Frequency Of Pulmonary Embolism Research Articles

Findings in chest angiotomographies with PET protocols

Objectives: To investígate and analyze the tomographic findings in AngioCT with PET protocol. Material and method: Tomography reports of patients undergoing AngioCT for suspected PE during the period from January 2020 to December 2022 performed at the high complexity hospital were analyzed. RESULTS: The analysis showed a significant increase in findings in 2021, associated with the frequency of pulmonary embolism (PE) in patients with SARS-CoV-2 infection. The predominant age range was 60 to 79 years. There was a slight predominance of male patients compared to female patients. Among the most common are pleural or pericardial effusion, atelectasis, and the ground glass or mosaic pattern. Conclusions: The results of this study demonstrate that CT angiography with a PET protocol is a valuable diagnostic tool in patients with suspected PE. Incidental detection of these injuries raises questions about appropriate management, follow-up, and the need for medical interventions. This phenomenon has led to a growing need to develop clear guidelines and criteria for the evaluation and management of incidentalomas found on chest PET scans. In this context, it is crucial to investigate and better understand the nature and clinical implications of these findings to improve medical decision making.

Features of various options for anticoagulant therapy for a new coronavirus infection against the background of obesity

BACKGROUND: When treating a new coronavirus infection, the prevention of venous thromboembolic complications in obese patients is of particular importance.
 AIM: To analyze various options for anticoagulant therapy in obese and non-obese patients in the treatment of a new coronavirus infection.
 MATERIAL AND METHODS: The patients were divided into two groups: the first group — obese patients — 151 (40.8%) people [average age 63 (56–69) years], the second group without obesity — 219 (59.2%) people [average age 63 (51.5–71.0) years], p=0.998. According to the prescribed anticoagulant and the presence of obesity, patients were divided into subgroups: subgroup 1 — non-obese + low-molecular-weight heparin (n=114), subgroup 2 — non-obese + unfractionated heparin (n=58), subgroup 3 — obesity + low-molecular-weight heparin (n=76), subgroup 4 — obesity + unfractionated heparin (n=66). Venous thrombotic complications and bleeding rates were assessed. Analysis of qualitative indicators was performed using Pearson χ2 and Fisher tests. The distribution of quantitative indicators was assessed using the Kolmogorov–Smirnov and Shapiro–Wilk tests (p 0.05). Due to the non-normal distribution of indicators, mean values were presented as median (Me) and interquartile range (Q1–Q3), and analysis was carried out using Wilcoxon, Mann–Whitney and Kruskal–Wallis tests.
 RESULTS: In nonobese patients, a comparable incidence of deep vein thrombosis was noted on low molecular weight heparin and unfractionated heparin — 1 (0.9%) case versus 3 (5.2%) cases (p=0.102). At the same time, there was a statistically significant difference in the frequency of pulmonary embolism without a source according to autopsy data — 2 (1.8%) versus 4 (6.9%) cases (p=0.004). In obese patients receiving unfractionated heparin, the incidence of this complication was higher and amounted to 9 (13.6%), and in patients receiving low molecular weight heparin — 2 (2.6%) cases (p=0.004). A higher incidence of bleeding was observed in patients with obesity compared to patients without it (10.6 vs 4.7% of cases, p=0.045). When analyzing hemorrhagic complications, it was found that the incidence of major and significant bleeding was higher in patients receiving unfractionated heparin rather than low molecular weight heparin (16.7 vs 5.3% of cases, p 0.001).
 CONCLUSION: The use of low molecular weight heparin in obese patients with new coronavirus infection was associated with a low incidence of pulmonary embolism and bleeding compared with patients receiving unfractionated heparin.

Sex-stratified patterns of emergency cardiovascular admissions prior and during the COVID-19 pandemic

The COVID-19 pandemic has had a significant impact on global public health, with long-term consequences that are still largely unknown. This study aimed to assess the data regarding acute cardiovascular hospital admissions in five European centers before and during the pandemic. A multicenter, multinational observational registry was created, comparing admissions to the emergency departments during a 3-months period in 2020 (during the pandemic) with the corresponding period in 2019 (pre-pandemic). Data on patient demographics, COVID-19 test results, primary diagnosis, comorbidities, heart failure profile, medication use, and laboratory results were collected. A total of 8778 patients were included in the analysis, with 4447 patients in 2019 and 4331 patients in 2020. The results showed significant differences in the distribution of cardiovascular diseases between the two years. The frequency of pulmonary embolism (PE) increased in 2020 compared to 2019, while acute heart failure (AHF) and other cardiovascular diseases decreased. The odds of PE incidence among hospitalized patients in 2020 were 1.316-fold greater than in 2019. The incidence of AHF was 50.83% less likely to be observed in 2020, and the odds for other cardiovascular diseases increased by 17.42% between the 2 years. Regarding acute coronary syndrome (ACS), the distribution of its types differed between 2019 and 2020, with an increase in the odds of ST-segment elevation myocardial infarction (STEMI) in 2020. Stratification based on sex revealed further insights. Among men, the incidence of AHF decreased in 2020, while other cardiovascular diseases increased. In women, only the incidence of STEMI showed a significant increase. When analyzing the influence of SARS-CoV-2 infection, COVID-positive patients had a higher incidence of PE compared to COVID-negative patients. COVID-positive patients with ACS also exhibited symptoms of heart failure more frequently than COVID-negative patients. These findings provide valuable information on the impact of the COVID-19 pandemic on acute cardiovascular hospital admissions. The increased incidence of PE and changes in the distribution of other cardiovascular diseases highlight the importance of monitoring and managing cardiovascular health during and post pandemic period. The differences observed between sexes emphasize the need for further research to understand potential sex-specific effects of COVID-19 on cardiovascular outcomes.

A CASE REPORT OF CHRONIC PULMONARY THROMBOEMBOLISM AND ACCOMPANYING CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION: CHRONIC PULMONARY THROMBOEMBOLISM AND HYPERTENSION

Aim. Our paper aims to discuss the radiological and clinical findings of chronic pulmonary embolism (CPTE) and chronic thromboembolic pulmonary hypertension (CTEPH) over the patient's findings.
 Material and Methods. We present the case of a 49-year-old female patient with CPTE and CTEPH.
 Results and Discussion. CPTE is a long-term consequence of unresolved pulmonary embolism. Since pulmonary embolism's frequency dramatically increased during the COVID-19 pandemic, CPTE once again has become one of the current topics of scientific conversations. Radiology is a gold standard for diagnosis. CPTE is a complex pathology and multisystemic evaluation is essential.
 Conclusions. Computed tomography (CT) findings can be classified into four groups: vascular, parenchymal, and systemic findings due to pulmonary hypertension and collateral formations. Changes in the ratio of right and left ventricle, size of the pulmonary artery, bowing sign and presence of mosaic attenuation should be directed us to the diagnosis of CTEPH in the patient with CPTE.

Upper-Extremity Deep Venous Thrombosis: Analysis of 348 Cases

ABSTRACT Objective: In this study, we aimed to determine the clinical features and outcomes of patients with UEDVT. Study design: 385 cases diagnosed with UEDVT were included in the study. Risk factors, symptoms, thrombosis localization and clinical outcomes were examined. Results: The most common risk factors were CVC (82%) and malignancy (45%). Edema (77%) and pain (56%) were the reasons for the patients' application. The most common site involved was the subclavian vein. Although the frequency of pulmonary embolism was 4%, 60-day mortality was determined as 9%. Conclusion: CVC and presence of malignancy are common risk factors for UEDVT. Despite its low frequency of PE, it has a non-low mortality associated with possible underlying diseases.

Unprovoked Versus Provoked Venous Thromboembolism in Pediatric Patients: Comparison of Characteristics and Outcomes

Background: The incidence of Venous thromboembolism (VTE) is increasing in the pediatric population which has led to a significant impact on morbidity, mortality and health care costs. The majority of VTE episodes diagnosed in children are considered provoked events secondary to an identifiable risk factor. In contrast, truly unprovoked VTE events are rare in children and there is limited data describing clinical course and outcomes in this population. The aim of this study is to highlight important differences in characteristics and outcomes of unprovoked VTE compared to provoked VTE in pediatric patients.Method: We performed a retrospective analysis of a prospectively maintained institutional thrombosis database. We identified all patients with an objectively confirmed VTE at our institution over a 5-year period from 2011 to 2016. Patients were managed according to standardized institutional protocols based on published guidelines. We compared patients with unprovoked VTE to those with provoked VTE with regards to demographics, prevalence of high risk thrombophilia (defined as inherited deficiency of antithrombin, protein C, or protein S, or antiphospholipid antibody syndrome), frequency of extensive VTE (defined as completely occlusive thrombosis involving >1 venous segment), frequency of pulmonary embolism (PE), frequency of recurrent VTE and frequency of post-thrombotic syndrome (PTS) assessed using the Manco-Johnson instrument in evaluable patients with history of VTE involving extremity veins, inferior vena cava, and/or superior vena cava. Data was compared using the Mann-Whitney U test or Fisher exact test as appropriate. Two-tailed p value less than 0.05 was considered statistically significant.Results: See Table 1 for a summary of the results. A total of 313 patients developed 336 VTE events at our institution during the study period. Of 336 VTE events, 24 (7%) were unprovoked events affecting 19 patients. Patients with unprovoked VTE were significantly older compared to patients with provoked VTE while gender distribution was similar between the 2 groups. The prevalence of high risk thrombophilia was significantly higher in patients with unprovoked VTE. Similarly, the frequencies of extensive VTE, PE and recurrent VTE were significantly higher in patients with unprovoked VTE. The frequency of physically and functionally significant PTS was not significantly different between the two groups. However, the frequency of PTS of any severity was significantly higher in patients with unprovoked VTE.Conclusion: Our study indicates that pediatric patients with unprovoked VTE represent a distinct patient population that appears to be at high risk for poor outcomes. Multicenter, prospective studies are needed to confirm our results and for developing optimal evidence-based risk stratified treatment approaches. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Pulmonary embolism in patients with COVID-19 and value of D-dimer assessment: a meta-analysis.

PurposeTo investigate, in a meta-analysis, the frequency of pulmonary embolism (PE) in patients with COVID-19 and whether D-dimer assessment may be useful to select patients for computed tomography pulmonary angiography (CTPA).MethodsA systematic literature search was performed for original studies which reported the frequency of PE on CTPA in patients with COVID-19. The frequency of PE, the location of PE, and the standardized mean difference (SMD) of D-dimer levels between patients with and without PE were pooled by random effects models.ResultsSeventy-one studies were included. Pooled frequencies of PE in patients with COVID-19 at the emergency department (ED), general wards, and intensive care unit (ICU) were 17.9% (95% CI: 12.0–23.8%), 23.9% (95% CI: 15.2–32.7%), and 48.6% (95% CI: 41.0–56.1%), respectively. PE was more commonly located in peripheral than in main pulmonary arteries (pooled frequency of 65.3% [95% CI: 60.0–70.1%] vs. 32.9% [95% CI: 26.7–39.0%]; OR = 3.540 [95% CI: 2.308–5.431%]). Patients with PE had significantly higher D-dimer levels (pooled SMD of 1.096 [95% CI, 0.844–1.349]). D-dimer cutoff levels which have been used to identify patients with PE varied between 1000 and 4800 μg/L.ConclusionThe frequency of PE in patients with COVID-19 is highest in the ICU, followed by general wards and the ED. PE in COVID-19 is more commonly located in peripheral than in central pulmonary arteries, which suggests local thrombosis to play a major role. D-dimer assessment may help to select patients with COVID-19 for CTPA, using D-dimer cutoff levels of at least 1000 μg/L.Key Points• The frequency of PE in patients with COVID-19 is highest in the ICU, followed by general wards and the ED.• PE in COVID-19 is more commonly located in peripheral than in central pulmonary arteries.• D-dimer levels are significantly higher in patients with COVID-19 who have PE.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00330-021-08003-8.

Systematic Screening for Deep Vein Thrombosis in Critically Ill Inpatients With COVID-19: Impact on the Incidence of Venous Thromboembolism.

Background: Several studies suggest an increased incidence of thrombosis in COVID-19 patients. However, evidence on how to prevent and even treat it is scarce. The aim of this study was to compare the cumulative incidence of venous thromboembolism (VTE) of two different methods for lower extremity deep vein thrombosis (LE-DVT) diagnosis: systematic vs. clinically guided complete compression venous ultrasonography (CCUS). We conducted a monocentric, prospective, open-label, non-randomized study. All consecutive patients admitted in three intensive care units (ICUs) of University Hospital of Toulouse for COVID-19 pneumonia were included: one performed systematic screening for LE-DVT, the others did not. The primary outcome was the 21-day cumulative incidence of VTE. The secondary end points were the 21-day cumulative incidences of major bleeding and death.Results: Among the 78 patients included, 27 (34.6%) underwent systematic screening for DVT 7 ± 2 days after ICU admission. Thirty-two patients (41.0%) were diagnosed with VTE, with a 21-day cumulative incidence of 42.3% (95% CI, 31.4–55.2), without difference between screened and non-screened patients (hazard ratio 1.45, 95% CI, 0.72–2.93). In the screened group, the frequency of isolated DVT was higher (25.9 vs. 5.9%, p-value = 0.027), but the frequency of pulmonary embolism was not reduced (25.9 vs. 29.4%, p-value = 0.745). The 21-day cumulative incidences of major bleeding and death were 9.6% (95% CI, 4.7–19.2) and 10.3% (95% CI, 5.0–20.8), respectively, without difference between the two groups.Conclusions: A systematic screening for DVT in patients hospitalized in ICU was not associated with a higher diagnosis of VTE or a reduced diagnosis of PE.

Pulmonary embolism in chronic kidney disease and end-stage renal disease hospitalizations: Trends, outcomes, and predictors of mortality in the United States.

Background:It is well-known that patients with chronic kidney disease and end-stage renal disease are at increased risk of pulmonary embolism than patients with normal kidney function. However, the data on trends, outcomes, and predictors of mortality in pulmonary embolism patients with chronic kidney disease and end-stage renal disease in the United States are limited.Methods:We queried the National Inpatient Sample database from 2010 to 2014. International Classification of Diseases-Ninth Revision-Clinical Modification codes were used to identify patients with normal kidney function, chronic kidney disease, and end-stage renal disease. The frequency of pulmonary embolism, complications, in-hospital mortality, and length of stay were calculated for each cohort. Multivariable logistic regression models were constructed to determine the predictors of mortality.Results:In the study population (2010–2014), there were 766,176 pulmonary embolism hospitalizations with normal kidney function, 79,824 with chronic kidney disease, and 9147 with end-stage renal disease. Among the study cohorts, the mortality rate was 2.7% in normal kidney function, 4.5% in chronic kidney disease, and 6.8% in end-stage renal disease hospitalizations. Median length of stay was highest in the end-stage renal disease cohort and lowest in the normal kidney function cohort. After adjusting for confounders, pulmonary embolism patients with chronic kidney disease died 1.15 times more often than those with normal kidney function and pulmonary embolism patients with end-stage renal disease died 4.2 times more often than those with normal kidney function.Conclusion:The mortality rate and length of stay in pulmonary embolism patients with chronic kidney disease and end-stage renal disease were significantly higher than those in pulmonary embolism patients with normal kidney function. Also, pulmonary embolism patients with chronic kidney disease and end-stage renal disease were at higher risk of in-hospital mortality than those with normal kidney function. There was statistically significant higher risk of mortality in elderly and Black patients with pulmonary embolism and concurrent chronic kidney disease or end-stage renal disease.

Effect of air pollution, air pressure and air temperature on new onset pulmonary thromboembolism: A case-control study

Aim: Air pollution affects many people globally and there are allegations and studies that it leads to serious health problems, such as pulmonary thromboembolism. In this study, we investigated the possible relationship between air conditions and pulmonary thromboembolism. Methods: This study was carried out by archive scanning. Patients with acute dyspnea who were shown to have PE by contrast-enhanced CT were included in the analysis. Patients with a history of trauma, malignancy, recent surgical intervention, or immobility were excluded from the study. On the day of complaints, Particulate matter 10 (PM10), sulfur dioxide (SO2), air temperature and air pressure values were obtained online from the relevant institution of Environment and Urban Ministry. These 215 patients’ data were then evaluated statistically. Results: Results suggest that the incidence of pulmonary embolism was higher on days when PM10 (P<0.001) and air pressure levels were high (P<0.001). However, SO2 and temperature were not directly associated with the frequency of pulmonary embolism (P=0.422, P=0.778). Conclusion: In light of this study, it can be said that air quality may have different consequences on human health. Elevated PM10 and air pressure levels can affect the circulatory system negatively and aggravate thromboembolism.

Low relative muscle volume: Correlation with prevalence of venous thromboembolism following total knee arthroplasty.

BackgroundThere have been many efforts to find modifiable risk factors for venous thromboembolism (VTE) in the perioperative period of total knee arthroplasty (TKA), while no study has investigated the relationship between the muscle mass and deep vein thrombosis (DVT) or pulmonary embolism frequency following TKA. This study aimed to evaluate the relationship between muscle volume and the prevalence of symptomatic and radiologically confirmed venous thromboembolism (VTE) after total knee arthroplasty (TKA).MethodsA total of 261 consecutive patients who underwent primary TKA between 2013 and 2015 were enrolled. Computed tomographic venography with pulmonary angiography (CTVPA) was performed between the 5th and 7th postoperative days to assess the presence of VTE. Four parameters of muscle volume at three levels were evaluated on CTVPA: (i) the cross-sectional area of all skeletal muscles (skeletal muscle index) and total psoas area at the level of the third lumbar vertebrae; (ii) the vastus lateralis muscle at the thigh level; and (iii) the posterior crural muscle at the lower leg level. The relationship between the muscle volume at each level and the prevalence of VTE after TKA was evaluated with multivariate adjusted logistic regression models.ResultsThe CTVPA scan showed no proximal DVT, and all thrombi were located in muscular, peroneal, and posterior tibial veins. In unilateral TKA, patients with lower muscle volume of the vastus lateralis at the thigh level in the nonoperated limb had significantly higher prevalence of distal DVT in the operated limb (adjusted OR: 2.97 at subclinical DVT revealed by CTVPA and adjusted OR: 2.68 at symptomatic DVT). This finding was also discovered in patients who underwent simultaneous bilateral TKA (adjusted OR: 1.73–2.97 at subclinical DVT and adjusted OR:1.76–1.86 at symptomatic DVT).ConclusionsThe relative muscle volume of the vastus lateralis at the thigh level was negatively associated with the prevalence of symptomatic and radiologically confirmed DVT, suggesting that low thigh muscle mass is an independent risk factor for VTE in the postoperative period of TKA.

Frequency, Cause, and Awareness of Pulmonary Embolism in Oncologic Patients

The frequency of pulmonary embolism (PE) in oncologic patients ranges from 1.1 % to 7.3 % depending on whether not only symptomatic findings but also incidental and initially overseen events are considered. The frequency of PE is tumor-specific. Most frequently PE occurs in patients with malignancy of the ovary (25 %), pancreas, brain, uterus, and multiple myeloma. Most rarely is PE found in patients with malignancy of the testis (< 1 %).The tumor-specific frequency shows that the association of malignancy and PE is not equally true for alle malignancies. A number of arguments that support the above association are also valid in non-oncologic patients.The awareness of the diagnosing radiologist and the thrombus mass decide whether or not an unexpected PE is detected. An increased awareness is suggested in patients with malignancies with high PE frequency and in patients with advanced oncologic disease.

Frequency, cause, and awareness of pulmonary embolism in oncologic patients

The frequency of pulmonary embolism (PE) in oncologic patients ranges from 1.1 % to 7.3 % depending on whether not only symptomatic findings but also incidental and initially overseen events are considered. The frequency of PE is tumor-specific. Most frequently PE occurs in patients with malignancy of the ovary (25 %), pancreas, brain, uterus, and multiple myeloma. Most rarely is PE found in patients with malignancy of the testis.The tumor-specific frequency shows that the association of malignancy and PE is not equally true for alle malignancies. A number of arguments that support the above association are also valid in non-oncologic patients.The awareness of the diagnosing radiologist and the thrombus mass decide whether or not an unexpected PE is detected. An increased awareness is suggested in patients with malignancies with high PE frequency and in patients with advanced oncologic disease.

A prediction model for surgical mortality and serious morbidity after primary debulking surgery

Objectives: The objective of this study was to determine the frequency of venous thromboembolism (VTE) in surgical gynecologic oncology patients, stratified by origin of malignancy. Methods: Using the American College of Surgeons National Surgical Quality Improvement Program database, 104,368 gynecologic surgeries were identified from 2006 to 2012. Patient demographics, 30day postoperative complications, and operative diagnosis were abstracted. Patients were stratified by origin of gynecologic malignancy. The primary outcome was the frequency of VTE. Institutional Board Review exemption was obtained. Results: A total of 104,368 gynecologic surgeries were identified and found to have a frequency of deep venous thrombosis (DVT) of 2.3 in 1000 (n= 242) and a frequency of pulmonary embolism (PE) of 2.9 in 1000 (n= 299). One-fifth (n= 49) of patients with DVT had a simultaneous PE. Of all gynecologic surgeries, 1.6% (n= 1657) were performed for ovarian cancer; 3.8% (3941) for uterine cancer; 0.6% (n= 619) for cervical cancer; and 0.3% (n= 310) for vulvar cancer. The rate of DVT observedwithin the ovarian cancer groupwas 1.9% (n= 32) compared to 0.9% (n= 37) in the uterine cancer group; and for PE was 1.3% (n= 21) and 1.1% (n= 42), respectively. The odds ratio (OR) of postoperative DVT in ovarian cancer compared to all gynecologic surgeries was 9.41 (CI, 6.25–13.73). When comparing ovarian cancer to uterine cancer, the adjusted OR of postoperative DVT was 1.899 (CI, 1.12–3.22, P=0.017), while the OR of PE was 9.31 (CI 6.54–12.96). In contrast, there were only three DVTs and two PEs within the cervical cancer group and no DVTs or PEs within the vulvar cancer group. Conclusions: The incidence of VTE among postoperative gynecologic patients is higher for ovarian cancer patients compared to other gynecologic malignancies in current clinical practice, based on this nationally representative cohort. This surgical sentinel event may not be able to be completely eliminated in this higher-risk population. However, continued attention must be directed to decrease VTE risk and to develop feasible benchmarks and clinical practice guidelines in conjunction with national organizations such as the Joint Commission.

Pulmonary embolism and hematologic outcome in cancer patients initiating chemotherapy.

Purpose: The aim of this study was to determine the relationship between chemotherapy use and the frequency of pulmonary embolism (PE) and associated mortality, clinical, and biochemical parameters. An additional aim was to analyze computed tomography pulmonary angiography findings. Materials and Methods: The study population comprised 65 of 368 consecutive patients diagnosed with PE who underwent chemotherapy in the Medical Oncology Department. The study population had cancer of various origins, including breast, colorectal, lung, gynecological, gastric and pancreatic, lymphatic, and other sites. The patients' clinical records were reviewed for leukocyte and platelet count, mean platelet volume (MPV), neutrophil to lymphocyte ratio, and level of mortality. As the parameters were normally distributed, the correlation coefficients and their significance were calculated using Pearson's test. One-way analysis of variance was used to compare the leukocyte counts among the cancer groups. A t-test was used to compare the means of the platelet and leukocyte counts between the patients. A Chi-square test was used to compare binary outcomes for categorical variables. Patients who died in the 1 st year and others (survivors and patients who died after the 1 st year) were compared using multinomial logistic regression analysis. Results: When the patients who died in the 1 st year and the survivors were compared, there was a statistically significant difference in the platelet count between the two groups. The platelet count, MPV, and leukocyte count of the patients with PE were significantly high. The leukocyte count was also significantly high in patients with breast, colorectal, lung, and gynecological cancers. Conclusion: Our results indicate that in cancer patients with PE who undergo chemotherapy, the platelet count, MPV, and leukocyte count are significantly high.

Pulmonary Embolism in Ischemic Stroke: Clinical Presentation, Risk Factors, and Outcome

BackgroundLimited information is available on the frequency of pulmonary embolism (PE) in patients with an acute ischemic stroke (AIS). We evaluated clinical characteristics, predisposing factors, and outcomes in AIS patients with PE.Methods and ResultsWe included all AIS patients admitted to participating institutions in the Registry of the Canadian Stroke Network. Clinically PE was documented by a physician and confirmed by computed tomography pulmonary angiography within 30 days of the stroke case index. The primary outcome was death or disability at discharge. Secondary outcomes included disposition, length of hospital stay, mortality at 3 months and 1 year. Among 11 287 patients with AIS, PE was found in 89 (0.78%) patients. History of cancer, deep vein thrombosis (DVT)/PE, and DVT during the hospitalization were associated with PE. PE was associated with higher risk of death at 30 days (25.8% versus 13.6%; P<0.001), at 1 year (47.2% versus 24.6%; P<0.001), and disability at discharge (85.4% versus 63.6%; P<0.001). Mean length of stay was longer in stroke patients with PE (36 versus 16 days; P=0.001). After adjusting for age, sex, and stroke severity, PE remained associated with lower survival at 30 days and 1 year, and death or disability at discharge (OR 3.02; 95% CI 1.56 to 5.83).ConclusionsIn this large cohort study, PE occurred in nearly 1% of AIS patients. PE was more common in patients with severe stroke, history of cancer, previous DVT/PE or acute DVT and associated with lower short‐ and long‐term survival, greater disability, and longer length of stay.

Diagnostic accuracy and clinical outcomes of ECG-gated, whole chest CT in the emergency department.

PurposeThe purpose of this study was to assess the diagnostic accuracy and one year prognosis of whole chest, “multiple rule out” CT for coronary artery disease (CAD) in Emergency Department patients.Methods and FindingsOne hundred and two Emergency Department patients at low to intermediate risk of acute coronary syndrome (ACS), pulmonary embolism and/or acute aortic syndrome underwent a research 64 channel ECG-gated, whole chest CT and a standard of care evaluation. Patients were classified with obstructive CAD with either a coronary CT stenosis greater than 50% or a non-evaluable coronary segment. SOC and 3 month follow up data were used to determine an adjudicated clinical diagnosis. The diagnostic ability of obstructive CAD on CT to identify clinical diagnoses was determined. Patients were followed up for 1 year for cardiac events. Seven (7%) patients were diagnosed with ACS. CT sensitivity to detect obstructive CAD in ACS patients was 100% (95% CI 65%, 100%), negative predictive value 100% (96%, 100%), specificity 88% (80%, 94%), and positive predictive value 39% (17%, 64%). Pulmonary embolism and acute aortic syndrome were not identified in any patients. No cardiac events occurred in patients without obstructive CAD over 1 year.ConclusionsWhole chest CT has high sensitivity and negative predictive value for ACS with excellent one year prognosis in patients without obstructive CAD on CT. The frequency of pulmonary embolism or acute aortic syndrome and the higher radiation dose suggest whole chest CT should be limited to select patients.ClinicalTrials.org #: NCT00855231

Clinical Sequelae of Thrombus in an Inferior Vena Cava Filter

The purpose of this study was to assess the long-term clinical sequelae of inferior vena cava (IVC) filter thrombus and the effect of anticoagulation on filter thrombus. Of 1,718 patients who had IVC filters placed during 2001-2008, 598 (34.8%) had follow-up abdominal CT. Filter thrombus was seen in 111 of the 598 (18.6%). There were 44 men (39.6%). The mean age at filter placement was 64 years. The medical diseases included cancer in 64, trauma in 15, stroke in 12, and others in 20. The frequency of filter thrombus on CT and asymptomatic filter thrombus on CT was calculated. The frequency of pulmonary embolism (PE) in patients with filter thrombus was calculated. The frequency of thrombus progression or regression (on CT, available in 56) was calculated. The effect of anticoagulation on filter thrombus regression/progression was evaluated using the Fisher exact test by comparing the group of patients who received anticoagulants versus those who did not. A P-value of <0.05 was considered significant. The overall frequency of filter thrombus was 18.6%. Total occlusion of the IVC filter was seen in 12 of 598 (2%). The filter thrombus was asymptomatic in 110 (18.3%). Filter thrombus was detected after a median of 35 days (range, 0-2082) following filter placement. Thrombus extended above the filter in 4 (3.6%); IVC thrombus below the filter was seen in 35(31.5%). Thrombus in the filter occluded <25% of the filter volume in 58 (52.3%), 25-50% in 21 (18.9%), and 50-75% in 20 (18%). Total IVC occlusion was seen in 12 (10.8%). Eighty-three patients received anticoagulation. Sixteen patients developed symptoms of PE. PE was confirmed on CT in 3 of 15 (2.7%). On follow-up, filter thrombus regressed completely in 19 (33.9%) after a median of 6 months. Filter thrombus decreased in size in 13 (23.2%) and it progressed without IVC occlusion in 7 (12.6%). In one (1.7%), filter thrombus progressed to IVC occlusion. Filter thrombus remained stable in 16 (28.6%). There was no significant difference in thrombus regression or progression rates whether or not the patients received anticoagulation for filter thrombus. In conclusion, asymptomatic thrombus in the filter is common and it rarely progresses to complete caval occlusion. Anticoagulation has little effect on the resolution of filter thrombosis and future occurrence of PE.

Suprarenal Inferior Vena Cava Filters: A 20-Year Single-Center Experience

To assess the clinical safety and efficacy of suprarenal inferior vena cava (IVC) filters during long-term follow-up. In this retrospective study, the authors collected the following data about patients who underwent suprarenal IVC filter placement at their institution between 1988 and 2007: demographics, clinical presentation, indications for filter placement, reasons for placing the filter in the suprarenal IVC, type of filter, frequency of pulmonary embolism (PE) after filter placement, and filter-related problems during follow-up. Seventy patients (32 male and 38 female patients; mean age, 60 years) had suprarenal IVC filters. Sixty-two patients presented with symptoms of venous thromboembolism (VTE) and eight had incidental asymptomatic VTE at imaging. Indications for filter placement were as follows: contraindication to anticoagulation (n = 48), complications and/or failure of anticoagulation (n = 12), added protection (n = 8), and prophylaxis (n = 2). Suprarenal placement was chosen due to IVC thrombus (n = 41), intrinsic and/or extrinsic narrowing of the infrarenal IVC (n = 9), renal and/or gonadal vein thrombus (n = 3), congenital IVC anomalies (n = 6), pelvic mass (n = 5), pregnancy (n = 3), and other reasons (n = 3). The following filters were used: Greenfield (n = 29), Simon Nitinol (n = 5), Vena-Tech (n = 3), TrapEase (n = 22), OptEase (n = 3), Tulip (n = 6), Bird's Nest (n = 1), and Recovery (n = 1). During follow-up (mean, 573 days +/- 953), postfilter PE was suspected in 10 patients; eight patients underwent computed tomography (CT), one of whom had PE at CT. None developed new symptoms of caval thrombosis. Abdominal CT (performed in 30 patients at a mean of 543 days +/- 768) showed thrombus in the filter in three patients, fracture in one patient, and penetration of the IVC wall in two patients. Suprarenal filters are safe and effective in preventing PE. The placement of IVC filters above the renal veins does not carry an added risk of complications.

Comparison of 3 Clinical Models for Predicting the Probability of Pulmonary Embolism

Two clinical models have been described to predict the probability of pulmonary embolism: the Canadian (or Wells) model, and the Geneva model. A third model has been developed recently at our institution (the Pisa model). We compared the performance of the 3 models in 215 consecutive patients with suspected pulmonary embolism. The clinical probability predicted by the models was categorized as low, intermediate, or high. In all patients, pulmonary angiography was used as the reference diagnostic standard. In patients with pulmonary embolism, the extent of pulmonary embolization was assessed on the lung scan as an index of disease severity. The prevalence of pulmonary embolism was 43.3%, and the median extent of pulmonary embolization at diagnosis was 39.8% (range, 4.5%-75.3%). The proportions of patients categorized as having low, intermediate, or high probability were, respectively: 12%, 60%, and 28%, for the Geneva model; 30%, 55%, and 15%, for the Wells model; 37%, 37%, and 26% for the Pisa model. The frequencies of pulmonary embolism in the low, intermediate, and high probability categories were, respectively: 50%, 39%, and 49% for the Geneva model; 12%, 54%, and 64% for the Wells model; 5%, 42%, and 98% for the Pisa model. Among patients with pulmonary embolism, there was a strong, positive relation between clinical probability predicted by the Pisa model and the extent of pulmonary embolization. The Pisa model proved more accurate than the 2 other models. It may be useful to physicians in defining precisely the pretest probability of pulmonary embolism.