism Severity Index (sPESI) and the Hestia criteria for predicting short-term mortality in patients with pulmonaryembolism (PE).This prospective cohort study evaluated consecutive eligible adults with PE diagnosed
Can Echocardiography Be Used to Diagnose PulmonaryEmbolism at the Bedside? TAKE-HOME MESSAGE When pretest probability for pulmonaryembolism is high, abnormalities in right ventricular function detected on echocardiogram strongly support the diagnosis; however, a normal echocardiogram cannot be used to rule out pulmonaryembolism. Can Echocardiography Be Used to Diagnose PulmonaryEmbolism at the Bedside? EBEM Commentators Robert R. Ehrman, MD Mark J. Favot, MD Department of Emergency Medicine (...) by cardiologists, and 1 unclear)andatthepointofcarein 7 studies; 7 studies were con- ducted solely in the ED. The authors identi?ed 9 unique echocardiographic signs of pulmo- nary embolism, as well as the unde?ned ?nding of “right-sided heart strain.” Overall, the signs of pulmonaryembolism were moder- atelyspeci?c(range61%to99%)but poorly sensitive (range 5% to 80%). Test characteristics were slightly improved when echocardiograms were performed by physicians. In the pooled and subgroup analyses, McConnell’s
is gener- ally more readily available in the ED and is read faster, with better interobserver agreement in inter- pretation compared with lung scintigraphy. 8 The Appropriate Use Criteria for Ventilation- Perfusion Imaging in PulmonaryEmbolism working group 9 offers additional practical pointers. For pregnant patients for whom pulmonaryembolism is suspected and for whom the chest radiograph result is normal, lung scintigraphy is a good choice because it limits the radiation to the mother (...) . If, on the other hand, the chest radiograph is grossly abnormal, then lung scinti- graphy would not be appropriate because it would likely be inconclusive owing to the inherent mismatch. The ability of CT pulmonary angiography to elucidate an alternative diagnosis, which may occur up to 33% of the time, may also be bene?cial. 10 This review suggests that both CT pulmonary angiography and lung scintigraphy may be useful in the evaluation of suspected pulmonaryembolism in the pregnant patient. 1. Whiting PF