Thrombosis |
From the U.O di Ematologia con Trapianto, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone", Università di Palermo, Italy (SS, AM, RA, LLC); Servizio Pronto Soccorso Accettazione, IRCCS Policlinico S. Matteo, Pavia, Italy (FF, MCB, EM, MAB); Dipartimento di Emergenza/Urgenza, IRCCS Ospedale Maggiore di Milano, Italy (FP); Dipartimento di Emergenza/Urgenza, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone", Università di Palermo, Italy (AG); Dipartimento di Medicina Interna e Sanità Pubblica, Università de LAquila, Italy (GM).
Correspondence: Sergio Siragusa MD, U.O di Ematologia con trapianto, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone", Via del Vespro 129, 90127 Palermo, Italy. E-mail: sergio.siragusa{at}unipa.it
We evaluated a simplified algorithm for safely postponing diagnostic imaging for pulmonary embolism (PE). At the index visit, patients were identified as being at high or low risk of PE; the former received full dosage low molecular weight heparin while the latter were left untreated until performance of diagnostic imaging (max 72 hours). During this period, no thromboembolic events occurred in low-risk patients (0/211, 0.% [upper 95% CI 0.9%]); only one event occurred in those at high-risk (1/125, 0.8% [upper 95% CI, 1.2]). Our study demonstrates that diagnostic imaging for PE can be safely deferred for up to 3 days.
Key words: pulmonary embolism, deferred tests, pretest clinical probability, D-dimer, low-molecular weight heparin.