• Remember the risk factors for AQUIRED THROMBOPHILIA:
  • Surgery (OR 21.7)
  • Trauma (OR 12.7)
  • Hospital/SNF (OR 8.0)
  • Cancer undergoing chemotherapy (OR 6.6)
  • Others: estrogen therapy, pregnancy, obesity, smoking
• Approximately 6% of patients with unprovoked VTEs have an undiagnosed cancer at the time of the VTE; approximately 10% will be diagnosed with cancer in the following year.
• Use the Well’s PE Criteria for those patients whom you suspect a PE; if the score is <6 consider a D-Dimer to guide management

EKG findings in PE:

• Sinus tachycardia: approximately 44% of patients
• S1Q3T3 (acute cor pulmonale): not sensitive/specific; found in 20% of patients with PE
• RV strain patter (TWI R precordial leads V1-V4): representative of elevated PA pressures; found in approximately 34% of patients

Indications for Thrombolytics in PE:

CLEAR INDICATIONS:

1. Persistent hypotension / shock due to an acute PE

POSSIBLE INDICATION:

1. Severe / Worsening RV Dysfunction
2. Cardiopulmonary arrest due to a PE
3. Extensive clot burden
4. Free floating RA / ventricular thrombus
5. Patient foramen ovale

Contraindications to thrombolytics:

1.  Intracranial neoplasm
2. Intracranial / spinal surgery or trauma
3. History of hemorrhagic stroke
4. Active bleeding
5. Any stroke within 3 months

Classification of PE and distinction:

Massive: cardiopulmonary shock or hypotension

Submassive: RV dysfunction / elevated cardiac biomarkers

Low Risk: normal echocardiogram / negative cardiac biomarkers