VTE Journal Club 4/21/16

VTE, adjusted D-dimer cutoffs, subsegmental PE, pregnancy

60 yr old female with no significant history comes in with pleuritic left-sided chest pain for the last day and feels short of breath. There is no recent illness or symptoms of viral infection. She has a recent travel history with a bus trip from the Midwest last week. Her vitals and exam are normal.

27 yr old female with pregnancy at 12 weeks presents with pleuritic right-sided chest pain for 3 days and mild short of breath. She was sent from her Ob clinic to be “ruled out for PE”. Her heart rate is 90 and the rest of her vitals and exam are normal. She has no recent illness or other symptoms except lingering nausea.

Pulmonary Embolism is potentially deadly but the diagnostic and treatment strategies also pose heavy risks of over exposure to radiation, contrast damage to kidneys, and extended anticoagulation.

What is your diagnostic approach for each of these patients and others?

Patient A ultimately has a CT Angiogram of the chest that shows isolated subsegmental PE. What is your further evaluation and treatment strategy?

Come to the Journal Club and discuss the evidence-based evaluation and treatment of PE. See the articles attached as basis for discussion. Should we use an adjusted D-dimer cutoff for certain populations? Are all non-massive PE equal, including the subsegmental PE? What is our strategy in pregnancy?

Invited: Hospitalists, Intensivists, Trauma Surgeons, Radiologists, Emergency Providers

Thursday, April 21, 2016
Upper Crust Pizza, 2727 Churn Creek, Redding

RSVP to Tiffany Tryan
225-7240 or TiffanyTryan@cep.com

Hope to see you there.

An Age-Adjusted D-dimer Threshold for Emergency Department Patients With Suspected Pulmonary Embolus:  Accuracy and Clinical Implications, ANN Emerg Med 2016;67:249-257


Age-Adjusted D-Dimer Cutoff Levels to Rule Out Pulmonary Embolism, The ADJUST-PE Study.  Mama 2014;311(11):1117-1124



Potential of an age adjustedD-dimer cut-off value to improve the exclusion of pulmonary embolism in older patients:  a retrospective analysis of three large cohorts. BMJ 010;340:c1475


The Emergency Medicine approach to the Evaluation and Treatment of Pulmonary Embolism, Emergency Medicine Practice, An Evidence-Based Approach, by EBmedicine.net 2012


Antithrombotic Therapy for VTE Disease, CHEST 2016; 149(2):315-352


Pregnancy Complicated by Venous Thrombosis, NEJM 2015; 36: 540-7





Pulmonary Embolism in Pregnancy with Jeff Kline, by Rob Orman, 3/2013 Podcast, Rob Orman, ERCast.org