Venous Thromboembolism (VTE) Clinical Scenarios

Tuesday, October 30, 2018, 12:00 AM - Saturday, October 30, 2021, 12:00 AM


Jointly Provided - Enduring Materials Internet

1. Identify the symptoms and physical signs of VTE.
2. Describe when to use D-Dimer and how to follow up with specific population with PE.
3. Explain when to use CPTA and V/Q scan to diagnose PE.
4. Identify when and how to use the PERC rule, PVI and other tools compared to clinical gestalt for estimating pretest probability of a PE diagnosis.
5. Describe how biomarkers, echoes, and the presence of a saddle embolus impact the decision for admission into the hospital.
6. Explain what differences in effectiveness and side effect profile between the different NOACs when prescribing them for certain patients.

Please click HERE to access the venous thromboembolism (VTE) clinical scenarios.

Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by Indiana University School of Medicine and Indiana University Health. Indiana University School of Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physicians

Indiana University School of Medicine designates this enduring activity for a maximum of .50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Reference List/Bibliography
1. Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, 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.
2. Wolf, Stephen J. et al. Prospective validation of wells criteria in the evaluation of patients with suspected pulmonary embolism. Annals of Emergency Medicine , Volume 44 , Issue 5 , 503 – 510.
3. Van Belle A, Bueller HR, Huisman MV, et al. Effectiveness of Managing Suspected Pulmonary Embolism Using an Algorithm Combining Clinical Probability, D-Dimer Testing, and Computed Tomography. JAMA: The Journal of the American Medical Association. Jan 11 2006;295(2):172–179.
4. Rosen, Peter, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice. Elsevier, 2018.
5. Crawford F, Andras A, Welch K, Sheares K, Keeling D, Chappell FM. D-dimer test for excluding the diagnosis of pulmonary embolism. Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD010864.
6. W Lucassen, GJ Geersing, PM Erkens, et al.: Clinical decision rules for excluding pulmonary embolism: a meta-analysis. Ann Intern Med. 155:448-460 2011
7.  Kline JA, et al. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost 2004; 2: 1247-55.
8. Kline JA, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost 2008; 6: 772-80.
9. Le Gal G, Righini M, Roy P, Sanchez O, Aujesky D, Bounameaux H, et al. Prediction of Pulmonary Embolism in the Emergency Department: The Revised Geneva Score. Ann Intern Med. 2006;144:165–171.
10. Zondag W, Mos IC, Creemers-schild D, et al. Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study. J Thromb Haemost. 2011;9(8):1500-7.
11. Beam DM, Kahler ZP, Kline JA. Immediate discharge and home treatment with rivaroxaban of low risk venous thromboembolism diagnosed in two U.S. emergency departments: a one-year preplanned analysis. Acad Emerg Med 2015;22:789-95.
12. Jiménez D, Aujesky D, Moores L, Gómez V, Lobo JL, Uresandi F, Otero R, Monreal M, Muriel A, Yusen RD, . Simplification of the Pulmona

For questions about accessibility or to request accommodations please contact the CME office at 317-274-0104 or [email protected] One week advance notice will allow us to provide seamless access. Please ensure to specify the accommodations you need in order to participate.

AMA PRA Category 1 Credits™ (0.50 hours), Non-Physician Attendance (0.50 hours)

Indiana University School of Medicine (IUSM) policy ensures that those who have influenced the content of a CE activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that IUSM may identify and resolve any conflicts of interest prior to the activity. All educational programs sponsored by Indiana University School of Medicine must demonstrate balance, independence, objectivity, and scientific rigor.

There are no relevant financial relationships with a commercial interest for anyone who was in control of the content of this activity, except:
Jeffrey A Kline, MD has disclosed he received research grants from Janssen Pharmaceuticals, Mallinckrodt Inc., Roche and Stago Diagnostica.

*Indiana University School of Medicine (IUSM) defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Reference List/Bibliography:
1. Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, 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.
2. Wolf, Stephen J. et al. Prospective validation of wells criteria in the evaluation of patients with suspected pulmonary embolism. Annals of Emergency Medicine , Volume 44 , Issue 5 , 503 – 510.
3. Van Belle A, Bueller HR, Huisman MV, et al. Effectiveness of Managing Suspected Pulmonary Embolism Using an Algorithm Combining Clinical Probability, D-Dimer Testing, and Computed Tomography. JAMA: The Journal of the American Medical Association. Jan 11 2006;295(2):172–179.
4. Rosen, Peter, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice. Elsevier, 2018.
5. Crawford F, Andras A, Welch K, Sheares K, Keeling D, Chappell FM. D-dimer test for excluding the diagnosis of pulmonary embolism. Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD010864.
6. W Lucassen, GJ Geersing, PM Erkens, et al.: Clinical decision rules for excluding pulmonary embolism: a meta-analysis. Ann Intern Med. 155:448-460 2011
7.  Kline JA, et al. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost 2004; 2: 1247-55.
8. Kline JA, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost 2008; 6: 772-80.
9. Le Gal G, Righini M, Roy P, Sanchez O, Aujesky D, Bounameaux H, et al. Prediction of Pulmonary Embolism in the Emergency Department: The Revised Geneva Score. Ann Intern Med. 2006;144:165–171.
10. Zondag W, Mos IC, Creemers-schild D, et al. Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study. J Thromb Haemost. 2011;9(8):1500-7.
11. Beam DM, Kahler ZP, Kline JA. Immediate discharge and home treatment with rivaroxaban of low risk venous thromboembolism diagnosed in two U.S. emergency departments: a one-year preplanned analysis. Acad Emerg Med 2015;22:789-95.
12. Jiménez D, Aujesky D, Moores L, Gómez V, Lobo JL, Uresandi F, Otero R, Monreal M, Muriel A, Yusen RD, . Simplification of the Pulmonary Embolism Severity Index for Prognostication in Patients With Acute Symptomatic Pulmonary Embolism. Arch Intern Med. 2010;170(15):1383–1389.