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Latest & greatest articles for pulmonary embolism
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Should we use an age adjusted D-dimer threshold in managing low risk patients with suspected pulmonaryembolism? BestBets: Should we use an age adjusted D-dimer threshold in managing low risk patients with suspected pulmonaryembolism? Should we use an age adjusted D-dimer threshold in managing low risk patients with suspected pulmonaryembolism? Report By: Dr Tom Jaconelli - Registrar in Emergency Medicine Search checked by Dr Steven Crane - Consultant in Emergency Medicine Institution: York (...) District Hospital, York, UK Date Submitted: 26th December 2014 Date Completed: 6th May 2015 Last Modified: 6th May 2015 Status: Green (complete) Three Part Question In [patients with signs and symptoms of pulmonaryembolism who are deemed low risk] is a [age adjusted D-dimer sensitive enough] compared to a standard D-dimer to [safely exclude pulmonaryembolism]? Clinical Scenario A70 year old man presents with pleuritic chest pain. A D-dimer taken at triage is mildly elevated from the standard positive
Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonaryembolism: a randomized clinical trial. Although retrievable inferior vena cava filters are frequently used in addition to anticoagulation in patients with acute venous thromboembolism, their benefit-risk ratio is unclear.To evaluate the efficacy and safety of retrievable vena cava filters plus anticoagulation vs anticoagulation alone for preventing pulmonaryembolism (...) recurrence in patients presenting with acute pulmonaryembolism and a high risk of recurrence.Randomized, open-label, blinded end point trial (PREPIC2) with 6-month follow-up conducted from August 2006 to January 2013. Hospitalized patients with acute, symptomatic pulmonaryembolism associated with lower-limb vein thrombosis and at least 1 criterion for severity were assigned to retrievable inferior vena cava filter implantation plus anticoagulation (filter group; n = 200) or anticoagulation alone
Thrombolysis for pulmonaryembolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Predictive value of the heart-type fatty acid-binding protein and the PulmonaryEmbolism Severity Index in patients with acute pulmonaryembolism in the emergency department Heart-type fatty acid-binding protein (h-FABP), sensitive troponins, natriuretic peptides, and clinical scores such as the PulmonaryEmbolism Severity Index (PESI) are candidates for risk stratification of patients with acute pulmonaryembolism (PE). The aim was to compare their respective prognostic values to predict
Do patients with an asymptomatic sub-segmental pulmonaryembolism need anticoagulation therapy? BestBets: Do patients with an asymptomatic sub-segmental pulmonaryembolism need anticoagulation therapy? Do patients with an asymptomatic sub-segmental pulmonaryembolism need anticoagulation therapy? Report By: Hyun Choi - CT3 Search checked by Christopher Morgan - Institution: Central Manchester University Hospitals NHS Foundation Trust, University Of Manchester Date Submitted: 27th November 2010 (...) Date Completed: 5th January 2015 Last Modified: 5th January 2015 Status: Green (complete) Three Part Question [In an asymptomatic patient with small subsegmental pulmonaryembolism] does [anticoagulation therapy or no treatment] lead to [reduced mortality and a lower rate of recurrent venous thromboembolism?] Clinical Scenario A 49 year old male, who was previously fit and well, attended the Emergency Department as a trauma patient after being involved in a road traffic collision. He underwent
Can Computed Tomography?Assessed Right-Sided Ventricular Dysfunction Predict Mortality in Hemodynamically Stable PulmonaryEmbolism? Systematic Review Snapshot TAKE-HOME MESSAGE Right-sided ventricular dysfunction assessed by computed tomography (CT) isassociatedwithall-causeshort-termmortalityandmorestronglyassociatedwith mortality caused by pulmonaryembolism. Can Computed Tomography–Assessed Right-Sided Ventricular Dysfunction Predict Mortality in Hemodynamically Stable PulmonaryEmbolism (...) only hemodynamically stable patients. Five of the included studies were retrospective and 5 were pro- spectively designed. Nine studies de?ned evidence of right-sided ventricular dysfunction similarly, using right-ventricular or left- ventricular-diameter ratios of 0.9 to 1.0, and 1 study de?ned right- sided ventricular dysfunction as a right ventricular/left ventricu- lar ratio greater than 1.5. Only 3 studies reported pulmonaryembolism–related mortality as an outcome. Overall mortality Pooled
PulmonaryembolismPulmonaryembolism - NICE CKS Clinical Knowledge Summaries Share Pulmonaryembolism: Summary Pulmonaryembolism is a condition in which one or more emboli, usually arising from a blood clot formed in the veins (or, rarely, in the right heart), are lodged in and obstruct the pulmonary arterial system. This results in reduced gas exchange of the affected lung tissue, causing hypoxaemia and a reduction in cardiac output. Large or multiple emboli may result in hypotension (...) , syncope, shock, and sudden death. The most common source of pulmonary emboli is deep vein thrombosis (DVT) in the lower limbs, which can be found in 70–80% of people with pulmonaryembolism. Only 15% of people with pulmonaryembolism have signs of DVT. Without anticoagulation, the risk of recurrent venous thromboembolism (DVT or pulmonaryembolism) within 3 months of a pulmonaryembolism is thought to be 50%. Risk factors for venous thromboembolism include: Recent surgery, hospitalization
Rapid Quantitative D-dimer to Exclude PulmonaryEmbolism: A Prospective Cohort Management Study ESSENTIALS: It is not known if D-dimer testing alone can safely exclude pulmonaryembolism (PE). We studied the safety of using a quantitative latex agglutination D-dimer to exclude PE in 808 patients. 52% of patients with suspected PE had a negative D-dimer test and were followed for 3 months. The negative predictive value of D-dimer testing alone was 99.8%, suggesting it may safely exclude (...) PE.Strategies are needed to exclude pulmonaryembolism (PE) efficiently without the need for imaging tests. Although validated rules for clinical probability assessment can be combined with D-dimer testing to safely exclude PE, the rules can be complicated or partially subjective, which limits their use.To determine if PE can be safely excluded in patients with a negative D-dimer without incorporating clinical probability assessment.We enrolled consecutive outpatients and inpatients with suspected PE from
Evaluation of Patients With Suspected Acute PulmonaryEmbolism: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians Evaluation of Patients With Suspected Acute PulmonaryEmbolism | Annals of Internal Medicine | American College of Physicians '); } '); })(); Sign in below to access your subscription for full content INDIVIDUAL SIGN IN | You will be directed to acponline.org to register and create your Annals account INSTITUTIONAL SIGN (...) IN | | Subscribe to Annals of Internal Medicine . You will be directed to acponline.org to complete your purchase. Search Clinical Guidelines | 3 November 2015 Evaluation of Patients With Suspected Acute PulmonaryEmbolism: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians Free Ali S. Raja, MD; Jeffrey O. Greenberg, MD; Amir Qaseem, MD, PhD, MHA; Thomas D. Denberg, MD, PhD; Nick Fitterman, MD; Jeremiah D. Schuur, MD, MHS; for the Clinical Guidelines Committee
Inferior Vena Cava Filters for Prevention of PulmonaryEmbolism 1 COVERAGE GUIDANCE: INFERIOR VENA CAVA FILTERS FOR PREVENTION OF PULMONARY EMBOLI Approved March 12, 2015 HERC COVERAGE GUIDANCE Inferior vena cava (IVC) filters are recommended for coverage in: ? Patients with active deep vein thrombosis/pulmonaryembolism (DVT/PE) for which anticoagulation is contraindicated (strong recommendation) ? Some hospitalized patients with trauma* (weak recommendation) Retrieval of removable IVC filters (...) -populations-130607.pdf Sobieraj, D.M., Coleman, C.I., Tongbram, V., Lee, S., Colby, J., Chen, W.T., et al. (2012). Venous thromboembolism in orthopedic surgery. Rockville, MD: AHRQ. Retrieved on October 2, 2014, from http://effectivehealthcare.ahrq.gov/ehc/products/186/992/CER- 49_VTE_20120313.pdf Young, T., Tang, H., & Hughes, R. (2010). Vena caval filters for the prevention of pulmonaryembolism. Cochrane Database Syst Rev, 2(2). DOI: 10.1002/14651858.CD006212.pub4 Additional sources Decousus, H
Accuracy of the Wells Clinical Prediction Rule for PulmonaryEmbolism in Older Ambulatory Adults To determine whether the Wells clinical prediction rule for pulmonaryembolism (PE), which produces a point score based on clinical features and the likelihood of diagnoses other than PE, combined with normal D-dimer testing can be used to exclude PE in older unhospitalized adults.Prospective cohort study.Primary care and nursing homes.Older adults (≥60) clinically suspected of having a PE (N = 294 (...) , mean age 76, 44% residing in a nursing home).The presence of PE was confirmed using a composite reference standard including computed tomography and 3-month follow-up. The proportion of individuals with an unlikely risk of PE was calculated according to the Wells rule (≤4 points) plus a normal qualitative point-of-care D-dimer test (efficiency) and the presence of symptomatic PE during 3 months of follow-up within these patients (failure rate).Pulmonaryembolism occurred in 83 participants (28
Outpatient versus inpatient treatment for acute pulmonaryembolism. Pulmonaryembolism (PE) is a common life-threatening cardiovascular condition, with an incidence of 23 to 69 new cases per 100,000 people per year. Outpatient treatment instead of traditional inpatient treatment in selected non-high-risk patients with acute PE might provide several advantages, such as reduction of hospitalizations, substantial cost saving and an improvement in health-related quality of life.To compare
Risk of deep venous thrombosis and pulmonaryembolism in individuals with polymyositis and dermatomyositis: a general population-based study Patients with polymyositis (PM) and dermatomyositis (DM) may have an increased risk of venous thromboembolism (VTE); however, no general population data are available to date. The purpose of this study was to estimate the future risk and time trends of new VTE (deep venous thrombosis (DVT) or pulmonaryembolism (PE)) in individuals with incident PM/DM
Validation of N-terminal pro-brain natriuretic peptide cut-off values for risk stratification of pulmonaryembolism The optimal N-terminal pro-brain natriuretic peptide (NT-proBNP) cut-off value for risk stratification of pulmonaryembolism remains controversial. In this study we validated and compared different proposed NT-proBNP cut-off values in 688 normotensive patients with pulmonaryembolism. During the first 30 days, 28 (4.1%) patients reached the primary outcome (pulmonaryembolism (...) a prognostic impact on top of that of the simplified PulmonaryEmbolism Severity Index and right ventricular dysfunction on echocardiography (OR 4.27 (95% CI 1.22-15.01); p=0.024, c-index 0.741). The use of a stepwise approach based on the simplified PulmonaryEmbolism Severity Index, NT-proBNP ≥ 600 pg·mL(-1) and echocardiography helped optimise risk assessment. Our findings confirm the prognostic value of NT-proBNP and suggest that a cut-off value of 600 pg·mL(-1) is most appropriate for risk
PE rule-out criteria (PERC) for excluding pulmonaryembolism. BestBets: PE rule-out criteria (PERC) for excluding pulmonaryembolism. PE rule-out criteria (PERC) for excluding pulmonaryembolism. Report By: Dr Johan Victor Rehnberg - ACCS (Emergency Medicine) CT2 Search checked by Dr Anna Vondy - Specialist Registrar (Emergency Medicine) Institution: Royal Liverpool University Hospital, Liverpool, UK Date Submitted: 7th November 2012 Date Completed: 26th February 2014 Last Modified: 26th (...) help exclude PE without the need for D-dimer testing. Search Strategy The Cochrane Library issue 10 of 12 October 2013: ‘(PulmonaryEmbolism’ [MeSH; explode all trees] AND ‘Diagnosis’ [MeSH term; explode all trees]) OR (‘PERC’ OR ‘PE rule out criteria’ OR ‘Pulmonaryembolism rule out criteria’ OR ‘PE rule-out criteria’ OR ‘Pulmonaryembolism rule-out criteria’ OR ‘PE rule out’ OR ‘Pulmonaryembolism rule out’ OR ‘PE rule-out’ OR ‘Pulmonaryembolism rule-out’). Medline/EMBASE from 2004 to 29th
Rivaroxaban (Xarelto- Bayer Inc.) new Indication: pulmonaryembolism Rivaroxaban (Xarelto- Bayer Inc.) new Indication: pulmonaryembolism Rivaroxaban (Xarelto- Bayer Inc.) new Indication: pulmonaryembolism CADTH Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation CADTH. Rivaroxaban (Xarelto- Bayer Inc.) new Indication: pulmonaryembolism (...) URL Indexing Status Subject indexing assigned by CRD MeSH Anticoagulants; Humans; Morpholines; PulmonaryEmbolism; Thiophenes Language Published English Country of organisation Canada Province or state Ontario English summary An English language summary is available. Address for correspondence Canadian Agency for Drugs and Technologies in Health (CADTH), 865 Carling Avenue, Suite 600, Ottawa, Ontario Canada, K1S 5S8 Email: email@example.com AccessionNumber 32014000739 Date abstract record