Commentaries
Vol. 3 No. 1 (2024)
The diagnostic procedure for subjects with suspected pulmonary embolism. A recent comparison among the recommendations available from the international guidelines
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Received: 24 January 2024
Accepted: 5 March 2024
Accepted: 5 March 2024
1073
Views
371
Downloads
Authors
Acute pulmonary embolism (PE) is a common and potentially life-threatening disease characterized by the occlusion of arterial lung vasculature, typically due to thrombi traveling from a thrombotic vein in the lower limb. Several guidelines have been proposed worldwide to assist clinicians in its diagnosis, however, they are not consistent on the usage of diagnostic tools. This commentary reviews the literature and discusses the concordance/discordance between these international guidelines on PE diagnosis.
Downloads
Download data is not yet available.
Citations
Klemen ND, Feingold PL, Hashimoto B, et al. Mortality risk associated with venous thromboembolism: a systematic review and Bayesian meta-analysis. Lancet Haemaol 2020;7:e583-e93. DOI: https://doi.org/10.1016/S2352-3026(20)30211-8
Lehnert P, Lange T, Moller CH, et al. Acute pulmonary embolism in a national danish cohort: increasing incidence and decreasing mortality. Thromb Haemost 2018;118:539-46. DOI: https://doi.org/10.1160/TH17-08-0531
Duffett L, Castellucci LA, Forgie MA. Pulmonary embolism: update on management and controversies. BMJ 2020;370:m2177. DOI: https://doi.org/10.1136/bmj.m2177
Scheres LJJ, van Hylckama Vlieg A, Cannegieter SC. Sex-specific aspects of venous thromboembolism: What is new and what is next? Res Pract Thromb Haemost 2022;6:e12722. DOI: https://doi.org/10.1002/rth2.12722
Barco S, Valerio L, Ageno W, et al. Age-sex specific pulmonary embolism-related mortality in the USA and Canada, 2000-18: an analysis of the WHO Mortality Database and of the CDC Multiple Cause of Death database. Lancet Respir Med 2021;9:33-42. DOI: https://doi.org/10.1016/S2213-2600(20)30417-3
Stein PD, Matta F, Musani MH, Diaczok B. Silent pulmonary embolism in patients with deep venous thrombosis: a systematic review. Am J Med 2010;123:426-31. DOI: https://doi.org/10.1016/j.amjmed.2009.09.037
Jimenez D, Aujesky D, Diaz G, et al. Prognostic significance of deep vein thrombosis in patients presenting with acute symptomatic pulmonary embolism. Am J Respir Crit Care Med 2010;181:983-91. DOI: https://doi.org/10.1164/rccm.200908-1204OC
Tzoran I, Saharov G, Brenner B, et al. Silent pulmonary embolism in patients with proximal deep vein thrombosis in the lower limbs. J Thromb Haemost 2012;10:564-71. DOI: https://doi.org/10.1111/j.1538-7836.2012.04648.x
Prandoni P, Lensing AWA, Prins MH, et al. Prevalence of pulmonary embolism among patients with recent onset of dyspnea on exertion. A cross-sectional study. J Thromb Haemost 2023;21:68-75. DOI: https://doi.org/10.1016/j.jtha.2022.09.007
Konstantinides SV, Meyer G. The 2019 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2019;40:3453-5. DOI: https://doi.org/10.1093/eurheartj/ehz726
Becattini C, Agnelli G, Maggioni AP, et al. Contemporary management and clinical course of acute pulmonary embolism: the COPE study. Thromb Haemost 2023;123:613-26. DOI: https://doi.org/10.1055/a-2031-3859
Kearon C. Natural history of venous thromboembolism. Circulation 2003;107:122-30. DOI: https://doi.org/10.1161/01.CIR.0000078464.82671.78
Dhakal P, Iftikhar MH, Wang L, et al. Overutilisation of imaging studies for diagnosis of pulmonary embolism: are we following the guidelines? Postgrad Med J 2019;95:420-4. DOI: https://doi.org/10.1136/postgradmedj-2018-135995
Mitchell AM, Jones AE, Tumlin JA, Kline JA. Prospective study of the incidence of contrast-induced nephropathy among patients evaluated for pulmonary embolism by contrast-enhanced computed tomography. Acad Emerg Med 2012;19:618-25. DOI: https://doi.org/10.1111/j.1553-2712.2012.01374.x
Turedi S, Erdem E, Karaca Y, et al. The high risk of contrast-induced nephropathy in patients with suspected pulmonary embolism despite three different prophylaxis: a randomized controlled trial. Acad Emerg Med 2016;23:1136-45. DOI: https://doi.org/10.1111/acem.13051
Brenner DJ, Elliston CD. Estimated radiation risks potentially associated with full-body CT screening. Radiology 2004;232:735-8. DOI: https://doi.org/10.1148/radiol.2323031095
Falster C, Hellfritzsch M, Gaist TA, et al. Comparison of international guideline recommendations for the diagnosis of pulmonary embolism. Lancet Haematol 2023;10:e922-35. DOI: https://doi.org/10.1016/S2352-3026(23)00181-3
Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and D-dimer. Ann Intern Med 2001;135:98-107. DOI: https://doi.org/10.7326/0003-4819-135-2-200107170-00010
LeGal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med 2006;144:165-71. DOI: https://doi.org/10.7326/0003-4819-144-3-200602070-00004
Klok FA, Kruisman E, Spaan J, et al. Comparison of the revised Geneva score with the Wells rule for assessing clinical probability of pulmonary embolism. J Thromb Haemost 2008;6:40-4. DOI: https://doi.org/10.1111/j.1538-7836.2007.02820.x
Ceriani E, Combescure C, Le Gal G, al. Clinical prediction rules for pulmonary embolism: a systematic review and meta-analysis. J Thromb Haemost 2010;8:957-70. DOI: https://doi.org/10.1111/j.1538-7836.2010.03801.x
Penaloza A, Verschuren F, Meyer G, al. Comparison of the unstructured clinician gestalt, the wells score, and the revised Geneva score to estimate pretest probability for suspected pulmonary embolism. Ann Emerg Med 2013;62:117-24. DOI: https://doi.org/10.1016/j.annemergmed.2012.11.002
Kline JA, Mitchell AM, Kabrhel C, et al. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost 2004;2:1247-55. DOI: https://doi.org/10.1111/j.1538-7836.2004.00790.x
Kline JA, Courtney DM, Kabrhel C, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost 2008;6:772-80. DOI: https://doi.org/10.1111/j.1538-7836.2008.02944.x
Roy PM, Meyer G, Vielle B, et al. Appropriateness of diagnostic management and outcomes of suspected pulmonary embolism. Ann Intern Med 2006;144:157-64. DOI: https://doi.org/10.7326/0003-4819-144-3-200602070-00003
Riley RS, Gilbert AR, Dalton JB, et al. Widely used types and clinical applications of D-Dimer assay. Lab Med 2016;47:90-102. DOI: https://doi.org/10.1093/labmed/lmw001
Righini M, Van Es J, Den Exter PL, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA 2014;311:1117-24. DOI: https://doi.org/10.1001/jama.2014.2135
van der Hulle T, Cheung WY, Kooij S, et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet 2017;390:289-97. DOI: https://doi.org/10.1016/S0140-6736(17)30885-1
Kearon C, de Wit K, Parpia S, et al. Diagnosis of pulmonary embolism with D-Dimer adjusted to clinical probability. N Engl J Med 2019;381:2125-34. DOI: https://doi.org/10.1056/NEJMoa1909159
Wiener RS, Schwartz LM, Woloshin S. When a test is too good: how CT pulmonary angiograms find pulmonary emboli that do not need to be found. BMJ 2013;347:f3368. DOI: https://doi.org/10.1136/bmj.f3368
Thompson BT KC, Pena C, Zachrison KS, et al. Clinical presentation, evaluation,and diagnosis of the nonpregnant adult with suspected pulmonary embolism. 2022. Available from: https://wwwuptodatecom/contents/clinical-presentation-evaluation-and-diagnosis-of-the-nonpregnant-adult-with-suspected-acute-pulmonary-embolism.
NICE G. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing (NG158). NICE Guidance2020. Available from: https://www.nice.org.uk/guidance/ng158.
Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020;41:543-603. DOI: https://doi.org/10.1093/eurheartj/ehz405
Bajc M, Schumichen C, Gruning T, et al. EANM guideline for ventilation/perfusion single-photon emission computed tomography (SPECT) for diagnosis of pulmonary embolism and beyond. Eur J Nucl Med Mol Imaging 2019;46:2429-51. DOI: https://doi.org/10.1007/s00259-019-04450-0
Rivera-Lebron B, McDaniel M, Ahrar K, et al. Diagnosis, treatment and follow up of acute pulmonary embolism: consensus practice from the PERT consortium. Clin Appl Thromb Hemost 2019;25:1076029619853037. DOI: https://doi.org/10.1177/1076029619853037
Tran HA, Gibbs H, Merriman E, et al. New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboembolism. Med J Aust 2019;210:227-35. DOI: https://doi.org/10.5694/mja2.50004
Wolf SJ, Hahn SA, Nentwich LM, et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with suspected acute venous thromboembolic disease. Ann Emerg Med 2018;71:e59-e109. DOI: https://doi.org/10.1016/j.annemergmed.2018.03.006
Lim W, Le Gal G, Bates SM, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. Blood Adv 2018;2:3226-56. DOI: https://doi.org/10.1182/bloodadvances.2018024828
Raja AS, Greenberg JO, Qaseem A, et al. Evaluation of patients with suspected acute pulmonary embolism: best practice advice from the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med 2015;163:701-11. DOI: https://doi.org/10.7326/M14-1772
Uresandi F, Monreal M, Garcia-Bragado F, et al. National Consensus on the Diagnosis, Risk Stratification and Treatment of Patients with Pulmonary Embolism. Spanish Society of Pneumology and Thoracic Surgery (SEPAR). Society Espanola Internal Medicine (SEMI). Spanish Society of Thrombosis and Haemostasis (SETH). Spanish Society of Cardiology (ESC). Spanish Society of Medicine Accident and Emergency (SEMES). Spanish Society of Angiology and Surgery Vascular (SEACV). Arch Bronconeumol 2013;49:534-47. DOI: https://doi.org/10.1016/j.arbres.2013.07.008
Guidelines for the diagnosis, treatment and prevention of pulmonary thromboembolism and deep vein thrombosis (JCS 2009). Circ J 2011;75:1258-81. DOI: https://doi.org/10.1253/circj.CJ-88-0010
Stein PD, Woodard PK, Weg JG, et al. Diagnostic pathways in acute pulmonary embolism: Recommendations of the PIOPED II investigators. Radiology 2007;242:15-21. DOI: https://doi.org/10.1148/radiol.2421060971
British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development G. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax 2003;58:470-83. DOI: https://doi.org/10.1136/thorax.58.6.470
Gibson NS, Sohne M, Kruip MJ, et al. Further validation and simplification of the Wells clinical decision rule in pulmonary embolism. Thromb Haemost 2008;99:229-34. DOI: https://doi.org/10.1160/TH07-05-0321
How to Cite
1.
Palareti G. The diagnostic procedure for subjects with suspected pulmonary embolism. A recent comparison among the recommendations available from the international guidelines. Bleeding Thromb Vascul Biol [Internet]. 2024 Mar. 19 [cited 2025 Nov. 10];3(1). Available from: https://www.btvb.org/btvb/article/view/122
Copyright (c) 2024 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Share
Similar Articles
- Alice Lipari, Esmeralda Capristo, Antonietta Ferretti, Erica De Candia, Anticoagulation in obese patients: challenges and strategies , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. 3 (2025)
- CO03 | Early discharge and home treatment of low-risk pulmonary embolism: a cohort study , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- Roger Lijnen, Désiré Collen, The key to fibrinolysis and thrombolysis , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. 3 (2025)
- Stefania Cavazza, Gualtiero Palareti*, Still unmet problems with low molecular weight heparin prophylaxis of venous thromboembolism. An Italian survey , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. 3 (2025)
- PO10 | Clinical and laboratory features of long-Covid syndrome: a cross-sectional study of 1,337 Covid-19 survivors , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- PO34 | A negative oncologic follow up doesn’t always really mean no cancer: two case report of cancer-associated thrombotic microangiopathy , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- PO08 | Efficacy and safety of thromboprophylaxis in hospitalized hematological patients: a monocenter retrospective study , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- PO64 | A silent hemorrhage in the immuno-thrombotic chaos of antiphospholipid syndrome , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- PO37 | Single centre experience on anticoagulation in carriers of non-mild inherited thrombophilia: direct oral anticoagulants (DOAC) efficacy and safety , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- PO63 | Atypical venous thrombosis in young patient with systemic lupus erythematosus and high-risk APL profile: provoked or not? , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
1-10 of 130
Next
You may also start an advanced similarity search for this article.
Most read articles by the same author(s)
- Daniela Poli, Emilia Antonucci, Gualtiero Palareti, Roberto Facchinetti, Pietro Falco, Giuseppina Serricchio, Teresa Lerede, Lucilla Masciocco, Paolo Gresele, Sophie Testa, Major bleedings in mechanical prosthetic heart valves patients on Vitamin K antagonist treatment. Data from the PLECTRUM Study , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 2 (2022)
- Cristina Legnani, Michela Cini, Sophie Testa, Alberto Tosetto, Claudia Dellanoce, Stefania Bellesso, Giuseppe Carli, Ilaria Nichele, Laura Lissandrini, Serena Zorzi, Emilia Antonucci, Gualtiero Palareti, Evaluation of Coaguchek® Pro II coagulation testing device performance to assess direct oral anticoagulant action. The DOAC-CHECK study , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 3 (2022)
- Daniela Poli, Walter Ageno, Emilia Antonucci, Salvatore Bradamante, Eugenio Bucherini, Paolo Chiarugi, Antonio Chistolini, Benilde Cosmi, Anna Falanga, Antonio Insana, Domenico Lione, Rosa Maria Lombardi, Giuseppe Malcangi, Rossella Marcucci, Giuliana Martini, Lucilla Masciocco, Carmelo Paparo, Daniele Pastori, Simona Pedrini, Vittorio Pengo, Pasquale Pignatelli, Andrea Toma, Sophie Testa, Gualtiero Palareti, Management of anticoagulation in atrial fibrillation patients in Italy: insight from the Atrial Fibrillation-Survey on Anticoagulated Patients Register (AF-START) , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 2 (2023)
- Gualtiero Palareti, Paolo Prandoni, Cristina Legnani, Emilia Antonucci, Serena Zorzi, Alberto Tosetto, Lorenza Bertù, Sophie Testa, Vittorio Pengo, Walter Ageno, Ida Martinelli, Benilde Cosmi, Eugenio Bucherini, Daniela Poli, Rationale and design of a study on D-dimer use to stratify patients after a first unprovoked venous thromboembolism for their risk of recurrence: extended low-dose Apixaban given only to patients with positive D-dimer results , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 1 (2022)
- Vittorio Pengo, Luca Sarti, Emilia Antonucci, Stefania Di Agostino, Elisa Bison, Gentian Denas, Daniela Poli, Pier Luigi Meroni, Roberto Gerli, Antonella Radice, Gualtiero Palareti, on behalf of FIRMA group and START collaborators, Descriptive analysis of patients positive for anti-phospholipid antibodies included in two Italian registries , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 3 (2023)
- Gianfranco De Girolamo, Luca Sarti, Sonia Cecoli, Karin Bonora, Chiara Ajolfi, Francesco Bellelli, Valeria Coluccio, Gualtiero Palareti, Marco Marietta, Safety and efficacy of treatment with vitamin K antagonists in patients managed in a network of anticoagulation services or as routine general care , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 1 (2022)
- Gualtiero Palareti, Management of atrial fibrillation: a practical and useful synopsis of last guidelines , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. 1 (2025)
