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Tytuł:
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Challenges in the diagnostic approach of suspected pulmonary embolism in COVID-19 patients.
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Autorzy:
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Stals M; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands.
Kaptein F; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands.
Kroft L; Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.
Klok FA; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands.
Huisman MV; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands.
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Źródło:
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Postgraduate medicine [Postgrad Med] 2021 Aug; Vol. 133 (sup1), pp. 36-41. Date of Electronic Publication: 2021 Jun 16.
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Typ publikacji:
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Journal Article; Review
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Język:
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English
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Imprint Name(s):
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Publication: 2015- : London : Informa Healthcare
Original Publication: New York : Vendome Group, -2006
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MeSH Terms:
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COVID-19*/blood
COVID-19*/complications
COVID-19*/diagnosis
COVID-19*/physiopathology
Pulmonary Embolism*/diagnosis
Pulmonary Embolism*/etiology
Algorithms ; Diagnosis, Differential ; Humans ; SARS-CoV-2 ; Symptom Assessment/methods
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Contributed Indexing:
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Keywords: COVID-19; D-dimer; diagnosis; diagnostic algorithm; pulmonary embolism; venous thromboembolism
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Entry Date(s):
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Date Created: 20210429 Date Completed: 20210831 Latest Revision: 20210831
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Update Code:
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20240104
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DOI:
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10.1080/00325481.2021.1920723
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PMID:
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33910469
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Accumulating studies on COVID-19 patients report high incidences of thrombotic complications, but guidance on the best diagnostic approach for suspected pulmonary embolism (PE) in COVID-19 patients is lacking. Diagnosing PE in these patients is challenging as signs and symptoms of PE and COVID-19 show wide overlap, D-dimer levels are often elevated in the absence of thrombosis and computed tomography pulmonary angiography (CTPA) may be unfeasible in the case of severe renal impairment and/or hemodynamic instability.This narrative review discusses available literature and guidelines on current diagnostic algorithms for suspected PE in special patient populations, in particular COVID-19. A special focus is on reviewing the literature aimed at identifying symptoms with a high suspicion for PE and on the diagnostic performance of diagnostic algorithms for suspected PE in the setting of COVID-19.Based on available literature, the index of suspicion for PE should be high in the case of unexplained abrupt worsening of respiratory status, typical symptoms of deep-vein thrombosis and/or acute unexplained right ventricular dysfunction. Despite the lack of prospective diagnostic management studies, we propose to adhere to current diagnostic algorithms applying assessment of pretest probability and D-dimer testing as available evidence suggests that these might be considered safe. Preferably, algorithms using adjusted D-dimer thresholds are recommended as it likely improves the yield of the clinical decision rule/D-dimer combination.