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Eur J Radiol 2021 May 8;140:109758. Epub 2021 May 8.

Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address:

Purpose: This retrospective study aims to analyze the distribution of demand and the duration of the diagnostic workup of suspected pulmonary embolism (PE) using computed tomography pulmonary angiography (CTPA).

Methods: Time data from physical examination to report creation were identified for each CTPA in 2013 and 2018 at a tertiary hospital. Multivariable multinomial logistic and linear regression models were used to evaluate differences between 3 time intervals (I1: 6am-2pm, I2: 2pm-10pm, I3: 10pm-6am). Read More

Lancet 2021 May 10. Epub 2021 May 10.

Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Department of Medicine, McGill University, Montreal, QC, Canada. Electronic address:

Venous thromboembolism, comprising both deep vein thrombosis and pulmonary embolism, is a chronic illness that affects nearly 10 million people every year worldwide. Strong provoking risk factors for venous thromboembolism include major surgery and active cancer, but most events are unprovoked. Diagnosis requires a sequential work-up that combines assessment of clinical pretest probability for venous thromboembolism using a clinical score (eg, Wells score), D-dimer testing, and imaging. Read More

Ann Am Thorac Soc 2021 May 13. Epub 2021 May 13.

University of Utah, Pulmonary and Critical Care Medicine, Salt Lake City, Utah, United States.

Rationale: Exposure to outdoor air pollution is associated with increased cardiovascular disease, respiratory illness, and mortality. The effect of air pollution on venous thromboembolism (VTE) is less certain.

Objectives: To test for associations between short-term exposure to air pollution and VTE. Read More

J Med Cases 2020 Jun 28;11(6):174-177. Epub 2020 May 28.

Northwestern Medicine Hospital, Mchenry, IL, USA.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has ravaged the global society as we know it. As almost a dozen pharmaceutical agents go into randomized controlled clinical trials, multiple studies have surfaced trying to associate a hypercoagulable state to coronavirus disease 2019 (COVID-19) patients. We report two COVID-19 cases who presented with occlusive pulmonary embolism (PE) strongly supporting a hypercoagulable state incurred by SARS-CoV-2. Read More

J Med Cases 2020 Jul 18;11(7):189-191. Epub 2020 Jun 18.

Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA.

The coronavirus disease 2019 (COVID-19) presents with variable clinical syndromes, from asymptomatic disease to acute respiratory failure. Complications such as acute respiratory distress syndrome (ARDS), secondary infection, acute cardiac injury, liver failure, renal failure, coagulable disorders and in many cases, death have been recognized. Venous thromboembolism (VTE) was found to be present in up to one-third of critically ill COVID-19 patients. Read More

J Card Surg 2021 May 12. Epub 2021 May 12.

Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.

Background: Acute pulmonary embolism (PE) is the third most common cause of cardiovascular death. For patients who are hemodynamically unstable, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support has been shown to provide hemodynamic stability, and allow time for definitive treatment and recovery. Ultrasound-assisted catheter directed thrombolysis (USAT) has the potential to be a safe adjunct and expedite right ventricular (RV) recovery for patients requiring VA-ECMO for PE. Read More

Front Cardiovasc Med 2021 26;8:654174. Epub 2021 Apr 26.

Central Diagnostic Laboratory, Maastricht University Medical Centre+, Maastricht, Netherlands.

Coronavirus Disease 2019 (COVID-19) patients often present with thromboembolic events. In COVID-19 patients, routine hemostatic assays cannot correctly identify patients at risk for thromboembolic events. Viscoelastic testing with rotational thromboelastometry (ROTEM) might improve the characterization of COVID-19-associated coagulopathy. Read More

Front Pharmacol 2021 26;12:658273. Epub 2021 Apr 26.

Department of Zoology, School of Basic and Applied Sciences, Central University of Punjab, Bathinda, India.

After gaining entry through ACE2 aided by TMPRSS2, the SARS-CoV-2 causes serious complications of the cardiovascular system leading to myocarditis and other myocardial injuries apart from causing lung, kidney and brain dysfunctions. Here in this review, we are going to divulge the cellular and immunological mechanisms behind the cardiovascular, thrombotic and platelet impairments that are caused in COVID-19. In addition, we also propose the significance of various anti-platelet and anti-thrombotic phytochemicals in the treatment of COVID-19. Read More

Thromb J 2021 May 12;19(1):31. Epub 2021 May 12.

Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Children's Medical Center Hospital, Dr. Gharib Street, Keshavarz Boulevard, Tehran, Iran.

Background: COVID-19 can induce thrombotic disease both in the venous and arterial circulations, as a result of inflammation, platelet activation, endothelial dysfunction, and stasis. Although several studies have described the coagulation abnormalities and thrombosis in adult patients with COVID-19, there is limited data in children. Here, we present an 18-month-old boy with a prolonged SARS-CoV-2 RNA shedding and chronic right atrial and superior vena cava (SVC) thrombosis. Read More

Clin Pediatr (Phila) 2021 May 12:99228211015522. Epub 2021 May 12.

Nicklaus Children's Hospital, Miami, FL, USA.

Can J Surg 2021 05 12;64(3):E289-E297. Epub 2021 May 12.

From the Division of Vascular Surgery, University of Ottawa at The Ottawa Hospital, Ottawa, Ont. (Strauss, Jetty); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Strauss, Seo, Carrier, Jetty); the Division of Hematology, Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. (Carrier); and the Ottawa Hospital Research Institute, Ottawa, Ont. (Carrier).

Since COVID-19 was declared a pandemic a year ago, our understanding of its effects on the vascular system has slowly evolved. At the cellular level, SARS-CoV-2 - the virus that causes COVID-19 - accesses the vascular endothelium through the angiotensin-converting enzyme 2 (ACE-2) receptor and induces proinflammatory and prothrombotic responses. At the clinical level, these pathways lead to thromboembolic events that affect the pulmonary, extracranial, mesenteric, and lower extremity vessels. Read More

Cureus 2021 Apr 8;13(4):e14366. Epub 2021 Apr 8.

Non-Invasive Cardiology, Fortis Escorts Hospital, Amritsar, IND.

More than 122 million cases of COVID-19 infection have been documented, and hundreds of thousands are being added every day. Several co-morbidities are associated with COVID-19, among which hypercoagulability has garnered the attention of many doctors and researchers. Most cases of vascular thrombosis are noted in intensive care unit (ICU) patients with serious disease; among these, many cases of deep venous thrombosis and pulmonary embolism have been noted. Read More

Kyobu Geka 2021 Feb;74(2):94-98

Department of Cardiovascular Surgery, Uji-Tokushukai Medical Center, Uji, Japan.

Background: Acute massive pulmonary embolism is a life-threatening disease and the reported rate of mortality is 52%.It is often treated with anticoagulation therapy or thrombolysis, but in case of critically ill patients with shock or cardiac arrest, its effect is limited. Surgical embolectomy is a treatment option for patients with hemodynamic instability. Read More

BMJ Case Rep 2021 May 11;14(5). Epub 2021 May 11.

Emergency Department, NHS Lanarkshire, East Kilbride, UK.

Venous thromboembolism (VTE) is a recognised complication of lower limb trauma in adult patients and classically presents with cardiopulmonary symptoms. However, the risk of VTE and its presenting signs and symptoms are less well documented in the paediatric population. We report the case of a child who presented to our emergency department with abdominal pain 2 weeks after lower limb fracture, who was subsequently found to have a pulmonary thromboembolism (PTE). Read More

BMC Cardiovasc Disord 2021 May 11;21(1):235. Epub 2021 May 11.

Department of Internal Medicine and Cardiology, Pirna Hospital, Pirna, Germany.

Background: The study analyzes changes in lung function, pulmonary pressure and diffusing capacity of the lung in patients with mitral valve regurgitation (MR) treated by MitraClip implantation.

Methods: A total of 43 patients (19 women and 24 men with an average age of 78.0 ± 6. Read More

Thromb Res 2021 May 1;203:82-84. Epub 2021 May 1.

Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland; Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany.

Semin Thorac Cardiovasc Surg 2021 May 8. Epub 2021 May 8.

Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD. Electronic address:

Massive pulmonary embolism (PE) is a life-threatening condition with a high mortality. Both systemic thrombolytics and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) have been used in the management of massive PE. However, the safety of VA- ECMO in the setting of recent thrombolytic administration is not clear. Read More

Am J Obstet Gynecol 2021 May 8. Epub 2021 May 8.

Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Columbia University Irving Medical Center, New York, NY.

Venous thromboembolism (VTE) represents a persistent proportionate cause of maternal mortality in the United States accounting for 9% to 10% of maternal deaths. Given that overall maternal mortality rose >40% since the late 1990s, it is likely absolute VTE mortality risk increased as well. This persistent risk may be secondary to increases in broad population-based risk factors for VTE such as obesity and cesarean delivery. Read More

Eur Heart J Acute Cardiovasc Care 2021 May;10(3):237-239

Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA.

JAMA 2021 May;325(18):1901-1902

Department of Pulmonary and Critical Care Medicine, Xinhua Hospital, Shanghai, China.

JAMA 2021 May;325(18):1902-1903

University College Dublin, Dublin, Ireland.

JAMA 2021 May;325(18):1903

Centre Hospitalo-Universitaire de Saint-Etienne, Université Jean Monnet, Saint-Etienne, France.

Echocardiography 2021 May 11. Epub 2021 May 11.

Department of Cardiology, LMU-Klinikum, Ludwig-Maximilians-University, Munich, Germany.

An elderly patient with a history of atrial fibrillation presented to our emergency room. Previous medical records from another hospital described a pacemaker lead in the echocardiography although the patient had no known history of a pacemaker implantation. Finally, by close examination, chest X-ray, and computed tomography, we found that a kyphoplasty of the spine had caused a so-called palacos embolism, which had repeatedly been mistaken for a pacemaker lead. Read More

J Emerg Med 2021 May 7. Epub 2021 May 7.

University of Kansas Health Systems, Kansas City, Kansas.

Background: Obstructive shock is an uncommon presentation to the emergency department (ED) and is most often caused by an acute pulmonary embolism. A very rare cause of obstructive shock is extensive deep venous thrombosis, otherwise known as phlegmasia cerulea dolens. We present a case of obstructive shock caused by placement of an inferior vena cava filter complicated by acute occlusion with extensive deep venous thrombosis. Read More

Semin Thromb Hemost 2021 May 10. Epub 2021 May 10.

Monash Haematology, Monash Health, Melbourne, Australia.

Upper extremity deep vein thrombosis (UEDVT) has been increasing in incidence due to the escalating use of central venous catheters such as peripherally inserted central catheters. UEDVT can be primary idiopathic or secondary to pacemaker leads, intravascular catheters or cancer. In comparison to conventional venous thromboembolism such as lower limb deep vein thrombosis or pulmonary embolism the risk factors, investigations, and management are not well defined. Read More

Semin Thromb Hemost 2021 May 10. Epub 2021 May 10.

Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Pediatric venous thromboembolism (VTE) is a condition increasingly encountered by emergency medicine physicians. Unfortunately, despite increased incidence, the diagnosis of pediatric VTE relies on a high index of suspicion from clinicians. Delays in diagnosis and initiation of treatment can lead to poor outcomes in children, including an increased risk of mortality from pulmonary embolism, increased risk of VTE recurrence, and the development of the post-thrombotic syndrome. Read More

Semin Thromb Hemost 2021 May 10. Epub 2021 May 10.

Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.

Isolated distal deep vein thrombosis (IDDVT) is presumed to be more benign than proximal DVT (PDVT) or pulmonary embolism (PE), suggesting a need for different management approaches. This subgroup analysis of the RE-COVERY DVT/PE global, observational study investigated patient characteristics, hospitalization details, and anticoagulant therapy in patients with IDDVT in real-world settings in 34 countries enrolled from January 2016 to May 2017. Data were analyzed descriptively according to the type and location of the index venous thromboembolism (VTE): IDDVT, PDVT ± distal DVT (DDVT), and PE ± DVT. Read More

Thromb Res 2021 May 1;203:74-80. Epub 2021 May 1.

Amsterdam UMC, Department of Intensive Care Medicine, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.

Patients with circulatory arrest due to pulmonary embolism (PE) should be treated with fibrinolytics. Current guidelines do not specify which regimen to apply, and it has been suggested that the regimen of 100 mg rtPA/2 h should be used, because this is recommended for hemodynamic instable PE in the ESC/ERS Guideline. This two hour regimen, however, is incompatible with key principles of cardiopulmonary resuscitation (CPR), such as employment of interventions that allow fast evaluation of effectiveness, and limitation of the total duration of CPR to avoid poor neurological outcomes. Read More

Acta Cardiol 2021 May 10:1-5. Epub 2021 May 10.

Department of Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Michigan State University, Kalamazoo, MI, USA.

Introduction: Left ventricular thrombus (LVT) is a well-recognised complication of ischaemic and non-ischaemic heart disease. The incidence of this complication has drastically reduced due to reperfusion therapies. Current guidelines recommend using warfarin for at least three months. Read More

Knee Surg Sports Traumatol Arthrosc 2021 May 10. Epub 2021 May 10.

Rush University Medical Center, 1611 W Harrison St, Chicago, IL, 60612, USA.

Purpose: To determine the incidence of symptomatic venous thromboembolism (VTE) following anterior cruciate ligament (ACL) reconstruction using a large national database and to identify corresponding independent risk factors.

Methods: The Humana administrative claims database was reviewed for patients undergoing ACL reconstruction from 2007 to 2017. Patient demographics, medical comorbidities, as well as concurrent procedures were recorded. Read More