Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study.

Importance: D-dimer measurement is an important step in the diagnostic strategy of clinically suspected acute pulmonary embolism (PE), but its clinical usefulness is limited in elderly patients.

Objective: To prospectively validate whether an age-adjusted D-dimer cutoff, defined as age × 10 in patients 50 years or older, is associated with an increased diagnostic yield of D-dimer in elderly patients with suspected PE.

Design, Settings, And Patients: A multicenter, multinational, prospective management outcome study in 19 centers in Belgium, France, the Netherlands, and Switzerland between January 1, 2010, and February 28, 2013.

[Role of vena cava filter in the management of venous thromboembolism].

Available since the 1960s, the use of inferior vena cava filter has now become an alternative therapeutic approach in the management of venous thromboembolism in case of a contraindication to or a complication of anticoagulation. Their effectiveness in protecting against pulmonary embolism seems obvious in patients in whom anticoagulant treatment cannot be administred, but the literature is mainly based on two small size randomized controlled trials. The most used filters are "retrievable" filters, which can be removed after a certain time or left in place permanently.

Multicentre validation of the Geneva Risk Score for hospitalised medical patients at risk of venous thromboembolism. Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE).

There is a need to validate risk assessment tools for hospitalised medical patients at risk of venous thromboembolism (VTE). We investigated whether a predefined cut-off of the Geneva Risk Score, as compared to the Padua Prediction Score, accurately distinguishes low-risk from high-risk patients regardless of the use of thromboprophylaxis. In the multicentre, prospective Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE) cohort study, 1,478 hospitalised medical patients were enrolled of whom 637 (43%) did not receive thromboprophylaxis.

Outpatient treatment of symptomatic pulmonary embolism: a systematic review and meta-analysis.

Background: Patients with acute deep vein thrombus (DVT) can safely be treated as outpatients. However the role of outpatient treatment in patients diagnosed with a pulmonary embolism (PE) is controversial. We sought to determine the safety of outpatient management of patients with acute symptomatic PE.

Adapting the D-dimer cutoff for thrombosis detection in elderly outpatients.

D-dimer measurement is an important step in diagnostic strategies for venous thromboembolism. It allows the safe ruling out of the diagnosis with no need for imaging tests in approximately 30% of outpatients. However, the usefulness of d-dimer is limited in elderly patients; the likelihood of a negative d-dimer strongly decreases with age, making physicians reluctant to order the test.

Prognostic value of the Geneva prediction rule in patients with pulmonary embolism.

Background: Assessment of pre-test probability of pulmonary embolism (PE) and prognostic stratification are two widely recommended steps in the management of patients with suspected PE. Some items of the Geneva prediction rule may have a prognostic value. We analyzed whether the initial probability assessed by the Geneva rule was associated with the outcome of patients with PE.

AngioJet rheolytic thrombectomy in patients presenting with high-risk pulmonary embolism and cardiogenic shock: a feasibility pilot study.

Aims: Pulmonary embolism (PE) associated with haemodynamic instability has exceedingly high mortality. While intravenous thrombolysis is considered the therapy of choice, percutaneous mechanical thrombectomy may represent an alternative treatment.

Methods And Results: The impact of AngioJet® rheolytic thrombectomy (RT) in PE associated with cardiogenic shock was assessed in a single-centre prospective pilot study.

The prognostic value of pro-B-Type natriuretic peptide in acute pulmonary embolism.

Aims: To assess the clinical performance of pro-B-type natriuretic peptide 1-108 (proBNP) for the prognosis of acute pulmonary embolism.

Methods: This study was ancillary to a recently published multicentre study including 570 patients with acute pulmonary embolism. ProBNP values were analysed using a new sandwich immunoassay proBNP1-108, Bioplex2200 (Bio-Rade Laboratories).

[Usefulness of preemptive anticoagulation in patients with suspected pulmonary embolism].

The usefulness of anticoagulation in patients with suspected non-massive pulmonary embolism (PE) is uncertain. We recently published a decision analysis model suggesting a benefit for preemptive anticoagulation in patients with an intermediate or high probability of PE, even with short diagnostic delays (0-3 h). In case of a low probability of PE, the decision to treat or not could partly rely on the expected diagnostic delay.

The Swiss cohort of elderly patients with venous thromboembolism (SWITCO65+): rationale and methodology.

Venous thromboembolism (VTE) is common and has a high impact on morbidity, mortality, and costs of care. Although most of the patients with VTE are aged ≥65 years, there is little data about the medical outcomes in the elderly with VTE. The Swiss Cohort of Elderly Patients with VTE (SWITCO65+) is a prospective multicenter cohort study of in- and outpatients aged ≥65 years with acute VTE from all five Swiss university and four high-volume non-university hospitals.

The history and historical treatments of deep vein thrombosis.

Deep vein thrombosis (DVT) is a common disease. However, unlike that of varicose veins, which have been depicted since antiquity in art and literature, its description was more recent in the history of medicine. The first well-documented case of DVT was reported during the Middle Ages: in 1271, Raoul developed a unilateral edema in the ankle, which then extended to the leg.

Prospective, multicenter validation of prediction scores for major bleeding in elderly patients with venous thromboembolism.

Background: The Outpatient Bleeding Risk Index (OBRI) and the Kuijer, RIETE and Kearon scores are clinical prognostic scores for bleeding in patients receiving oral anticoagulants for venous thromboembolism (VTE). We prospectively compared the performance of these scores in elderly patients with VTE.

Methods: In a prospective multicenter Swiss cohort study, we studied 663 patients aged ≥ 65 years with acute VTE.

Echocardiography and pulmonary embolism severity index have independent prognostic roles in pulmonary embolism.

We analysed a cohort of patients with normotensive pulmonary embolism (PE) in order to assess whether combining echocardiography and biomarkers with the pulmonary embolism severity index (PESI) improves the risk stratification in comparison to the PESI alone. The PESI was calculated in normotensive patients with PE who also underwent echocardiography and assays of cardiac troponin I and brain natriuretic peptide. 30-day adverse outcome was defined as death, recurrent PE or shock.

Predicting deep venous thrombosis in pregnancy: external validation of the LEFT clinical prediction rule.

The assessment of clinical probability represents an important step in the diagnostic strategy of patients with suspected deep vein thrombosis. The recently derived LEFt clinical prediction rule for pregnant women combines three variables: symptoms in the left leg (L), calf circumference difference of 2 centimeters or over (E for edema) and first trimester presentation (Ft) but is lacking an external validation. The LEFt rule was computed among pregnant women with suspected deep vein thrombosis who were included in a multicenter prospective diagnostic management outcome study.

Prospective comparison of clinical prognostic scores in elder patients with a pulmonary embolism.

Background: The Geneva Prognostic Score (GPS), the Pulmonary Embolism Severity Index (PESI) and its simplified version (sPESI) are well-known clinical prognostic scores for a pulmonary embolism (PE).

Objectives: To compare the prognostic performance of these scores in elderly patients with a PE.

Patients And Methods: In a multicenter Swiss cohort of elderly patients with venous thromboembolism, we prospectively studied 449 patients aged ≥ 65 years with a symptomatic PE.

[Role of endovascular therapy in the management of patients with lower extremity atherosclerotic disease according to new European guidelines].

For the first time, the European Society of Cardiology has edited guidelines on the treatment of peripheral artery disease. With respect to the treatment of lower extremity disease, the endovascular approach is recommended in the majority of cases, independently of clinical presentation (claudication or critical limb ischemia) and of lesion complexity (TASC II A-B-C). For very complex lesions (TASC II D) surgery remains preferred.

Symptomatic subsegmental pulmonary embolism: what is the next step?

The introduction of computed tomography pulmonary angiography (CTPA) has led to an increase in the incidence of pulmonary embolism (PE) diagnosis. However, the case fatality rate is lower and the mortality rates of PE have remained unchanged, suggesting a lower severity of illness. Specifically, the multiple-detector CTPA increased the rate of subsegmental filling defect reported in patients with suspected PE.

Serial limited versus single complete compression ultrasonography for the diagnosis of lower extremity deep vein thrombosis.

The diagnostic approach to deep vein thrombosis (DVT) has evolved during the last 3 decades. Contrast venography has been replaced by noninvasive tests. Compression ultrasonography (CUS) is currently the most widely used diagnostic test.

Diagnosis of and treatment for symptomatic carotid stenosis: an updated review.

Carotid stenoses of ≥50% account for about 15-20% of strokes. Their degree may be moderate (50-69%) or severe (70-99%). Current diagnostic methods include ultrasound, MR- or CT-angiography.

Diagnostic value of single complete compression ultrasonography in pregnant and postpartum women with suspected deep vein thrombosis: prospective study.

Objective: To assess the safety of using single complete compression ultrasonography in pregnant and postpartum women to rule out deep vein thrombosis.

Design: Prospective outcome study.

Setting: Two tertiary care centres and 18 private practices specialising in vascular medicine in France and Switzerland.

Using an age-dependent D-dimer cut-off value increases the number of older patients in whom deep vein thrombosis can be safely excluded.

Background: D-dimer testing to rule out deep vein thrombosis is less useful in older patients because of a lower specificity. An age-adjusted D-dimer cut-off value increased the proportion of older patients (>50 years) in whom pulmonary embolism could be excluded. We retrospectively validated the efficacy of this cut-off combined with clinical probability for the exclusion of deep vein thrombosis.

[Bleeding risk in patients with venous thromboembolism].

About 2 to 2,5% of patients with venous thromboembolism suffer from a major bleed in the first 90 days of treatment with anticoagulation. Many predictors of hemorrhages have been identified, and include the stability of INRs, a bleeding history, cancer, chronic kidney disease and an advanced age. This knowledge may help care-providers to identify high-risk situations and to determine the best duration of treatment for their patients.