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1. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

Author

Konstantinides, Stavros V., Meyer, Guy, Becattini, Cecilia, Bueno, Hector, Geersing, Geert-Jan, Harjola, Veli-Pekka, Huisman, Menno V., Humbert, Marc, Jennings, Catriona Sian, Jimenez, David, Kucher, Nils, Lang, Irene Marthe, Lankeit, Mareike, Lorusso, Roberto, Mazzolai, Lucia, Meneveau, Nicolas, Ni Ainle, Fionnuala, Prandoni, Paolo, Pruszczyk, Piotr, Righini, Marc, Torbicki, Adam, Van Belle, Eric, Luis Zamorano, Jose, Nazzareno, Galié, J Simon, R Gibbs, Victor, Aboyans, Walter, Ageno, Stefan, Agewall, Ana, G Almeida, Felicita, Andreotti, Emanuele, Barbato, Johann, Bauersachs, Andreas, Baumbach, Farzin, Beygui, Jørn, Carlsen, Marco De Carlo, Marion, Delcroix, Victoria, Delgado, Pilar Escribano Subias, Donna, Fitzsimons, Sean, Gaine, Samuel, Z Goldhaber, Deepa, Gopalan, Gilbert, Habib, Sigrun, Halvorsen, David, Jenkins, Hugo, A Katus, Barbro, Kjellström, Mitja, Lainscak, Patrizio, Lancellotti, Geraldine, Lee, Grégoire Le Gal, Emmanuel, Messas, Joao, Morais, Steffen, E Petersen, Anna Sonia Petronio, Massimo Francesco Piepoli, Susanna, Price, Marco, Roffi, Aldo, Salvi, Olivier, Sanchez, Evgeny, Shlyakhto, Iain, A Simpson, Stefan, Stortecky, Matthias, Thielmann, Anton Vonk Noordegraaf, Cecilia, Becattini, Héctor, Bueno, Geert-Jan, Geersing, Veli-Pekka, Harjola, Menno, V Huisman, Marc, Humbert, Catriona Sian Jennings, David, Jiménez, Nils, Kucher, Irene Marthe Lang, Mareike, Lankeit, Roberto, Lorusso, Lucia, Mazzolai, Nicolas, Meneveau, Fionnuala Ní Áinle, Paolo, Prandoni, Piotr, Pruszczyk, Marc, Righini, Adam, Torbicki, Eric, Vanbelle, José, Luiszamorano, Stephan, Windecker, Colin, Baigent, Jean-Philippe, Collet, Veronica, Dean, Chris, P Gale, Diederick, Grobbee, Gerhard, Hindricks, Bernard, Iung, Peter, Jüni, Ulf, Landmesser, Christophe, Leclercq, Maddalena, Lettino, Basil, S Lewis, Bela, Merkely, Christian, Mueller, Dimitrios, J Richter, Miguel, Sousa-Uva, Rhian, M Touyz, Naima, Hammoudi, Hamlet, Hayrapetyan, Julia, Mascherbauer, Firdovsi, Ibrahimov, Oleg, Polonetsky, Mariya, Tokmakova, Bosko, Skoric, Ioannis, Michaloliakos, Martin, Hutyra, Søren, Mellemkjaer, Mansour, Mostafa, Julia, Reinmets, Pertti, Jääskeläinen, Denis, Angoulvant, George, Giannakoulas, Endre, Zima, Vizza, Carmine Dario, Akhmetzhan, Sugraliyev, Ibadete, Bytyçi, Aija, Maca, Egle, Ereminiene, Steve, Huijnen, Robert, Xuereb, Nadejda, Diaconu, Nebojsa, Bulatovic, Ilyasse, Asfalou, Marijan, Bosevski, Bożena, Sobkowicz, Daniel, Ferreira, Antoniu Octavian Petris, Olga, Moiseeva, Marco, Zavatta, Slobodan, Obradovic, Iveta, Šimkova, Peter, Radsel, Borja, Ibanez, Gerhard, Wikström, Drahomir, Aujesky, Cihangir, Kaymaz, Alexander, Parkhomenko, Joanna, Pepke-Zaba, University of Zurich, Konstantinides, Stavros V, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Konstantinides S.V., Meyer G., Bueno H., Galie N., Gibbs J.S.R., Ageno W., Agewall S., Almeida A.G., Andreotti F., Barbato E., Baumbach A., Beygui F., Carlsen J., De Carlo M., Delcroix M., Subias P.E., Gaine S., Goldhaber S.Z., Gopalan D., Habib G., Jenkins D., Kjellstrom B., Lainscak M., Lee G., Le Gal G., Messas E., Morais J., Piepoli M.F., Price S., Salvi A., Sanchez O., Stortecky S., Thielmann M., Noordegraaf A.V., Becattini C., Geersing G.-J., Harjola V.-P., Huisman M.V., Humbert M., Jennings C.S., Jimenez D., Kucher N., Lang I., Lankeit M., Lorusso R., Mazzolai L., Meneveau N., Ainle F.N., Prandoni P., Pruszczyk P., Righini M., Torbicki A., Van Belle E., Zamorano J.L., Windecker S., Aboyans V., Baigent C., Collet J.-P., Dean V., Delgado V., Fitzsimons D., Gale C.P., Grobbee D.E., Hindricks G., Iung B., Juni P., Katus H.A., Landmesser U., Leclercq C., Lettino M., Lewis B.S., Merkely B., Mueller C., Petersen S.E., Petronio A.S., Richter D.J., Roffi M., Shlyakhto E., Simpson I.A., Sousa-Uva M., Touyz R.M., Hammoudi N., Hayrapetyan H., Mascherbauer J., Ibrahimov F., Polonetsky O., Lancellotti P., Tokmakova M., Skoric B., Michaloliakos I., Hutyra M., Mellemkjaer S., Mansour M., Reinmets J., Jaaskelainen P., Angoulvant D., Bauersachs J., Giannakoulas G., Zima E., Vizza C.D., Sugraliyev A., Bytyci I., Maca A., Ereminiene E., Huijnen S., Xuereb R., Diaconu N., Bulatovic N., Asfalou I., Bosevski M., Halvorsen S., Sobkowicz B., Ferreira D., Petris A.O., Moiseeva O., Zavatta M., Obradovic S., Simkova I., Radsel P., Ibanez B., Wikstrom G., Aujesky D., Kaymaz C., Parkhomenko A., Pepke-Zaba J., CTC, MUMC+: MA Med Staf Spec CTC (9), and RS: Carim - V04 Surgical intervention

Subjects
ORAL ANTICOAGULANT-THERAPY, diagnosis, [SDV]Life Sciences [q-bio], Medizin, 030204 cardiovascular system & hematology, Embolectomy, Guideline, RECURRENT VENOUS THROMBOEMBOLISM, 0302 clinical medicine, Pregnancy, Daily practice, Diagnosis, Pulmonary medicine, Venous thrombosis, Pulmonary Medicine, Thrombolytic Therapy, DEEP-VEIN THROMBOSIS, Disease management (health), Societies, Medical, ComputingMilieux_MISCELLANEOUS, health care economics and organizations, Risk assessment, ddc:616, RIGHT-VENTRICULAR DYSFUNCTION, Disease Management, Shock, MOLECULAR-WEIGHT HEPARIN, Thrombolysis, humanities, 3. Good health, Pulmonary embolism, Europe, Anticoagulation, Biomarkers, Dyspnoea, Echocardiography, Guidelines, Heart failure, Right ventricle, Treatment, Venous thromboembolism, medicine.vein, Acute Disease, Medical emergency, Cardiology and Cardiovascular Medicine, guidelines, pulmonary embolism, venous thrombosis, shock dyspnoea, heart failure: right ventricle: diagnosis, risk assessment: echocardiography, biomarkers, treatment, anticoagulation, thrombolysis, pregnancy, venous thromboembolism, embolectomy, Diagnosi, education, Cardiology, MEDLINE, Thrombolysi, 610 Medicine & health, Inferior vena cava, 2705 Cardiology and Cardiovascular Medicine, EXTRACORPOREAL MEMBRANE-OXYGENATION, 03 medical and health sciences, Medical, medicine, Humans, RIGHT HEART THROMBI, VENTILATION-PERFUSION SCINTIGRAPHY, Health professionals, business.industry, INFERIOR VENA-CAVA, 10031 Clinic for Angiology, Anticoagulants, 030229 sport sciences, Biomarker, medicine.disease, INHALED NITRIC-OXIDE, Societies, business
Abstract

Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

Published
2019

2. Pregnancy-adapted YEARS algorithm for diagnosis of suspected pulmonary embolism

Author

van der Pol, Liselotte M., Tromeur, Cecile, Bistervels, Ingrid M., Ni Ainle, Fionnuala, van Bemmel, Thomas, Bertoletti, Laurent, Couturaud, Francis, van Dooren, Yordi P. A., Elias, Antoine, Faber, Laura M., Hofstee, Herman M. A., van der Hulle, Tom, Kruip, Marieke J. H. A., Maignan, Maxime, Mairuhu, Albert T. A., Middeldorp, Saskia, Nijkeuter, Mathilde, Roy, Pierre-Marie, Sanchez, Olivier, Schmidt, Jeannot, ten Wolde, Marije, Klok, Frederikus A., Huisman, Menno V., Pernod, Gilles, Fogteloo, A. J., Kroft, L. J. M., van der Wall, S. J., Beenen, L. F. M., Veen, C. S. B., Hannigsberg, J., Merviel, P., Nonent, M., Buchmuller, A., Chauleur, C., Meyer, G., Planquette, B., Dessole, L., Moumneh, T., Elias, M., Kent, E., Breen, A., Kevane, B., ten Cate, H., Hamulyak, K., Hematology, Graduate School, ACS - Pulmonary hypertension & thrombosis, Amsterdam Reproduction & Development (AR&D), Vascular Medicine, ARD - Amsterdam Reproduction and Development, Radiology and Nuclear Medicine, ACS - Microcirculation, AGEM - Digestive immunity, AGEM - Re-generation and cancer of the digestive system, Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Service de Médecine Vasculaire et Thérapeutique, Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), CIC Brest, Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital de la Cavale Blanche, Departments of Clinical Epidemiology and General Internal Medicine (DCEGIM), Leiden University Medical Center (LUMC), Department of General Internal Medicine (DGIM Leiden), Service des Urgences (PMR), CHRU - ANGERS, Hôpital Européen Georges Pompidou [APHP] (HEGP), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Service de Pneumologie, soins intensifs (Pneumo - HEGP), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université Paris Descartes - Paris 5 (UPD5), Université Sorbonne Paris Cité (USPC), Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Innovations thérapeutiques en hémostase (IThEM - U1140), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de soins intensifs [Clermont Ferrand], CHU Clermont-Ferrand-Hôpital Gabriel Montpied, Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-Université de Brest (UBO), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], and CHU Clermont-Ferrand

Subjects
Hemoptysis, Computed Tomography Angiography, [SDV]Life Sciences [q-bio], Deep vein, 030204 cardiovascular system & hematology, 0302 clinical medicine, 030202 anesthesiology, Pregnancy, Pulmonary angiography, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Non-U.S. Gov't, ComputingMilieux_MISCELLANEOUS, Computed tomography angiography, Venous Thrombosis, Medicine(all), 030219 obstetrics & reproductive medicine, medicine.diagnostic_test, Obstetrics, Research Support, Non-U.S. Gov't, Obstetrics and Gynecology, Venous Thromboembolism, General Medicine, Thrombosis, Clinical Trial, Pulmonary embolism, 3. Good health, Multicenter Study, medicine.anatomical_structure, Acute Disease, Maternal death, Female, Radiology, Pregnancy Complications, Cardiovascular/diagnosis, Algorithm, Algorithms, Adult, medicine.medical_specialty, Pregnancy Complications, Cardiovascular, Fibrin Fibrinogen Degradation Products/analysis, Suspected pulmonary embolism, Research Support, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, medicine, Journal Article, Cardiovascular diagnosis, Humans, Pulmonary Embolism/diagnosis, Fetus, business.industry, Cardiovascular/diagnosis, Venous Thromboembolism/diagnosis, medicine.disease, Pregnancy Complications, Multicenter study, Pulmonary Embolism, business, Venous Thrombosis/diagnosis, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Acute pulmonary embolism is one of the leading causes of maternal death, with the overall incidence reported to be 1.72 cases per 1000 deliveries, accounting for approximately 1 death in every 100,000 deliveries. Since the D-dimer test has low specificity and sensitivity, it is common for pregnant women with suspected pulmonary embolism to undergo computed tomography (CT) pulmonary angiography or ventilation-perfusion (V/Q) scanning, both of which involve radiation exposure to the mother and fetus. It is unknown whether a pregnancy-adapted clinical screening algorithm could be used to safely avoid diagnostic imaging in a subset of pregnant women with suspected pulmonary embolism. The researchers performed a multicenter, international, prospective study of pregnant women with suspected pulmonary embolism. They assessed 3 criteria from the YEARS algorithm (clinical signs of deep vein thrombosis, hemoptysis, and pulmonary embolism as the most likely diagnosis) and measured the D-dimer level as components of the screening algorithm. Pulmonary embolism was ruled out if none of the 3 criteria were met and the D-dimer level was less than 1000 ng/mL, or if 1 or more of the 3 criteria were met and the D-dimer level was less than 500 ng/mL. Adaptation of the YEARS algorithm for pregnant women involved compression ultrasonography for women with symptoms of deep vein thrombosis; if the results were positive (ie, a clot was present), CT pulmonary angiography was not performed. All patients in whom pulmonary embolism had not been ruled out by screening criteria underwent CT pulmonary angiography. The primary outcome was the incidence of venous thromboembolism (VTE) at 3 months. The secondary outcome was the proportion of patients in whom CT pulmonary angiography was not indicated to safely rule out pulmonary embolism. A total of 510 women were screened, of whom 12 (2.4%) were excluded. Pulmonary embolism was diagnosed in 20 patients (4.0%) at baseline. During follow-up, popliteal deep vein thrombosis was diagnosed in 1 patient (0.21%; 95% confidence interval, 0.0%–1.2%); no patient had pulmonary embolism. CT pulmonary angiography was not indicated, and thus was avoided, in 195 patients (39%; 95% confidence interval, 35%–44%). The efficiency of the algorithm was highest during the first trimester of pregnancy and lowest during the third trimester; CT pulmonary angiography was avoided in 65% of patients who began the study in the first trimester and in 32% who began the study in the third trimester. The researchers concluded that the pregnancy-adapted YEARS diagnostic algorithm safely ruled out acute pulmonary embolism in pregnant patients who were referred for suspected pulmonary embolism. Using this approach, they found that the main advantage was that CT pulmonary angiography was averted in 32% to 65% of the patients, depending on the trimester of presentation, without compromising safety.

Published
2019

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