Diagnostic strategies for excluding pulmonary embolism in clinical outcome studies: a systematic review

Article Abstract:

Background: Pulmonary embolism is a common clinical disorder that is associated with high morbidity and mortality if untreated. It is important to confirm or rule out the diagnosis in patients with clinical suspicion of the disease. Purpose: To evaluate various diagnostic strategies for excluding pulmonary embolism. Data Sources: MEDLINE (1966 to February 2003), EMBASE, and DARE; study investigators; and reference lists. Study Selection: Prospective clinical outcome studies. Data Extraction: The researchers recorded the frequency of symptomatic venous thromboembolism over 3 months of follow-up in patients in whom pulmonary embolism had been excluded according to various strategies. Strategies were divided into three categories according to the number of rounds of diagnostic tests needed to exclude pulmonary embolism. Data Synthesis: 25 studies involving more than 7000 patients were included. In all referred patients, two strategies ? normal results on pulmonary angiography or lung scintigraphy and normal D-dimer levels combined with low clinical probability ? safely excluded pulmonary embolism (failure rates less than or equal to 3%). In the second round of diagnostic tests, in patients who had had a nondiagnostic lung scan, both pulmonary angiography and serial leg testing for venous thrombosis were accurate and safe. When D-dimer testing combined with clinical probability was inconclusive, a normal perfusion lung scan safely excluded pulmonary embolism. Accumulating evidence shows that normal results on spiral computed tomography may also safely exclude the disease. Conclusions: Many diagnostic strategies to exclude pulmonary embolism have been evaluated in consecutive patients. Interest is likely to increase in a simple, fast strategy, starting with a normal perfusion lung scan or a combination of normal D-dimer levels and low clinical probability. After the initial round of testing, a reliable diagnostic methods, such as angiography or lung scintigraphy, is warranted.

Diagnosis, Pulmonary embolism, Author Abstract

---

Increased Risk for Fetal Loss in Carriers of the Factor V Leiden Mutation

Article Abstract:

Pregnant women with the factor V Leiden mutation have an increased risk of miscarriage and stillbirth. The factor V Leiden mutation causes abnormal blood clotting. Researchers compared the rate of miscarriage and stillbirth in 228 pregnant women with the mutation and 121 pregnant women without the mutation. Women with the mutation were twice as likely to miscarry or have a stillborn baby compared to women without the mutation. Among women with the mutation, the risk of miscarriage and stillbirth was higher in women who had two copies of the mutation rather than one.

Complications and side effects, Blood clotting disorders, Blood coagulation disorders, Miscarriage

---

The incidence of venous thromboembolism in family members of patients with factor V Leiden mutation and venous thrombosis

Article Abstract:

Aggressive intervention for relatives of patients with the factor V Leiden genetic mutation does not seem to be necessary. The factor V Leiden mutation has been associated with increased risk for deep venous blood clots. The frequency of deep venous blood clots was determined among 30 immediate relatives of 6 patients carrying two copies of the mutation and 437 immediate relatives of 112 patients carrying one copy of the mutation. The frequency among immediate relatives ranged from 0.10% to 1.1% depending on the patients' genetic status and the family members' age.

Health aspects, Gene mutations, Gene mutation, Thromboembolism, Thrombosis, Deep vein, Deep vein thrombosis

Similar abstracts:

• Abstracts: Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review
• Abstracts: Update: multistate outbreak of monkeypox -- Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003. Multistate outbreak of monkeypox -- Illinois, Indiana, and Wisconsin, 2003
• Abstracts: JAMA-EXPRESS: Rapid Peer Review and Publication. Access to JAMA. JAMA online -- new features, new functions

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.