Tag Archives: vascular

How can the Simplified Pulmonary Embolism Severity Index (sPESI) be used to manage patients presenting with a pulmonary embolism?

The Bottom Line:  The Pulmonary Embolism Severity Index is a validated tool for predicting 30-day mortality in patients presenting at the hospital with PE.  The Simplified PESI (sPESI) predicts 30-day mortality with accuracy similar to the PESI And can assist … Continue reading

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How effective are the new oral anticoagulants at preventing recurrence of venous thromboembolism?

Bottom line:  Compared to LMWH The new oral anticoagulants (NOACs) are safe and effective for treatment of thromboembolism.  Rivaroxaban and apixiban have lower bleeding risk compared to warfarin therapy. Summary:  Lana A. Castellucci, et al.  Clinical and safety outcomes associated with … Continue reading

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What is the predictive value of blood pressure differential in predicting aortic dissection in patients with chest pain?

Bottom line:  Presence of chest pain with blood pressure differential and/or pulse differential should raise clinical suspicion of aortic dissection.  There is evidence that the presence of pressure difference >20mmHg is a strong predictor of dissection, but absence of pressure differential should … Continue reading

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What are the mechanisms for coagulopathy and thrombophilia in patients with cirrhosis?

From Cirrhosis and its complications.  In:  Harrison’s Internal Medicine, 18th ed. Under Major Complications, toward the bottom of the page. Explains that patients with cirrhosis experience a decrease in production of clotting factors and diminished clearance of anticoagulants.  Portal hypertension … Continue reading

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In patients with acute pulmonary embolism, does elevated plasma lactate indicate an increased mortality risk?

Bottom line:   An elevated plasma lactate is associated with an increased risk for 30-day mortality in patients presenting with acute pulmonary embolism. Summary:  Vanni S, et al.  Prognostic value of plasma lactate levels among patients with acute pulmonary embolism: the … Continue reading

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Which chest x-ray findings are associated with a diagnosis of pulmonary embolism?

Bottom line:  While no individual CXR finding is diagnostic, some findings (when present, see below) do increase risk for PE.  Absence of abnormal findings are not helpful. Summary:  Worsley DF, et al.  Chest radiographic findings in patients with acute pulmonary … Continue reading

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How effective is aspirin at preventing recurrence of VTE or PE?

Bottom line:  Aspirin may decrease risk for recurrent symptomatic VTE in patients with first unprovoked VTE who have completed initial anticoagulation therapy. Summary:  Pulmonary embolism, Treatment section, Antiplatelet therapy.  In:  DynaMed. DynaMed summarizes results of two RCTs evaluating effectiveness of … Continue reading

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