Pulmonary Embolism

A must have resource for clinicians and investigators interested in pulmonary embolism and deep venous thrombosis * Highly illustrated with numerous tables and graphs alongside clear concise text * Includes chapters addressing pulmonary embolism (PE) and deep venous thrombosis (DVT) in relation to diseases and disorders such as; chronic heart failure, cancer, diabetes, stroke, chronic obstructive pulmonary disease (COPD) and many more * Discusses the role the different tools offered in imaging for PE, including echocardiography, multidetector computed tomography (CT), single photon emission computed tomography (SPECT), ventilation-perfusion (V-Q) imaging, dual energy CT, and magnetic resonance angiography * Contains 29 new chapters and includes new content on epidemiology of deep venous thrombosis; use of the new anticoagulants (dabigatran, rivaroxaban, and apixaban) for DVT and PE; indications and results with thrombolytic therapy and with vena cava filters; and information and indications for invasive mechanical thrombectomy and thrombolysis * Written by an internationally recognized and respected expert in the field

Contents

Prologue xi Preface to the Third Edition xiii Introduction 1 Part I Prevalence, risks, and prognosis of pulmonary embolism and deep venous thrombosis 1 Pulmonary embolism and deep venous thrombosis at autopsy 5 2 Incidence of pulmonary embolism and deep venous thrombosis in hospitalized patients and in emergency departments 18 3 Case fatality rate and population mortality rate from pulmonary embolism and deep venous thrombosis 24 4 Prognosis inacutepulmonary embolism based on right ventricular enlargement and biochemical markers in stable patients 31 5 Prognosis inacutepulmonary embolism based on scoring systems 43 6 Pulmonaryembolismfollowingdeep venous thrombosis and outcome with untreated pulmonary embolism 49 7 Resolutionofpulmonaryembolism 54 8 Upper extremity deep venous thrombosis 61 9 Thromboembolic disease involving the superior vena cava and brachiocephalic veins 66 10 Venous thromboembolic disease in the four seasons 69 11 Regional differences in the United States of rates of diagnosis of pulmonary embolism and deep venous thrombosis and mortality from pulmonary embolism 73 12 Venous thromboembolism according to age and in the elderly 78 13 Pulmonary thromboembolism in infants and children 95 14 Venous thromboembolism in men and women 99 15 Pulmonary embolism and deep venous thrombosis in blacks and whites 103 16 Pulmonary thromboembolism in Asians/Pacific Islanders 108 17 Pulmonary thromboembolism in American Indians and Alaskan Natives 116 18 Venous thromboembolism in patients with cancer 118 19 Venous thromboembolism in patients with heart failure 128 20 Obesity as a risk factor in venous thromboembolism 133 21 Hypertension, smoking, and cholesterol 139 22 Overlap of venous and arterial thrombosis risk factors 141 23 Venous thromboembolism in patients with ischemic and hemorrhagic stroke 143 24 Paradoxical embolism 146 25 Pulmonary embolism and deep venous thrombosis in hospitalized adults with chronic obstructive pulmonary disease 149 26 Pulmonary embolism and deep venous thrombosis in hospitalized patients with asthma 156 27 Deep venous thrombosis and pulmonary embolism in hospitalized patients with sickle cell disease 158 28 Diabetesmellitus and risk of venous thromboembolism 162 29 Risk of venous thromboembolism with rheumatoid arthritis 164 30 Venous thromboembolism with inflammatory bowel disease 166 31 Venous thromboembolism with chronic liver disease 168 32 Nephrotic syndrome 171 33 Human immunodeficiency virus infection 173 34 Venous thromboembolism in pregnancy 176 35 Amniotic fluid embolism 182 36 Air travel as a risk for pulmonary embolism and deep venous thrombosis 184 37 Estrogen-containing oral contraceptives and venous thromboembolism 187 38 Estrogen and testosterone in men 192 39 Tamoxifen 194 40 Venous thromboembolism following bariatric surgery 198 41 Hypercoagulable syndrome 204 Part II Diagnosis of deep venous thrombosis 42 Deep venous thrombosis of the lower extremities: clinical evaluation 215 43 Clinical scoring system for assessment of deep venous thrombosis 220 44 Clinical probability score plus single negative ultrasound for exclusion of deep venous thrombosis 223 45 D-dimer for the exclusion of acute deep venous thrombosis 225 46 D-dimer combined with clinical probability assessment for exclusion of acute deep venous thrombosis 234 47 D-dimer and single negative compression ultrasound for exclusion of deep venous thrombosis 236 48 Contrast venography 237 49 Compression ultrasound for the diagnosis of deep venous thrombosis 240 50 Impedance plethysmography and fibrinogen uptake tests for diagnosis of deep venous thrombosis 247 51 Ascending CT venography and venous phase CT venography for diagnosis of deep venous thrombosis 250 52 Magnetic resonance venography for diagnosis of deep venous thrombosis 255 53 P-selectin and microparticles to predict deep venous thrombosis 260 Part III Diagnosis of acute pulmonary embolism 54 Clinical characteristics of patients with no prior cardiopulmonary disease 265 55 Relation of right-sided pressures to clinical characteristics of patients with no prior cardiopulmonary disease 272 56 The history and physical examination in all patients irrespective of prior cardiopulmonary disease 275 57 Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes 280 58 Clinical assessment in the critically ill 286 59 The electrocardiogram 289 60 The plain chest radiograph 303 61 Arterial blood gases and the alveolar arterial oxygen difference in acute pulmonary embolism 308 62 Fever in acute pulmonary embolism 316 63 Leukocytosis in acute pulmonary embolism 319 64 Alveolar dead-space in the diagnosis of pulmonary embolism 321 65 Empirical assessment and clinical models for diagnosis of acute pulmonary embolism 324 66 Prognostic models for pulmonary embolism 329 67 D-dimer for the exclusion of acute pulmonary embolism 335 68 D-dimer combined with clinical probability for exclusion of acute pulmonary embolism 346 69 D-dimer in combination with amino-terminal pro-B-type natriuretic peptide for exclusion of acute pulmonary embolism 349 70 Tissue plasminogen activator, plasminogen activator inhibitor-1, and thrombin antithrombin III complexes in the exclusion of acute pulmonary embolism 350 71 Echocardiogram in the diagnosis of acute pulmonary embolism 352 72 Trends in the use of diagnostic imaging in patients hospitalized with acute pulmonary embolism 356 73 Techniques of perfusion and ventilation imaging 358 74 Ventilation perfusion lung scan criteria for interpretation prior to the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) 363 75 Observations from PIOPED: ventilation perfusion lung scans alone and in combination with clinical assessment 367 76 Ventilation perfusion lung scans according to complexity of lung disease 374 77 Perfusion lung scans alone in acute pulmonary embolism 376 78 Probability interpretation of ventilation perfusion lung scans in relation to the largest pulmonary arterial branches in which pulmonary embolism is observed 379 79 Revised criteria for evaluation of lung scans recommended by nuclear physicians in PIOPED 381 80 Criteria for very-low-probability interpretation of ventilation perfusion lung scans, 385 81 Probability assessment based on the number of mismatched segmental equivalent perfusion defects 391 82 Probability assessment based on the number of mismatched vascular defects and stratification according to prior cardiopulmonary disease 395 83 The addition of clinical assessment to stratification according to prior cardiopulmonary disease further optimizes the interpretation of ventilation perfusion lung scans 401 84 Pulmonary scintigraphy scans since PIOPED 407 85 Single photon emission computed tomographic (SPECT) lung scans 412 86 SPECT with radiolabeled markers 426 87 Standard and augmented techniques in pulmonary angiography 427 88 Subsegmental pulmonary embolism 435 89 Quantification of pulmonary embolism by conventional and CT angiography 440 90 Complications of pulmonary angiography 442 91 Contrast-enhanced spiral CT for the diagnosis of acute pulmonary embolism before the Prospective Investigation of Pulmonary Embolism Diagnosis 446 92 Methods of PIOPED II 458 93 Multidetector spiral CT of the chest for acute pulmonary embolism: results of the PIOPED II trial 467 94 Multidetector CT pulmonary angiography since PIOPED II 473 95 Outcome studies of pulmonary embolism versus accuracy 478 96 Contrast-induced nephropathy 480 97 Radiation exposure and risk 483 98 Magnetic resonance angiography for the diagnosis of acute pulmonary embolism 490 99 Serial noninvasive leg tests in patients with suspected pulmonary embolism 499 100 Diagnosis of pulmonary embolism in the coronary care unit 501 101 Silent pulmonary embolism with deep venous thrombosis 506 102 Fat embolism syndrome 511 103 Diagnostic approach to acute pulmonary embolism 516 Part IV Prevention and treatment of deep venous thrombosis and pulmonary embolism 104 Warfarin and other vitamin K antagonists 523 105 Unfractionated heparin, low-molecular-weight heparin,heparinoid, and pentasaccharide 531 106 Parenteral inhibitors of factors Va, VIIIa, tissue factor, and thrombin 540 107 Novel oral anticoagulants 545 108 Aspirin for venous thromboembolism 552 109 Immediate therapeutic levels of heparin in relation to timing of recurrent events, 555 110 Intermittent pneumatic compression 558 111 Graduated compression stockings 561 112 Ankle exercise and venous blood velocity 565 113 Thrombolytic therapy for deep venous thrombosis 567 114 Mechanical and ultrasonic enhancement of catheter-directed thrombolytic therapy for deep venous thrombosis 572 115 Thrombolytic therapy for treatment of acute pulmonary embolism 574 116 Catheter-tip embolectomy in the management of acute massive pulmonary embolism 589 117 Vena cava filters 597 118 Withholding treatment of patients with acute pulmonary embolism who have a high risk of bleeding provided and negative serial noninvasive leg tests 615 119 Home treatment of deep venous thrombosis 617 120 Home treatment of acute pulmonary embolism 622 121 Pulmonary embolectomy 626 122 Chronic thromboembolic pulmonary hypertension and pulmonary thromboendarterectomy 634 123 Prevention and treatment of deep venous thrombosis and acute pulmonary embolism: American College of Chest Physicians Guidelines 639 Index 647

Paul D. Stein MD,Professor of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA. Dr. Stein's major research in recent years has been in the field of venous thromboembolism. Dr. Stein initiated the PIOPED II and PIOPED III national collaborative studies and was national principal investigator and chairperson of the steering committees. He has written over 240 articles on venous thromboembolism from among over 560 peer reviewed articles. Dr Stein is a past president of the Laennec Society and of the American College of Chest Physicians. He is Fellow of the American College of Physicians and the American College of Cardiology and a Master Fellow of the American College of Chest Physicians. He is also a Fellow of the American Society of Mechanical Engineers. Fellowship is reserved for those who have made a significant contribution to the field of mechanical engineering. He received the Lifetime Achievement Award from the American Heart Association Midwest Affiliate, the Laureate Award of the American College of Physicians, Michigan Chapter, the Daniel Drake Award from the University of Cincinnati College of Medicine, and the Research Excellence Award from the Michigan State University College of Osteopathic Medicine. Dr. Stein also wrote a book, A Physical and Physiological Basis for the Interpretation of Cardiac Auscultation: Evaluations Based Primarily on Second Sound and Ejection Murmurs.