Emergency department diagnosis and management of acute pulmonary embolism.

Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 0372544 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2141 (Electronic) Linking ISSN: 00071048 NLM ISO Abbreviation: Br J Haematol Subsets: MEDLINE

Publication: Oxford : Wiley-Blackwell
Original Publication: Oxford : Blackwell Scientific Publications

Emergency Service, Hospital* ; Fibrin Fibrinogen Degradation Products*/analysis ; Pulmonary Embolism*/blood ; Pulmonary Embolism*/diagnosis ; Pulmonary Embolism*/therapy; Female ; Humans ; Acute Disease/therapy ; Anticoagulants/therapeutic use ; Anticoagulants/adverse effects ; Disease Management ; Prognosis

Despite advances in clinical decision support, the diagnosis, prognostic risk stratification, treatment and disposition of emergency department patients with pulmonary embolism remain challenging. The use of diagnostic risk stratification tools and D-dimer can decrease unnecessary exposure to radiation and intravenous contrast; however, D-dimer is elevated in many conditions including normal pregnancy, so imaging is often indicated. Once diagnosed, prognostic risk stratification tools can inform treatment decisions across the risk spectrum, including identifying low-risk patients with pulmonary embolism who can safely be treated at home. For patients requiring hospitalization, alternatives to unfractionated heparin can improve time to therapeutic anticoagulation and reduce treatment-related bleeding risk.
(© 2024 The Author(s). British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.)

Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing G‐J, Harjola V‐P, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS) The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Heart J. 2020;41(4):543–603.
Falster C, Hellfritzsch M, Gaist TA, Brabrand M, Bhatnagar R, Nybo M, et al. Comparison of international guideline recommendations for the diagnosis of pulmonary embolism. Lancet Haematol. 2023;10(11):e922–e935.
Germini F, Al‐Haimus F, Hu Y, Mondoux S, Ibrahim Q, Chan N, et al. Implementation, clinical benefit and safety of a D‐dimer‐focused pulmonary embolism testing pathway in the emergency department. Ann Emerg Med. 2024; in press.
Parry BA, Chang AM, Schellong SM, House SL, Fermann GJ, Deadmon EK, et al. International, multicenter evaluation of a new D‐dimer assay for the exclusion of venous thromboembolism using standard and age‐adjusted cut‐offs. Thromb Res. 2018;166:63–70.
Kabrhel C, Van Hylckama Vlieg A, Muzikanski A, Singer A, Fermann GJ, Francis S, et al. Multicenter evaluation of the YEARS criteria in emergency department patients evaluated for pulmonary embolism. Acad Emerg Med. 2018;25(9):987–994.
Cohen SL, Feizullayeva C, McCandlish JA, Sanelli PC, McGinn T, Brenner B, et al. Comparison of international societal guidelines for the diagnosis of suspected pulmonary embolism during pregnancy. Lancet Haematol. 2020;7(3):e247–e258.
Goodacre S, Horspool K, Nelson‐Piercy C, Knight M, Shephard N, Lecky F, et al. The Di PEP study: an observational study of the diagnostic accuracy of clinical assessment, D‐dimer and chest x‐ray for suspected pulmonary embolism in pregnancy and postpartum. BJOG. 2019;126(3):383–392.
van der Pol LM, Tromeur C, Bistervels IM, Ni Ainle F, van Bemmel T, Bertoletti L, et al. Pregnancy‐adapted YEARS algorithm for diagnosis of suspected pulmonary embolism. N Engl J Med. 2019;380(12):1139–1149.
Watson NW, Carroll BJ, Krawisz A, Schmaier A, Secemsky EA. Trends in discharge rates for acute pulmonary embolism in US emergency departments. Ann Intern Med. 2024;177(2):134–143.
Prucnal CK, Jansson PS, Deadmon E, Rosovsky RP, Zheng H, Kabrhel C. Analysis of partial thromboplastin times in patients with pulmonary embolism during the first 48 hours of anticoagulation with unfractionated heparin. Acad Emerg Med. 2020;27(2):117–127.
Aday AW, Beckman JA. Pulmonary embolism and unfractionated heparin: time to end the roller coaster ride. Acad Emerg Med. 2020;27(2):176–178.
Palareti G. Direct oral anticoagulants and bleeding risk (in comparison to vitamin K antagonists and heparins), and the treatment of bleeding. Semin Hematol. 2014;51(2):102–111.
Kooiman J, van Hagen N, Iglesias del Sol A, Planken EV, Lip GY, van der Meer FJ, et al. The HAS‐BLED score identifies patients with acute venous thromboembolism at high risk of major bleeding complications during the first six months of anticoagulant treatment. PLoS One. 2015;10(4):e0122520.
Rosovsky R, Chang Y, Rosenfield K, Channick R, Jaff MR, Weinberg I, et al. Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10‐year analysis. J Thromb Thrombolysis. 2019;47:31–40.

Keywords: emergency medicine; pulmonary embolism; venous thromboembolism

0 (Anticoagulants)
0 (Fibrin Fibrinogen Degradation Products)
0 (fibrin fragment D)

Date Created: 20240826 Date Completed: 20241116 Latest Revision: 20241205

20241209

10.1111/bjh.19725

39183380