pulmonary embolism

•
In clinical trials involving middle-aged and older men with hypogonadism, testosterone treatment led to improved sexual activity and libido, correction of anemia, and modestly improved energy, mood, and walking ability. (The following key points also refer to findings from clinical trials involving this patient population.)
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Testosterone treatment did not improve cognition in men without a previously diagnosed cognitive disorder and did not prevent progression to diabetes in men with prediabetes or improve glycemic control in those with diabetes.
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Testosterone treatment did not increase the risk of major cardiovascular events among men with preexisting cardiovascular disease.
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Testosterone treatment did not increase the risk of prostate cancer or acute urinary retention and did not worsen lower urinary tract symptoms.
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Testosterone treatment was associated with an increased risk of clinical fractures and pulmonary embolism.
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The decision to administer testosterone treatment in a man with hypogonadism should be based on the severity of the hypogonadism and an assessment of the potential benefits and risks of treatment.

Author/s:

Shalender Bhasin, Peter J Snyder

Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability

John Bayhi — Wed, 04 Dec 2019 18:30:19 +0000

Date Added:

December 4, 2019

Journal/Publication:

The New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

November 28, 2019

Issue:

Volume:

381

Pages:

2125-2134

URL:

Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/NEJMoa1909159

Keywords

pulmonary embolism

d-dimer

computed tomography

PMID (1):

31774957

MeSH

Humans

prospective studies

retrospective studies

Venous Thromboembolism

Computed Tomography Angiography

anticoagulants

Angiography

Though the full article is not freely available, I thought the abstract was worth sharing. In primary care patients with low or moderate probability of a pulmonary embolus, PE can essentially be ruled out with D-dimer testing. James W. Mold, MD, MPH

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BACKGROUND:

Retrospective analyses suggest that pulmonary embolism is ruled out by a d-dimer level of less than 1000 ng per milliliter in patients with a low clinical pretest probability (C-PTP) and by a d-dimer level of less than 500 ng per milliliter in patients with a moderate C-PTP.

METHODS:

We performed a prospective study in which pulmonary embolism was considered to be ruled out without further testing in outpatients with a low C-PTP and a d-dimer level of less than 1000 ng per milliliter or with a moderate C-PTP and a d-dimer level of less than 500 ng per milliliter. All other patients underwent chest imaging (usually computed tomographic pulmonary angiography). If pulmonary embolism was not diagnosed, patients did not receive anticoagulant therapy. All patients were followed for 3 months to detect venous thromboembolism.

RESULTS:

A total of 2017 patients were enrolled and evaluated, of whom 7.4% had pulmonary embolism on initial diagnostic testing. Of the 1325 patients who had a low C-PTP (1285 patients) or moderate C-PTP (40 patients) and a negative d-dimer test (i.e., <1000 or <500 ng per milliliter, respectively), none had venous thromboembolism during follow-up (95% confidence interval [CI], 0.00 to 0.29%). These included 315 patients who had a low C-PTP and a d-dimer level of 500 to 999 ng per milliliter (95% CI, 0.00 to 1.20%). Of all 1863 patients who did not receive a diagnosis of pulmonary embolism initially and did not receive anticoagulant therapy, 1 patient (0.05%; 95% CI, 0.01 to 0.30) had venous thromboembolism. Our diagnostic strategy resulted in the use of chest imaging in 34.3% of patients, whereas a strategy in which pulmonary embolism is considered to be ruled out with a low C-PTP and a d-dimer level of less than 500 ng per milliliter would result in the use of chest imaging in 51.9% (difference, -17.6 percentage points; 95% CI, -19.2 to -15.9).

CONCLUSIONS:

A combination of a low C-PTP and a d-dimer level of less than 1000 ng per milliliter identified a group of patients at low risk for pulmonary embolism during follow-up. (Funded by the Canadian Institutes of Health Research and others; PEGeD ClinicalTrials.gov number, NCT02483442.).

Author/s:

Kearon, C, de Wit, K, Parpia, S, Schulman, S, Afilalo, M, Hirsch, A, Spencer, FA, Sharma, S, D'Aragon, F, Deshaies, JF, Le Gal, G, Lazo-Langer, A, Wu, C, Rudd-Scott, L, Bates, SM, Julian, JA, PEGeD Study Investigators

Treatment of Superficial Vein Thrombosis: A Systematic Review and Meta-Analysis

Jeffrey Wilson — Wed, 03 Apr 2019 14:13:21 +0000

Date Added:

April 3, 2019

Journal/Publication:

Journal of Thrombosis and Haemostasis

Publisher:

Wiley-Blackwell

Publication Date:

March 1, 2019

Issue:

Volume:

119

Pages:

479-489

URL:

Treatment of Superficial Vein Thrombosis: A Systematic Review and Meta-Analysis

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1055/s-0039-1677793

Keywords

PMID (1):

30716777

MeSH

venous thrombosis

pulmonary embolism

fondaparinux

This meta-analysis calculated that superficial thrombosis occurring in the lower extremity was associated with a 10% rate of deep vein thrombosis and/or PE. Treatment with fondaparinux (Arixstra) lowered the risk to 1.4%. They found insufficient evidence to support other treatments. James W. Mold, MD, MPH

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BACKGROUND:

The optimal first line treatment for patients with isolated superficial venous thrombosis (SVT) of the lower extremity is unknown.

OBJECTIVE:

This article reports estimates of the rate of venous thromboembolic complications among patients with SVT according to treatment.

MATERIALS AND METHODS:

A systematic review and meta-analysis was performed using unrestricted searches of electronic databases. Reported events were transformed to event per 100 patient-years of follow-up and a random effects model was used to calculate pooled rates according to pre-specified treatment categories. The primary outcome was the occurrence of deep vein thrombosis (DVT) or pulmonary embolism (PE) during the study follow-up period.

RESULTS:

Seventeen articles, including 6,862 patients, were included in the meta-analysis. Fondaparinux had the lowest event rate with 1.4 events per 100 patient-years of follow-up (95% confidence interval [CI], 0.5-2.8, I 2 = 18%). Pooled event rates for DVT or PE ranged from 9.3 to 16.6 events per 100 patient-years across other treatment categories, and the pooled event rate for no treatment/placebo was 10.5 events per 100 patient-years (95% CI, 3.0-22.0). Major bleeding was low and similar across all treatment categories. Heterogeneity was moderate to high for most pooled estimates.

CONCLUSION:

While pooled event rates suggest that fondaparinux achieves the lowest rate of DVT or PE, low-quality evidence for other treatments prevents firm conclusions about the optimal treatment for SVT.

Author/s:

Duffett, Lisa, Kearon, Clive, Rodger, Marc, Carrier, Marc