British Thoracic Society guidelines for the management of suspected acute pulmonary embolism

Thorax

Volumn 58, Issue 6, 2003, Pages 470-483

  Campbell, I A ^a   Fennerty, A ^f   Miller, A C ^g   Baglin, T ^b   Gibbs, S ^c   Gray, H ^d   Hansell, D ^e   Reid, J ^e   Bounameaux, H ^f   Remy Jardin, M ^f   Wells, P ^f  

^a ROYAL COLLEGE OF PHYSICIANS   (United Kingdom)

^b British Society for Haematology   (United Kingdom)

^c British Junior Cardiac Association   (United Kingdom)

^d British Nuclear Energy Society   (United Kingdom)

^e ROYAL COLLEGE OF RADIOLOGISTS   (United Kingdom)

^f Mayday Hospital ^*

^g MAYDAY UNIVERSITY HOSPITAL   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ALTEPLASE; D DIMER; HEPARIN; LOW MOLECULAR WEIGHT HEPARIN; WARFARIN; XIMELAGATRAN;

ANTICOAGULATION; CLINICAL EXAMINATION; CLINICAL FEATURE; CLINICAL PRACTICE; COMPUTER ASSISTED TOMOGRAPHY; DEEP VEIN THROMBOSIS; DRUG CHOICE; ECHOGRAPHY; HEPARINIZATION; HUMAN; LUNG ANGIOGRAPHY; LUNG EMBOLISM; LUNG SCINTISCANNING; MAGNETIC RESONANCE ANGIOGRAPHY; MEDICAL SOCIETY; PRACTICE GUIDELINE; PREGNANCY; PRIORITY JOURNAL; REVIEW; RISK FACTOR; THROMBECTOMY; UNITED KINGDOM; VENA CAVA FILTER;

EID: 0038471175     PISSN: 00406376     EISSN: None     Source Type: Journal    
DOI: 10.1136/thorax.58.6.470     Document Type: Review

References (307)

1. British Thoracic Society. Suspected acute pulmonary embolism: a practical approach. Thorax 1997;52(Suppl 4):S1-24. Available from http://www.brit-thoracic.org.uk/guide/download_guide.html#embolism.
2. Harbour R, Miller J. A new system for grading recommendations in evidence based guidelines. BMJ 2001;323:334-6.
3. Knottnerus JA, van Weel C, Muris JW. Evaluation of diagnostic procedures. BMJ 2002;324:477-80.
4. Goldhaber SZ, Grodstein F, Stampfer MJ, et al. A prospective study of risk factors for pulmonary embolism in women. JAMA 1997;277:642-5.
5. Hansson PO, Eriksson H, Welin L, et al. Smoking and abdominal obesity: risk factors for venous thromboembolism among middle-aged men. Arch Intern Med 1999;159:1886-90.
6. Rosendaal FR. Venous thrombosis: a multicausal disease. Lancet 1999;353:1167-73.
7. Blaszyk H, Bjornsson J. Factor V Leiden and morbid obesity in fatal postoperative pulmonary embolism. Arch Surg 2000;135:1410-3.
8. Farmer R, Lawrenson R, Todd J, et al. A comparison of the risks of venous thromboembolic disease in association with different combined oral contraceptives. Br J Clin Pharmacol 2000;49:580-90.
9. Heit JA, Silverstein MD, Mohr DN, et al. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 2000;160:809-15.
10. Oger E. Incidence of venous thromboembolism: a community-based study in Western France. Thromb Haemost 2000;83:657-60.
11. Bernstein CN, Blanchard JF, Houston DS, et al. The incidence of deep venous thrombosis and pulmonary embolism among patients with inflammatory bowel disease: a population-based cohort study. Thromb Haemost 2001;85:430-4.
12. Danilenko-Dixon DR, Heit JA, Silverstein MD, et al. Risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or post partum: a population-based, case-control study. Am J Obstet Gynecol 2001;184:104-10.
13. Heit JA, Silverstein MD, Mohr DN. The epidemiology of venous thromboembolism in the community. Thromb Haemost 2001;86:452-63.
14. Golin V, Sprovieri SR, Bedrikow R, et al. Pulmonary thromboembolism: retrospective study of necropsies performed over 24 years in a university hospital in Brazil. Sao Paulo Med J 2002;120:105-8.
15. Tveit DP, Hypolite IO, Hshieh P, et al. Chronic dialysis patients have high risk for pulmonary embolism. Am J Kidney Dis 2002;39:1011-7.
16. Tsai AW, Cushman M, Rosamond WD, et al. Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology. Arch Intern Med 2002;162:1182-9.
17. Khan A, Emberson J, Dowd GS. Standardized mortality ratios and fatal pulmonary embolism rates following total knee replacement: a cohort of 936 consecutive cases. J Knee Surg 2002;15:219-22.
18. Hirsh J, O'Donnell MJ. Venous thromboembolism after long flights: are airlines to blame? Lancet 2001;357:1461-2.
19. Ferrari E, Chevallier T, Chapelier A, et al. Travel as a risk factor for venous thromboembolic disease: a case-control study. Chest 1999;115:440-4.
20. Samama MM. An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients: the Sirius study. Arch Intern Med 2000;160:3415-20.
21. Lapostolle F, Surget V, Borron SW, et al. Severe pulmonary embolism associated with air travel. N Engl J Med 2001;345:779-83.
22. Scurr JH, Machin SJ, Bailey-King S, et al. Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial. Lancet 2001;357:1485-9.
23. Oger E, Scarabin PY. Assessment of the risk for venous thromboembolism among users of hormone replacement therapy. Drugs Aging 1999;14:55-61.
24. Anonymous. Oral contraceptives and cardiovascular risk. Drug Ther Bull 2000;38:1-5.
25. Writing Group for the Women's Health Initiative Investigators. Risks and benefits of oestrogen plus progestin in healthy postmenopausal women. JAMA 2002;288:321-3.
26. Kemmeren JM, Algra A, Grobbee DE. Third generation oral contraceptives and risk of venous thrombosis: meta-analysis. BMJ 2001;323:131-9.
27. Lidegaard O, Edstrom B, Kreiner S. Oral contraceptives and venous thromboembolism: a five-year national case-control study. Contraception 2002;65:187-96.
28. McColl MD, Ramsay JE, Tait RC, et al. Risk factars for pregnancy associated venous thromboembolism. Thromb Haemost 1997;78:1183-8.
29. Gherman RB, Goodwin TM, Leung B, et al. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy. Obstet Gynecol 1999;94:730-4.
30. Ros HS, Lichtenstein P, Bellocco R, et al. Pulmonary embolism and stroke in relation to pregnancy: how can high-risk women be identified? Am J Obstet Gynecol 2002;186:198-203.
31. Greaves M. Thrombophilia. Clin Med 2001;1:432-5.
32. Seligsohn U, Lubetsky A. Genetic susceptibility to venous thrombosis. N Engl J Med 2001;344:1222-31.
33. Folsom AR, Aleksic N, Wang L, et al. Protein C, antithrombin, and venous thromboembolism incidence: a prospective population-based study. Arterioscl Thromb Vasc Biol 2002;22:1018-22.
34. Martinelli I, De Stefano V, Taioli E, et al. Inherited thrombophilia and first venous thromboembolism during pregnancy and puerperium. Thromb Haemost 2002;87:791-5.
35. Kearon C, Gent M, Hirsh J, et al. A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Engl J Med 1999;340:901-7.
36. De Stefano V, Martinelli I, Mannucci PM, et al. The risk of recurrent venous thromboembolism among heterozygous carriers of the G20210A prothrombin gene mutation. Br J Haematol 2001;113:630-5.
37. Eichinger S, Weltermann A, Mannhalter C, et al. The risk of recurrent venous thromboembolism in heterozygous carriers of factor V Leiden and a first spontaneous venous thromboembolism. Arch Intern Med 2002;162:2357-60.
38. Greaves M, Baglin T. Laboratory testing for heritable thrombophilia: impact on clinical management of thrombotic disease. Br J Haematol 2000;109:699-703.
39. British Committee for Standards in Haematology. Investigation and management of heritable thrombophilia. Br J Haematol 2001;114:512-28.
40. Grau E, Real E, Medrano J, et al. Recurrent venous thromboembolism in a Spanish population: incidence, risk factors, and management in a hospital setting. Thromb Res 1999;96:335-41.
41. Prandoni P, Lensing A, Buller H, et al. Deep-vein thrombosis and the incidence of subsequent symptomatic cancer. N Engl J Med 1992;327:1128-33.
42. Monreal M, Casals A, Boix J, et al. Occult cancer in patients with acute pulmonary embolism. A prospective study. Chest 1993;103:816-9.
43. Bastounis EA, Karayiannakis AJ, Makri GG, et al. The incidence of occult cancer in patients with deep venous thrombosis: a prospective study. J Intern Med 1996;239:153-6.
44. Baron JA, Gridley G, Weiderpass E, et al. Venous thromboembolism and cancer. Lancet 1998;351:1077-80.
45. Sorensen HT, Mellemkjaer L, Steffensen FH, et al. The risk of a diagnosis of cancer after primary deep venous thrombosis or pulmonary embolism. N Engl J Med 1998;338:1169-73.
46. Cornuz J, Pearson SD, Creager MA, et al. Importance of findings on the initial evaluation for cancer in patients with symptomatic idiopathic deep venous thrombosis. Ann Intern Med 1996;125:785-93.
47. Hettiarachchi RJ, Lok J, Prins MH, et al. Undiagnosed malignancy in patients with deep vein thrombosis: incidence, risk indicators, and diagnosis. Cancer 1998;83:180-5.
48. Sorensen HT, Mellemkjaer L, Olsen JH, et al. Prognosis of cancers associated with venous thromboembolism. N Engl J Med 2000;343:1846-50.
49. Joung S, Robinson B. Venous thromboembolism in cancer patients in Christchurch, 1995-1999. NZ Med J 2002;115:257-60.
50. Heit JA, Melton LJ, Lohse CM, et al. Incidence of venous thromboembolism in hospitalised patients vs community residents. Mayo Clin Proc 2001;76:1102-10.
51. Heit JA, O'Fallon WM, Petterson TM, et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med 2002;162:1245-8.
52. Ferrari E, Baudouy M, Cerboni P, et al. Clinical epidemiology of venous thromboembolic disease. Results of a French Multicentre Registry. Eur Heart J 1997;18:685-91.
53. Kasper W, Konstantinides S, Geibel A, et al. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry J Am Coll Cardiol 1997;30:1165-71.
54. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER) Lancet 1999;353:1386-9.
55. Nakamura M, Fujioka H, Yamada N, et al. Clinical characteristics of acute pulmonary thromboembolism in Japan: results of a multicenter registry in the Japanese Society of Pulmonary Embolism Research. Clin Cardiol 2001;24:132-8.
56. Janata K, Holzer M, Domanovits H, et al. Mortality of patients with pulmonary embolism. Wien Klin Wochenschr 2002;14:766-72.
57. Heit JA, Silverstein MD, Mohr DN, et al. Predictors of survival after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med 1999;159:445-53.
58. Wicki J, Perrier A, Perneger T, et al. Predicting adverse outcome in patients with acute pulmonary embolism: a risk score. Thromb Haemost 2000;84:548-52.
59. Heit JA, Mohr DN, Silverstein MD, et al. Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med 2000;160:761-8.
60. Ferrari E, Imbert A, Chevalier T, et al. The ECG in pulmonary embolism. Predictive value of negative T waves in precordial leads: 80 case reports. Chest 1997;111:537-43.
61. Jones JS, Neff TL, Carlson SA. Use of the alveolar-arterial oxygen gradient in the assessment of acute pulmonary embolism. Am J Emerg Med 1998;16:333-7.
62. Afzal A, Noor HA, Gill SA, et al. Leukocytosis in acute pulmonary embolism. Chest 1999;115:1329-32.
63. Prediletto R, Miniati M, Tonelli L, et al. Diagnostic value of gas exchange tests in patients with clinical suspicion of pulmonary embolism. Crit Care 1999;3:111-6.
64. Elliott CG, Goldhaber SZ, Visani L, et al. Chest radiographs in acute pulmonary embolism. Results from the International Cooperative Pulmonary Embolism Registry. Chest 2000;118:33-8.
65. Rodger M, Carrier M, Jones G, et al. Diagnostic value of arterial blood gas measurement in suspected pulmonary embolism. Am J Respir Crit Care Med 2000;162:2105-8.
66. Rodger M, Makropoulos D, Turek M, et al. Diagnostic value of the electrocardiogram in suspected pulmonary embolism. Am J Cardiol 2000;86:807-9.
67. Stein PD, Afzal A, Henry JW, et al. Fever in acute pulmonary embolism. Chest 2000;117:39-42.
68. Daniel KR, Courtney DM, Kline JA. Assessment of cardiac stress from massive pulmonary embolism with 12-lead ECG. Chest 2001;120:474-81.
69. Petrov DB. Appearance of right bundle branch block in electrocardiograms of patients with pulmonary embolism as a marker for obstruction of the main pulmonary trunk. J Electrocardiol 2001;34:185-8.
70. Ullman E, Brady WJ, Perron AD, et al. Electrocardiographic manifestations of pulmonary embolism. Am J Emerg Med 2001;19:514-9.
71. Girard P, Decousus M, Laporte S, et al. Diagnosis of pulmonary embolism in patients with proximal deep vein thrombosis: specificity of symptoms and perfusion defects at baseline and during anticoagulant therapy. Am J Respir Crit Care Med 2001;164:1033-7.
72. Pacouret G, Schellenberg F, Hamel E, et al. Troponin I in massive acute pulmonary embolism: results of a prospective series (French). Presse Med 1998;27:1627.
73. Peetz D, Post F, Voigtlander T, et al. Troponin I as a marker of right ventricular overload in acute pulmonary embolism (German). Lab Med 1998;22:553-8.
74. Giannitsis E, Muller-Bardorff M, Kurowski V, et al. Independent prognostic value of cardiac troponin T in patients with confirmed pulmonary embolism. Circulation 2000;102:211-7.
75. Meyer T, Binder L, Hruska N, et al. Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction. J Am Coll Cardiol 2000;36:1632-6.
76. Douketis JD. Elevated cardiac troponin levels in patients with submassive pulmonary embolism. Arch Intern Med 2002;162:79-81.
77. Konstantinides S, Geibel A, Olschewski M, et al. Importance of cardiac troponins I and T in risk stratification of patients with acute pulmonary embolism. Circulation 2002;106:1263-8.
78. Jonata K, Holzer M, Laggner AN, et al. Cardiac troponin T in the severity assessment of patients with pulmonary embolism: cohort study. BMJ 2003;326:312-3.
79. Iwadate K, Tanno K, Doi M, et al. Two cases of right ventricular ischemic injury due to massive pulmonary embolism. Forens Sci Int 2001;116:189-95.
80. Tverskaya MS, Karpova VV, Virganskii AO, et al. Structural and metabolic changes in cardiac conducting system during massive pulmonary embolism. Bull Exp Biol Med 2001;130:940-4.
81. Dieter RS, Ernst E, Ende DJ, et al. Diagnostic utility of cardiac troponin-I levels in patients with suspected pulmonary embolism. Angiology 2002;53:583-5.
82. Sonson BJ, Lijmer JG, Mac Gillavry MR, et al. Comparison of a clinical probability estimate and two clinical models in patients with suspected pulmanary embolism. Thromb Haemost 2000;83:199-203.
83. Leclercq MG, Lutisan JG, van Marwijk Kooy M, et al. Ruling out clinically suspected pulmonary embolism by assessment of clinical probability and D-dimer levels: a management study. Thromb Haemost 2003;89:97-103.
84. Wells PS, Ginsberg JS, Anderson DR, et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med 1998;129:997-1005.
85. Miniati M, Prediletto R, Formichi B, et al. Accuracy of clinical assessment in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med 1999;159:864-71.
86. Perrier A, Miron MJ, Desmarais S, et al. Using clinical evaluation and lung scan to rule out suspected pulmonary embolism: is it a valid option in patients with normal results of lower-limb venous compression ultrasonography? Arch Intern Med 2000;160:512-6.
87. Righini M, Goehring C, Bounameaux H, et al. Effects of age on the performance of common diagnostic tests for pulmonary embolism. Am J Med 2000;109:357-61.
88. Lukaschek J, Schmid HR, Vorburger C, et al. Critical appraisal of the diagnostics of 270 consecutive cases of suspected venous thromboembolism and established consequences at a non-university centre. Swiss Med Week 2001;131:653-8.
89. Wicki J, Perneger TV, Junod AF, et al. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med 2001;161:92-7.
90. Chagnon I, Bounameaux H, Aujesky D, et al. Comparison of two clinical prediction rules and implicit assessment among patients with suspected pulmonary embolism. Am J Med 2002;113:269-75.
91. Musset D, Parent F, Meyer G, et al. Diagnostic strategy for patients with suspected pulmonary embolism: a prospective multicentre outcome study. Lancet 2002;360:1914-20.
92. Rosen M, Sands D, Morris J, et al. Does a physician's ability to accurately assess the likelihood of pulmonary embolism increase with training? Acad Med 2000;75:1199-205.
93. Wells PS, Anderson DR, Rodger M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost 2000;83:416-20.
94. 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.
95. Bova C, Greco F, Ferrari A, et al. The usefulness of the association of clinical probability, rapid plasma measurement of D-dimer, compression echography of the lower limbs and echocardiography in the diagnosis of acute pulmonary embolism (Italian). Ital Heart J 2000;1:116-21.
96. Campo JF, Hernandez MJ, Anta M, et al. Concordance in the clinical diagnosis of pulmonary embolism (Spanish). Med Clin (Barc) 1998;111:121-4.
97. Egermayer P, Town GI, Turner JG, et al. Usefulness of D-dimer, blood gas, and respiratory rate measurements for excluding pulmonary embolism. Thorax 1998;53:830-4.
98. Kline JA, Nelson RD, Jackson RE, et al. Criteria for the safe use of D-dimer testing in emergency department patients with suspected pulmonary embolism: a multicenter US study. Ann Emerg Med 2002;39:144-52.
99. Miron MJ, Perrier A, Bounameaux H, et al. Contribution of noninvasive evaluation to the diagnosis of pulmonary embolism in hospitalised patients. Eur Respir J 1999;13:1365-70.
100. Ghirardini G, Battioni M, Bertellini C, et al. D-dimer after delivery in uncomplicated pregnancies. Clin Exp Obstet Gynecol 1999;26:211-2.
101. De Monye W, Sanson BJ, MacGillavry MR, et al. Embolus location affects the sensitivity of a rapid quantitative D-dimer assay in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med 2002;165:345-8.
102. Kline JA, Johns KL, Colucciello SA, et al. New diagnostic tests for pulmonary embolism. Ann Emerg Med 2000;35:168-80.
103. Ginsberg JS, Wells PS, Kearon C, et al. Sensitivity and specificity of a rapid whole-blood assay for D-dimer in the diagnosis of pulmonary embolism. Ann Intern Med 1998;129:1006-11.
104. MacGillavry MR, Lijmer JG, Sanson BJ, et al. Diagnostic accuracy of triage tests to exclude pulmonary embolism. Thromb Haemost 2001;85:995-8.
105. Chunilal SD, Brill-Edwards PA, Stevens PB, et al. The sensitivity and specificity of a red blood cell agglutination D-dimer assay for venous thromboembolism when performed on venous blood. Arch Intern Med 2002;162:217-20.
106. Perrier A, Desmarais S, Miron MJ, et al. Non-invasive diagnosis of venous thromboembolism in outpatients. Lancet 1999;353:190-5.
107. Freyburger G, Trillaud H, Labrouche S, et al. D-dimer strategy in thrombosis exclusion: a gold standard study in 100 patients suspected of deep venous thrombosis or pulmonary embolism. Thromb Haemost 1998;79:32-7.
108. Anderson D, Wells P. D-dimer for the diagnosis of venous thromboembolism. Curr Opin Hematol 2000;7:296-301.
109. Pacouret G. Association between D-dimer and helical CT scanning in the diagnosis of pulmonary embolism: a prospective study of 106 ambulatory patients (French). Presse Med 2002;31:13-8.
110. Bates SM, Grand Maison A, Johnston M, et al. A latex D-dimer reliably excludes venous thromboembolism. Arch Intern Med 2001;161:447-53.
111. Kovacs MJ, MacKinnon KM, Anderson D, et al. A comparison of three rapid D-dimer methods for the diagnosis of venous thromboembolism. Br J Haematol 2001;115:140-4.
112. Reber G, Bounameaux H, Perrier A, et al. Performances of a new, automated latex assay for the exclusion of venous thromboembolism. Blood Coag Fibrinol 2001;12:217-20.
113. Burkill GJ, Bell JR, Chinn RJ, et al. The use of a D-dimer assay in patients undergoing CT pulmonary angiography for suspected pulmonary embolus. Clin Radiol 2002;57:41-6.
114. Palareti G, Legnani C, Cosmi B, et al. Risk of venous thromboembolism recurrence: high negative predictive value of D-dimer performed after oral anticoagulation is stopped. Thromb Haemost 2002;87:7-12.
115. Nilsson T, Mare K, Carlsson A. Value of structured clinical and scintigraphic protocols in acute pulmonary embolism. J Intern Med 2001;250:213-8.
116. Prologo JD, Glauser J. Variable diagnostic approach to suspected pulmonary embolism in the ED of a major academic tertiary care center. Am J Emerg Med 2002;20:5-9.
117. Lemb M, Pohlabeln H. Pulmonary thromboembolism: a retrospective study on the examination of 991 patients by ventilation/perfusion SPECT using Technegas. Nucl Med 2001;40:179-86.
118. Gottschalk A. New criteria for ventilation-perfusion lung scan interpretation: a basis for optimal interaction with helical CT angiography. Radiographics 2000:1206-10.
119. Itti E, Nguyen S, Robin F, et al. Distribution of ventilation/perfusion ratios in pulmonary embolism: an adjunct to the interpretation of ventilation/perfusion lung scans. J Nucl Med 2002;43:1596-602.
120. Worsley DF, Alavi A. Radionuclide imaging of acute pulmonary embolism. Radiol Clin N Am 2001;39:1035-52.
121. Burkill GJ, Bell JR, Padley SP. Survey on the use of pulmonary scintigraphy, spiral CT and conventional pulmonary angiography for suspected pulmonary embolism in the British isles. Clin Radiol 1999;54:807-10.
122. Hagen PJ, van Strijen MJ, Kieft GJ, et al. The application of a Dutch consensus diagnostic strategy for pulmonary embolism in clinical practice. Neth J Med 2001;59:161-9.
123. Chan WL, McLean R, Carolan MG. What happens after a lung scan? Management and outcome of patients in a regional hospital. Australas Radiol 2002;46:375-80.
124. Khorasani R, Gudas TF, Nikpoor N, et al. Treatment of patients with suspected pulmonary embolism and intermediate-probability lung scans: is diagnostic imaging underused? Am J Roentgenol 1997;169:1355-7.
125. Kuijer PM, Turkstra F, van Beek EJ, et al. A survey of the diagnostic and therapeutic management of patients with suspected pulmonary embolism in the Netherlands. Neth J Med 1997;50:261-6.
126. Broekhuizen-de Gost HS, Tiel-van Buul MM, Ubbink M, et al. The value of the 'non-diagnostic' lung scan - further classification as to the risk of pulmonary embolism is not reliable (Dutch). Ned Tijdschr Geneeskd 2000;144:1537-42.
127. Rosen MP, Sands DZ, Kuntz KM Physicians' attitudes toward misdiagnosis of pulmonary embolism: a utility analysis. Acad Radiol 2000;7:14-20.
128. Walsh G, Jones DN. Subsequent investigation and management of patients with intermediate-category and -probability ventilation-perfusion scintigraphy. Australas Radiol 2000;44:424-7.
129. Berghout A, Oudkerk M, Hicks SG, et al. Active implementation of a consensus strategy improves diagnosis and management in suspected pulmonary embolism. Q J Med 2000;93:335-40.
130. Gray HW, Bessent RG, McKillop JH. A preliminary evaluation of diagnostic odds in lung scan reporting. Nucl Med Commun 1998;19:113-8.
131. Rajendran JG, Jacobson AF. Review of 6-month mortality following low-probability lung scans. Arch Intern Med 1999;159:349-52.
132. Van Beek EJR, Brouwers EMJ, Song B, et al. Lung scintigraphy and helical computed tomography for the diagnosis of pulmonary embolism: a meta-analysis. Clin Appl Thromb Hems 2001;7:87-92.
133. Hartmann I, Hagen P, Melissant C, et al. Diagnosing acute pulmonary embolism: effect of chronic obstructive pulmonary disease on the performance of D-dimer testing, ventilation/perfusion scintigraphy, spiral computed tomographic angiography, and conventional angiography. Am J Respir Crit Care Med 2000;162:2232-7.
134. Infante JR, Torres-Avisbal M, Gonzalez FM, et al. Effect of different observers on the interpretation of pulmonary perfusion scintigraphy (Spanish). Revist Esp Med Nucl 2002;21:93-8.
135. Forbes KP, Reid JH, Murchison JT. Do preliminary chest X-ray findings define the optimum role of pulmonary scintigraphy in suspected pulmonary embolism? Clin Radiol 2001;56:397-400.
136. Wilson HT, Meagher TM, Williams SJ. Combined helical computed tomographic pulmonary angiography and lung perfusion scintigraphy for investigating acute pulmonary embolism. Clin Radiol 2002;57:33-6.
137. British Nuclear Medicine Society. Quality guidelines for ventilation / perfusion imaging for pulmonary embolic disease, http://www.bnms.org.uk/bnms.htm; 2001.
138. Bastuji-Garin S, Schaeffer A, Wolkenstein P, et al. Pulmonary embolism; lung scanning interpretation: about words. Chest 1998;114:1551-5.
139. Gray HW, Neilly JB. The role and value of ventilation perfusion imaging in pulmonary embolism. In: Oudkerk M, van Beek, EJR, ten cate JW, eds. Pulmonary embolism: epidemiology, diagnosis and treatment. Oxford: Blackwell Science, 1999:84-123.
140. Clarke SEM, Burwood R, Cox C. Reaudit lung scintigraphy: ventilation and perfusion imaging for the investigation of possible acute pulmonary embolism. London: South Thames Region Nuclear Medicine Audit Group, 2001.
141. Turkstra F, Kuijer PM, van Beek EJ, et al. Diagnostic utility of ultrasonography of leg veins in patients suspected of having pulmonary embolism. Ann Intern Med 1997;126:775-81.
142. Torres JA, Aracil E, Puras E, et al. Role of venous duplex imaging of lower extremity for pulmonary embolism diagnostic. Angiologia 1999;51:71-6.
143. MacGillavry M, Sanson B, Bullet H, et al. Compression ultrasonography of the leg veins in patients with clinically suspected pulmonary embolism: is a more extensive assessment of compressibility useful? Thromb Haemost 2000;84:973-6.
144. Barrellier M, Lezin B, Landy S, et al. Prevalence of duplex ultrasonography detectable venous thrombosis in patients with suspected or acute pulmonary embolism. J Mal Vasc 2001;26:23-30.
145. Girard P, Musset D, Parent F, et al. High prevalence of detectable deep venous thrombosis in patients with acute pulmonary embolism. Chest 1999;116:903-8.
146. Daniel KR, Jackson RE, Kline JA. Utility of lower extremity venous ultrasound scanning in the diagnosis and exclusion of pulmonary embolism in outpatients. Ann Emerg Med 2000;35:547-54.
147. Meyerovitz MF, Mannting F, Polak JF, et al. Frequency of pulmonary embolism in patients with low-probability lung scan and negative lower extremity venous ultrasound. Chest 1999;115:980-2.
148. Elias A, Mallard L, Elias M, et al. A single complete ultrasound investigation of the venous network for the diagnostic management of patients with a clinically suspected first episode of deep venous thrombosis of the lower limbs. Thromb Haemost 2003;289:221-7.
149. Hull RD, Raskob GE, Ginsberg JS, et al. A noninvasive strategy for the treatment of patients with suspected pulmonary embolism. Arch Intern Med 1994;154:289-97.
150. Wells PS, Ginsberg JS, Anderson DR, et al. Utility of ultrasound imaging of the lower extremities in the diagnostic approach in patients with suspected pulmonary embolism. J Intern Med 2001;250:262-4.
151. Diffin DC, Leyendecker JR, Johnson SP, et al. Effect of anatomic distribution of pulmonary emboli on interobserver agreement in the interpretation of pulmonary angiography. Am J Roentgenol 1998;171:1085-9.
152. Baile EM, King GG, Muller NL, et al. Spiral computed tomography is comparable to angiography for the diagnosis of pulmonary embolism. Am J Respir Crit Care Med 2000;161:1010-5.
153. Van Rossum AB, Bongaerts AHH, Woodard PK. Helical computed tomography and pulmonary embolism. In: Oudkerk M vBE, ten Cate JW, eds. Pulmonary embolism: epidemioiogy, diagnosis and treatment. Oxford: Blackwell Science, 1999:192-225.
154. Remy-Jardin M, Remy J, Mayo JR, et al. Acute pulmonary embolism. In: CT angiography of the chest. Philadelphia: Lippincott Williams & Wilkins, 2001:51-66.
155. Mayo JR, Remy-Jardin M, Muller NL, et al. Pulmonary embolism: prospective comparison of spiral CT with ventilation-perfusion scintigraphy. Radiology 1997;205:447-52.
156. Garg K, Welsh CH, Feyerabend AJ, et al. Pulmonary embolism: diagnosis with spiral CT and ventilation-perfusion scanning - correlation with pulmonary angiographic results or clinical outcome. Radiology 1998;208:201-8.
157. Van Rossum AB, Pattynama PM, Mallens WM, et al. Can helical CT replace scintigraphy in the diagnostic process in suspected pulmonary embolism? A retrolective-prolective cohort study focusing on total diagnostic yield. Eur Radiol 1998;8:90-6.
158. Blachere H, Latrabe V, Montaudon M, et al. Pulmonary embolism revealed on helical CT angiography: comparison with ventilation-perfusion radionuclide lung scanning. Am J Roentgenol 2000;174:1041-7.
159. Cueto SM, Cavanaugh SH, Benenson RS, et al. Computed tomography scan versus ventilation-perfusion lung scan in the detection of pulmonary embolism. J Emerg Med 2001;21:155-64.
160. Bankier AA, Janata K, Fleischmann D, et al. Severity assessment of acute pulmonary embolism with spiral CT: evaluation of two modified angiographic scores and comparison with clinical data. J Thorac Imaging 1997;12:150-8.
161. Mastora I, Remy-Jardin M, Masson P, et al. Severity of acute pulmonary embolism: evaluation of a new spiral CT angiographic score in correlation with echocardiographic data. Eur Radiol 2003;13:29-35.
162. Van Rossum AB, van Erkel AR, van Persijn van Meerten EL, et al. Accuracy of helical CT for acute pulmonary embolism: ROC analysis of observer performance related to clinical experience. Eur Radiol 1998;8:1160-4.
163. Chartrand-Lefebvre C, Howarth N, Lucidarme O, et al. Contrast-enhanced helical CT for pulmonary embolism detection: inter- and intra-observer agreement among radiologists with variable experience. Am J Roentgenol 1999;172:107-12.
164. Domingo ML, Marti-Bonmati L, Dosda R, et al. Interobserver agreement in the diagnosis of pulmonary embolism with helical CT. Eur J Radiol 2000;34:136-40.
165. Remy-Jardin M, Remy J, Baghaie F, et al. Clinical value of thin collimation in the diagnostic workup of pulmonary embolism. Am J Roentgenol 2000;175:407-11.
166. Perrier A, Howarth N, Didier D, et al. Performance of helical computed tomography in unselected outpatients with suspected pulmonary embolism. Ann Intern Med 2001;135:88-97.
167. Qanadli SD, El Hajjam M, Vieillard-Baron A, et al. New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography. Am J Roentgenol 2001;176:1415-20.
168. Bourriot K, Couffinhall T, Bernard V, et al. Clinical outcome after a negative spiral CT pulmonary angiogram in an in-patient population from cardiology and pneumology wards. Chest 2003:123:359-65.
169. Mullins MD, Becker DM, Hagspiel KD, et al. The role of spiral volumetric computed tomography in the diagnosis of pulmonary embolism. Arch Intern Med 2000;160:293-8.
170. Rathbun SW, Raskob GE, Whitsett TL. Sensitivity and specificity of helical computed tomography in the diagnosis of pulmonary embolism: a systematic review Ann Intern Med 2000;132:227-32.
171. Safrieł Y, Zinn H. CT pulmonary angiography in the detection of pulmonary emboli: a meta-analysis of sensitivities and specificities. Clin Imag 2002;26:101-5.
172. Harvey R, Gefter W, Hrung J, et al. Accuracy of CT angiography versus pulmonary angiography in the diagnosis of acute pulmonary embolism: evaluation of the literature with summary ROC curve analysis. Acad Radiol 2000;7:786-97.
173. Remy-Jardin M, Remy J, Artaud D, et al. Spiral CT of pulmonary embolism: diagnostic approach, interpretive pitfalls and current indications. Eur Radiol 1998;8:1376-90.
174. Howling SJ, Hansell DM. Spiral computed tomography for pulmonary embolism. Hosp Med 2000;61:41-5.
175. Stein PD, Henry JW. Prevalence of acute pulmonary embolism in central and subsegmental pulmonary arteries and relation to probability interpretation of ventilation/perfusion lung scans. Chest 1997;111:1246-8.
176. Qanadli S, Hajjam M, Mesurolle B, et al. Pulmonary embolism detection: prospective evaluation of dual-section helical CT versus selective pulmonary arteriography in 157 patients. Radiology 2000;217:447-55.
177. Remy-Jardin M, Tillie-Leblond I, Szapiro D, et al. CT angiography of pulmonary embolism in patients with underlying respiratory disease: impact of multi-slice CT (MSCT) on image quality and negative predictive value. Eur Radiol 2002;12:1971-8.
178. De Monye W, van Strijen MJ, Huisman MV, et al. Suspected pulmonary embolism: prevalence and anatomic distribution in 487 consecutive patients. Radiology 2000;215:184-8.
179. Raptopoulos V, Boiselle PM. Multi-detector row spiral CT pulmonary angiography: comparison with single-detector row spiral CT. Radiology 2001;221:606-13.
180. Schoepf UJ, Holzknecht N, Helmberger TK, et al. Subsegmental pulmonary emboli: improved detection with thin-collimation multi-detector row spiral CT. Radiology 2002;222:483-90.
181. Reid JH, Murchison JT. Acute right ventricular dilatation: a new helical CT sign of massive pulmonary embolism. Clin Radiol 1998;53:694-8.
182. Wintersperger BJ, Stabler A, Seemann M, et al. Evaluation of right ventricular performance in patients with acute pulmonary embolism by helical CT (German). Rofo Fortschr 1999;170:542-9.
183. Ferretti GR, Bosson JL, Buffaz PD, et al. Acute pulmonary embolism: role of helical CT in 164 patients with intermediate probability at ventilation-perfusion scintigraphy and normal results at duplex US of the legs. Radiology 1997;205:453-8.
184. Garg K, Sieler H, Welsh CH, et al. Clinical validity of helical CT being interpreted as negative for pulmonary embolism: implications for patient treatment. Am J Roentgenol 1999;172:1627-31.
185. Lomis NN, Yoon HC, Moran AG, et al. Clinical outcomes of patients after a negative spiral CT pulmonary arteriogram in the evaluation of acute pulmonary embolism. J Vasc Intervent Radiol 1999;10:707-12.
186. Lorut C, Ghossains M, Horellou M, et al. A non-invasive diagnostic strategy including spiral computed tomography in patients with suspected pulmonary embolism. Am J Respir Crit Care Med 2000;162:1413-8.
187. Goodman LR, Lipchik RJ, Kuzo RS, et al. Subsequent pulmonary embolism risk after a negative helical CT pulmonary angiogram: prospective comparison with scintigraphy. Radiology 2000;215:535-42.
188. Gottsater A, Berg A, Centergard J, et al. Clinically suspected pulmonary embolism: is it safe to withhold anticoagulation after a negative spiral CT? Eur Radiol 2001;11:65-72.
189. Nilsson T, Olausson A, Johnsson H, et al. Negative spiral CT in acute pulmonary embolism. Acta Radiol 2002;43:486-91.
190. Novelline RA, Baltarowich OH, Athanasoulis CA, et al. The clinical course of patients with suspected pulmonary embolism and a negative pulmonary arteriogram. Radiology 1978;126:561-7.
191. Cheely R, McCartney WH, Perry JR, et al. The role of noninvasive tests versus pulmonary angiography in the diagnosis of pulmonary embolism. Am J Med 1981;70:17-22.
192. Henry JW, Relyea B, Stein PD. Continuing risk of thromboemboli among patients with normal pulmonary angiograms. Chest 1995;107:1375-8.
193. Van Beek EJ, Kuijer PM, Buller HR, et al. The clinical course of patients with suspected pulmonary embolism. Arch Intern Med 1997;157:2593-8.
194. Swensen SJ, Sheedy PF, Ryu JH, et al. Outcomes after withholding anticoagulation from patients with suspected acute pulmonary embolism and a negative computed tomogram: a cohort study. Mayo Clin Proc 2002;77:130-8.
195. Ginsberg MS, Oh J, Welber A, et al. Clinical usefulness of imaging performed after CT angiography that was negative for pulmonary embolus in a high-risk oncologic population. Am J Roentgenol 2002;179:1205-8.
196. Cham MD, Yankelevitz DF, Shaham D, et al. Deep venous thrombosis: detection by using indirect CT venography. The Pulmonary Angiography-Indirect CT Venography Cooperative Group. Radiology 2000;216:744-51.
197. Duwe K, Shiau M, Budorick N, et al. Evaluation of the lower extremity veins in patients with suspected pulmonary embolism: a retraspective comparison of helical CT venography and sonography. Am J Roentgenol 2000;175:1525-31.
198. Garg K, Kemp JL, Wojcik D, et al. Thromboembolic disease: comparison of combined CT pulmonary angiography and venography with bilateral leg sonography in 70 patients. Am J Roentgenol 2000;175:997-1001.
199. Ghaye B, Szapiro D, Willems V, et al. Combined CT venography of the lower limbs and spiral CT angiography of pulmonary arteries in acute pulmonary embolism: preliminary results of a prospective study. J Belg Radiol 2000;83:271-8.
200. Au VW, Walsh G, Fon G. Computed tomography pulmonary angiography with pelvic venography in the evaluation of thrombo-embolic disease. Australas Radiol 2001;45:141-5.
201. Loud PA, Katz DS, Bruce DA, et al. Deep venous thrombosis with suspected pulmonary embolism: detection with combined CT venography and pulmonary angiography. Radiology 2001;219:498-502.
202. Nicolas M, Debelle L, Laurent V, et al. Incremental lower extremity CT venography, a simplified approach for the diagnosis of deep venous thrombosis in patients with pulmonary embolism. J Radiol 2001;82:251-6.
203. Peterson DA, Kazerooni EA, Wakefield TW, et al. Computed tomographic venography is specific but not sensitive for diagnosis of acute lower-extremity deep venous thrombosis in patients with suspected pulmonary embolus. J Vasc Surg 2001;34:798-804.
204. Wildberger JE, Mahnken AH, Sinha AM, et al. A differentiated approach to the diagnosis of pulmonary embolism and deep venous thrombosis using multi-slice CT (German). Rofo Fortschr 2002;174:301-7.
205. Jonetz-Mentzel L, Eger C, Basche S. CT venography and CT angiography of the pulmonary arteries in acute pulmonary embolism (German). Zentralbl Chir 2002;127:755-9.
206. Rodemoker J, Griesshaber V, Hidajat N, et al. Combined CT pulmonary angiography and venography for diagnosis of pulmonary embolism and deep vein thrombosis: radiation dose. J Thorac Imaging 2001;16:297-9.
207. Velmahos GC, Vassiliu P, Wilcox A, et al. Spiral computed tomography for the diagnosis of pulmonary embolism in critically ill surgical patients: a comparison with pulmonary angiography. Arch Surg 2001;136:505-11.
208. Tillie-Leblond I, Mastora I, Radenne F, et al. Risk of subsequent pulmonary embolism after a negative spiral angiogram in patients with underlying pulmonary disease: a one-year clinical follow-up study. Radiology 2002;232:461-7.
209. Kasper W, Konstantinides S, Geibel A, et al. Prognostic significance of right ventricular afterload stress detected by echocardiography in patients with clinically suspected pulmonary embolism. Heart 1997;77:346-9.
210. Serafini O, Bisignani G, Greco F, et al. The role of 2D-Doppler electrocardiography in the early diagnosis of massive acute pulmonary embolism and therapeutic monitoring (Italian). G Ital Cardiol 1997;27:462-9.
211. Jackson RE, Rudoni RR, Hauser AM, et al. Prospective evaluation of two-dimensional transthoracic echocardiography in emergency department patients with suspected pulmonary embolism. Acad Emerg Med 2000;7:994-8.
212. Miniati M, Monti S, Pratali L, et al. Value of transthoracic echocardiography in the diagnosis of pulmonary embolism: results of a prospective study in unselected patients. Am J Med 2001;110:528-35.
213. Vieillard-Baron A, Page B, Augarde R, et al. Acute cor pulmonale in massive pulmonary embolism: incidence, echocardiographic pattern, clinical implications and recovery rate. Intensive Care Med 2001;27:1481-6.
214. Comess K, DeRook F, Russell M, et al. The incidence of pulmonary embolism in unexplained sudden cardiac arrest with pulseless electrical activity. Am J Med 2000;109:351-6.
215. Krivec B, Voga G, Zuran I, et al. Diagnosis and treatment of shock due to massive pulmonary embolism: approach with transoesophageal echocardiography and intrapulmonary thrombolysis. Chest 1997;112:1310-6.
216. Antakly-Hanon Y, Vieillard-Baron A, Qanadli SD, et al. The value of transoesophageal echocardiography for the diagnosis of pulmonary embolism with acute cor pulmonale (French). Arch Mal Coeur Vaiss 1998;91:843-8.
217. Otmani A, Tribouilloy C, Leborgne L, et al. Diagnostic value of echocardiography and thoracic spiral CT angiography in the diagnosis of acute pulmonary embolism (French). Ann Cardiol Angeiol 1998;47:707-15.
218. Pruszczyk P, Torbicki A, Kuch-Wocial A, et al. Diagnostic value of transoesophageal echocardiography in suspected haemodynamically significant pulmonary embolism. Heart 2001;85:628-34.
219. Mathis G, Bitschnau R, Gehmacher O, et al. Chest ultrasound in diagnosis of pulmonary embolism in comparison to helical CT. Ultraschall Med 1999;20:54-9.
220. Reissig A, Heyne JP, Kroegel C. Sonography of lung and pleura in pulmonary embolism: sonomorphologic characterisation and comparison with spiral CT scanning. Chest 2001;120:1977-83.
221. Lechleitner P, Riedl B, Raneburger W, et al. Chest sonography in the diagnosis of pulmonary embolism: a comparison with MRI angiography and ventilation perfusion scintigraphy (German). Ultraschall Med 2002;23:373-8.
222. Coche EE, Muller NL, Kim KI, et al. Acute pulmonary embolism: ancillary findings at spiral CT. Radiology 1998;207:753-8.
223. Shah AA, Davis SD, Gamsu G, et al. Parenchymal and pleural findings in patients with and patients without acute pulmonary embolism detected at spiral CT. Radiology 1999;211:147-53.
224. Meaney JF, Weg JG, Chenevert TL, et al. Diagnosis of pulmonary embolism with magnetic resonance angiography. N Engl J Med 1997;336:1422-7.
225. Gupta A, Frazer CK, Ferguson JM, et al. Acute pulmonary embolism: diagnosis with MR angiography. Radiology 1999;210:353-9.
226. Bock JC, Lehmann J. MR imaging of experimental pulmonary embolism using a macromolecular contrast medium (German). Rofo Fortschr 1997;167:516-20.
227. Li KC, Pelc LR, Napel SA, et al. MRI of pulmonary embolism using Gd-DTPA-polyethylene glycol polymer enhanced 3D fast gradient echo technique in a canine model. Magn Reson Imag 1997;15:543-50.
228. Hurst DR, Kazerooni EA, Stafford-Johnson D, et al. Diagnosis of pulmonary embolism: comparison of CT angiography and MR angiography in canines. J Vasc Intervent Radiol 1999;10:309-18.
229. Reittner P, Coxson HO, Nakano Y, et al. Pulmonary embolism: comparison of gadolinium-enhanced MR angiography with contrast-enhanced spiral CT in a porcine model. Acad Radiol 2001;8:343-50.
230. Oudkerk M, van Beek EJR, Wielopolski P, et al. Comparison of contrast-enhanced magnetic resonance angiography and conventional pulmonary angiography for the diagnosis of pulmonary embolism: a prospective study. Lancet 2002;359:1643-7.
231. Ong YE, Crowther A, Miller A. Rapid diagnosis of massive pulmonary embolism in a district general hospital. Int J Clin Pract 2000;54:144-6.
232. Oliver TB, Reid JH, Murchison JT. Interventricular septal shift due to massive pulmonary embolism shown by CT pulmonary angiography: an old sign revisited. Thorax 1998;53:1092-4.
233. Wood KE. Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest 2002;121:877-905.
234. Smulders YM. Contribution of pulmonary vasoconstriction to haemodynamic instability after acute pulmonary embolism. Implications for treatment? Neth J Med 2001;58:241-7.
235. Daniels LB, Parker JA, Patel SR, et al. Relation of duration of symptoms with response to thrombolytic therapy in pulmonary embolism. Am J Cardiol 1997;80:184-8.
236. Arcasoy SM, Kreit JW. Thrombolytic therapy of pulmonary embolism: a comprehensive review of current evidence. Chest 1999;115:1695-707.
237. Thabut G, Thabut D, Myers R, et al. Thrombolytic therapy of pulmonary embolism: a meta-analysis. J Am Coll Cardiol 2002;40:1660-7.
238. Jerjes-Sanchez C, Ramirez-Rivera A, Garcia M de L, et al. Streptokinase and heparin versus heparin alone in massive pulmonary embolism: a randomised controlled trial. J Thromb Thrombolys 1995;2:227-9.
239. Rose PS, Punjabi NM, Pearse DB. Treatment of right heart thromboemboli. Chest 2002;121:806-14.
240. Konstantinides S, Geibel A, Olschewski M, et al. Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism: results of a multicenter registry. Circulation 1997;96:882-8.
241. Grifoni S, Olivotto I, Cecchini P, et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation 2000;101:2817-22.
242. Hamel E, Pacouret G, Vincentelli D, et al. Thrombolysis or heparin therapy in massive pulmonary embolism with right ventricular dilation: results from a 128-patient monocenter registry. Chest 2001;120:120-5.
243. Konstantinides S, Geibel A, Heusel G, et al. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med 2002;347:1143-50.
244. Serra-Prat M, Jovell AJ, Aymerich M. Efficacy and safety of thrombolytic therapy in pulmonary embolism: meta-analysis of randomised controlled trials (Spanish). Med Clin (Barc) 1999;112:685-9.
245. Agnelli G, Becattini C, Kirschstein T. Thrombolysis vs heparin in the treatment of pulmonary embolism: a clinical outcome-based meta-analysis. Arch Intern Med 2002;162:2537-41.
246. Gisselbrecht M, Diehl JL, Meyer G, et al. Comparison of efficacy and tolerability of a thrombolytic treatment with rt-PA in acute massive pulmonary embolism in the elderly and patients under 75 years of age (French). Rev Med Interne 1997;18:521-7.
247. Kanter DS, Mikkola KM, Patel SR, et al. Thrombolytic therapy for pulmonary embolism. Frequency of intracranial hemorrhage and associated risk factors. Chest 1997;111:1241-5.
248. Mikkola KM, Patel SR, Parker JA, et al. Increasing age is a major risk factor for hemorrhagic complications after pulmonary embolism thrombolysis. Am Heart J 1997;134:69-72.
249. Pacouret G, Barnes SJ, Hopkins G, et al. Rapid haemodynamic improvement following saruplase in recent massive pulmonary embolism. Thromb Haemost 1998;79:264-7.
250. Tebbe U, Graf A, Kamke W, et al. Haemodynamic effects of double bolus reteplase versus alteplase infusion in massive pulmonary embolism. Am Heart J 1999;138:39-44.
251. Meneveau N, Schiele F, Vuillemenot A, et al. Streptokinase vs alteplase in massive pulmonary embolism. A randomised trial assessing right heart haemodynamics and pulmonary vascular obstruction. Eur Heart J 1997;18:1141-8.
252. Meneveau N, Schiele F, Metz D, et al. Comparative efficacy of a two-hour regimen of streptokinase versus alteplase in acute massive pulmonary embolism: immediate clinical and haemodynamic outcome and one-year follow-up. J Am Coll Cardiol 1998;31:1057-63.
253. Schmitz-Rode T, Kilbinger M, Gunther RW. Simulated flow pattern in massive pulmonary embolism: significance for selective intrapulmonary thrombolysis. Cardiovasc Intervent Radiol 1998;21:199-204.
254. Verstraete M, Miller GA, Bounameaux H, et al. Intravenous and intrapulmonary recombinant tissue-type plasminogen activator in the treatment of acute massive pulmonary embolism. Circulation 1988;77:353-60.
255. Meyer G, Gisselbrecht M, Diehl JL, et al. Incidence and predictors of major hemorrhagic complications from thrombolytic therapy in patients with massive pulmonary embolism. Am J Med 1998;105:472-7.
256. Fava M, Loyola S, Flores P, et al. Mechanical fragmentation and pharmacologic thrombolysis in massive pulmonary embolism. J Vasc Intervent Radiol 1997;8:261-6.
257. Murphy JM, Mulvihill N, Mulcahy D, et al. Percutaneous catheter and guidewire fragmentation with local administration of recombinant tissue plasminogen activator as a treatment for massive pulmonary embolism. Eur Radiol 1999;9:959-64.
258. Voigtlander T, Rupprecht HJ, Nowak B, et al. Clinical application of a new rheolytic thrombectomy catheter system for massive pulmonary embolism. Catheter Cardiovasc Interv 1999;47:91-6.
259. Fava M, Loyola S, Huete I. Massive pulmonary embolism: treatment with the hydrolyser thrombectomy catheter. J Vasc Intervent Radiol 2000;11:1159-64.
260. Schmitz-Rode T, Janssens U, Duda SH, et al. Massive pulmonary embolism: percutaneous emergency treatment by pigtail rotation catheter. J Am Coll Cardiol 2000;36:375-80.
261. Müller-Hülsbeck S, Brossmann J, Jahnke T, et al. Mechanical thrombectomy of major and massive pulmonary embolism with use of the Amplatz thrombectomy device. Invest Radiol 2001;36:317-22.
262. De Gregorio MA, Gimeno MJ, Mainar A, et al. Mechanical and enzymatic thrombolysis for massive pulmonary embolism. J Vasc Intervent Radiol 2002;13:163-9.
263. Zwaan M, Kripke N, Lorch H, et al. In-vitro evaluation of different embolectomy catheters for the treatment of acute pulmonary embolism (German). Rofo Fortschr 1999;171:485-91.
264. Doerge H, Schoendube FA, Voss M, et al. Surgical therapy of fulminant pulmonary embolism: early and late results. Thorac Cardiovasc Surg 1999;47:9-13.
265. Chartier L, Michon P, Loubeyre C, et al. Mobile right heart thrombi in pulmonary embolism (French). Arch Mal Coeur Vaiss 1997;90:1471-6.
266. Casazza F, Agostoni O, Mandelli V, et al. The cardiologist facing pulmonary embolism: the experience of 160 cases of acute cor pulmonale (Italian). Ital Heart J 2000;1:520-6.
267. Courtney DM, Sasser HC, Pincus CL, et al. Pulseless electrical activity with witnessed arrest as a predictor of sudden death from massive pulmonary embolism in outpatients. Resuscitation 2001;49:265-72.
268. Kurkciyan I, Meron G, Sterz F, et al. Pulmonary embolism as a cause of cardiac arrest: presentation and outcome. Arch Intern Med 2000;160:1529-35.
269. Ruiz-Bailen M, Aguayo-de-Hoyos E, Serrano-Corcoles MC, et al. Thrombolysis with recombinant tissue plasminogen activator during cardiopulmonary resuscitation in fulminant pulmonary embolism. A case series. Resuscitation 2001;51:97-101.
270. Kawahito K, Murata S, Adachi H, et al. Resuscitation and circulatory support using extracorporeal membrane oxygenation for fulminant pulmonary embolism. Artif Organs 2000;24:427-30.
271. Simonneau G, Sors H, Charbonnier B, et al. A comparison of low-molecular-weight heparin with unfractionated heparin for acute pulmonary embolism. The THESEE Study Group. N Engl J Med 1997;337:663-9.
272. Hirsh J, Warkentin TE, Shaughnessy SG, et al. Heparin and low-molecular-weight heparin mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest 2001;119:64-94S.
273. Hyers TM, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease. Chest 2001;119:176S-93S.
274. Wells PS, Kovacs MJ, Bormanis J, et al. Expanding eligibility for outpatient treatment of deep venous thrombosis and pulmonary embolism with low-molecular-weight heporin: a comparison of patient self-injection with homecare injection. Arch Intern Med 1998;158:1809-12.
275. Dolovich LR, Ginsberg JS, Douketis JD, et al. A meta-analysis comparing low-molecular-weight heparins with unfractionoted heparin in the treatment of venous thromboembolism: examining some unanswered questions regarding location of treatment, product type, and dosing frequency. Arch Intern Med 2000;160:181-8.
276. Kovacs MJ, Anderson D, Morrow B, et al. Outpatient treatment of pulmonary embolism with dalteparin. Thromb Haemost 2000;83:209-11.
277. Merli G, Spiro TE, Olsson CG, et al. Subcutaneous enoxaparin once or twice daily compared with intravenous unfractionated heparin for treatment of venous thromboembolic disease. Ann Intern Med 2001;134:191-202.
278. Van den Belt AG, Prins MH, Lensing AW, et al. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst Rev 2000:CD001100.
279. Hull RD, Raskob GE, Brant RF, et al. Low-molecular-weight heparin vs heparin in the treatment of patients with pulmonary embolism. American-Canadian Thrombosis Study Group Arch Intern Med 2000;160:229-36.
280. Couturaud F, Julian JA, Kearon C. Low molecular weight heparin administered once versus twice daily in patients with venous thromboembolism: a meta-analysis. Thromb Haemost 2001;86:980-4.
281. Wåhlander K, Lapidus L, Olsson C-G, et al. Pharmacokinetics, pharmacodynamics and clinical effects of the oral direct thrombin inhibitor ximelagatran in acute treatment of patients with pulmonary embolism and deep vein thrombosis. Thromb Res 2002;107:93-9.
282. British Thoracic Society. Optimum duration of anticoagulation for deep-vein thrombosis and pulmonary embolism. Lancet 1992;340:873-6.
283. Hirsh J. The optimal duration of anticoagulant therapy for venous thrombosis. N Engl J Med 1995;332:1710-1.
284. Schulman S, Rhedin AS, Lindmarker P, et al. A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism. N Engl J Med 1995;332:1661-5.
285. Agnelli G, Prandoni P, Santamaria MG, et al. Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. N EngJ J Med 2001;345:165-9.
286. Pinede L, Ninet J, Duhaut P, et al. Comparison of 3 and 6 months of oral anticoagulant therapy after a first episode of proximal deep vein thrombosis or pulmonary embolism and comparison of 6 and 12 weeks of therapy after isolated calf deep vein thrombosis. Circulation 2001;103:2453-60.
287. Schulman S, Granqvist S, Holmstrom M, et al. The duration of oral anticoagulant therapy after a second episode of venous thromboembolism. The Duration of Anticoagulation Trial Study Group. N Engl J Med 1997;336:393-8.
288. Hirsh J, Dalen JE, Anderson DR, et al. Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest 2001;119:8-21S.
289. Palareti G, Leali N, Coccheri S, et al. Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study. Lancet 1996;348:423-8.
290. Bigaroni A, Perrier A, de Moerloose P, et al. Risk of major bleeding in unselected patients with venous thromboembolism. Blood Coagul Fibrinolysis 2000;11:199-202.
291. Levine MN, Raskob G, Landefeld S, et al. Hemorrhagic complications of anticoagulant treatment. Chest 2001;119:108-21S.
292. Stein P, Hull R, Raskob G. Withholding treatment in patients with acute pulmonary embolism who have a high risk of bleeding and negative serial non-invasive leg tests. Am J Med 2000;109:301-6.
293. Odén A, Fahlén M. Oral anticoagulation and risk of death: a medical record linkage study. BMJ 2002;325:1073-5.
294. Haire WD. Vena caval filters for the prevention of pulmonary embolism. N Engl J Med 1998;338:463-4.
295. Decousus H, Leizorovicz A, Parent F, et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. N Engl J Med 1998;338:409-15.
296. White R, Zhou H, Kim J, et al. A population-based study of the effectiveness of inferior vena cava filter use among patients with venous thromboembolism. Arch Intern Med 2000;160:2033-41.
297. Geffroy S, Furber A, L'Hoste P, et al. Very long term outcome of 68 vena caval filters implanted percutaneously (French). Arch Mal Coeur Vaiss 2002;95:38-44.
298. Asch MR. Initial experience in humans with a new retrievable inferior vena cava filter. Radiology 2002;225:835-44.
299. Sing RF, Jacobs DG, Heniford BT. Bedside insertion of inferior vena cava filters in the intensive care unit. J Am Coll Surg 2001;192:570-5.
300. De Swiet M. Management of pulmonary embolus in pregnancy. Eur Heart J 1999;20:1378-85.
301. Ginsberg JS, Greer I, Hirsh J. Use of antithrombotic agents during pregnancy. Chest 2001;119:122-31S.
302. Greer IA. The acute management of venous thromboembolism in pregnancy. Curr Opin Obstet Gynecol 2001;13:569-75.
303. Laurent P, Dussarat GV, Bonal J, et al. Low molecular weight heparins: a guide to their optimum use in pregnancy. Drugs 2002;62:463-77.
304. Douketis J, Foster G, Crowther M, et al. Clinical risk factors and timing of recurrent venous thromboembolism during the initial 3 months of anticoagulant therapy. Arch Intern Med 2000;160:3431-6.
305. Hutten BA, Prins MH, Gent M, et al. Incidence of recurrent thromboembolic and bleeding complications among patients with venous thromboembolism in relation to both malignancy and achieved international normalized ratio: a retrospective analysis. J Clin Oncol 2000;18:3078-83.
306. Lee AY. Treatment of venous thromboembolism in cancer patients. Thromb Res 2001;102:195-208.
307. Jarrett BP, Dougherty MJ, Calligaro KD. Inferior vena cava filters in malignant disease. J Vasc Surg 2002;36:704-7.