2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

Peer reviewe

Evaluation du risque hémorragique en cas de maladie thromboembolique veineuse: état des lieux en 2012

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. Bleeding prediction rules for prevalent users of warfarin have not been validated for patients in venous thromboembolism, and their usefulness remains to be determined

Faut-il traiter les embolies pulmonaires sous-segmentaires ?

The expanded use of multi-detector computed tomography has increased the proportion of diagnosed subsegmental pulmonary embolism. The clinical significance and prognosis of these embolisms remain unknown and the benefit of anticoagulation is not yet proven. Several previously validated diagnostic strategies for pulmonary embolism exclusion (based on single-detector computed tomography and ventilation-perfusion lung scan) were unable to detect most of these subsegmental pulmonary embolisms. However, these strategies have been proven safe, with very few thromboembolic events at 3 months. Furthermore, the comparison between studies using single-detector and multi-detector computed tomography suggests increased rates of PE diagnosis and increased rates of anticoagulated patients without improvement of the three-month followup. Subsegmental pulmonary embolisms seem to have less clinical impact than proximal pulmonary embolisms and a better long-term prognosis. In some patients with isolated subsegmental pulmonary embolism, the bleeding risk related to anticoagulation might outweigh the benefit of preventing recurrent thromboembolic event

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 Contrast venography has been replaced by noninvasive tests.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. Whereas CUS has a high accuracy for proximal DVT (thrombosis of the popliteal and more proximal veins), it has been shown to lack sensitivity and specificity for distal DVT. Ultrasonography can either be limited to the proximal veins and repeated within 1 week (serial limited CUS) or extended to both proximal and distal veins and performed on one occasion (single complete CUS). Both strategies are reliable diagnostic options for the management of patients with suspected DVT. The main limitation of proximal CUS is the need to repeat the test once in patients with initial negative findings. Conversely, complete CUS detects many distal DVTs for which systematic anticoagulation therapy is debatable and exposes patients to potentially unnecessary anticoagulation. Incorporation of D-dimer testing and clinical pretest probability assessment in the diagnostic algorithm is beneficial because it allows excluding DVT without the need for diagnostic imaging in about a third of patients