Embolie pulmonaire-TVP

Embolie pulmonaire et maladie thromboembolique; thrombophlébite :

Pulmonary embolism management in the emergency department, Serebriakoff P, Cafferkey J, de Wit K, et al, Emergency Medicine Journal, Published Online First: 05 April 2022. doi: 10.1136/emermed-2021-212001

Thrombolytic therapy for pulmonary embolism.Zuo Z, Yue J, Dong BR, et al.  Cochrane Database Syst Rev. 2021 Apr 15;4:CD004437. doi: 10.1002/14651858.CD004437.pub6. (Systematic review)

Direct Oral Anticoagulants vs Low-Molecular-Weight Heparin and Recurrent VTE in Patients With Cancer: A Randomized Clinical Trial. Schrag D, Uno H, Rosovsky R, Rutherford C, Sanfilippo K, Villano JL, Drescher M, Jayaram N, Holmes C, Feldman L, Zattra O, Farrar-Muir H, Cronin C, Basch E, Weiss A, Connors JM; CANVAS Investigators.  JAMA. 2023 Jun 13;329(22):1924-1933. doi: 10.1001/jama.2023.7843. PMID: 37266947; PMCID: PMC10265290.

Anticoagulants oraux directs et warfarine dans la fibrillation auriculaire et la thromboembolie veineuse, INESS, avril 2019

American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism, Blood Adv. 2020 Oct 13;4(19):4693-4738. doi: 10.1182/bloodadvances.2020001830. PMID: 33007077; PMCID: PMC7556153.

2019 ESC Guidelines for the Diagnosis and Management of Acute Pulmonary Embolism Developed in Collaboration With the European Respiratory Society (ERS): The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2019;Aug 31:[Epub ahead of print].

Diagnostic algorithm for patients with suspected pulmonary embolism without haemodynamic instability

Risk-adjusted management strategy for acute pulmonary embolism

Recommendations for acute-phase treatment of high-risk pulmonary embolism

Recommendations for acute-phase treatment of intermediate- or low-risk pulmonary embolism

Graphic representation of transthoracic echocardiographic parameters in the assessment of right ventricular pressure overload

2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. Farge D, Frere C, Connors JM, Ay C, Khorana AA, Munoz A, Brenner B, Kakkar A, Rafii H, Solymoss S, Brilhante D, Monreal M, Bounameaux H, Pabinger I, Douketis J; International Initiative on Thrombosis and Cancer (ITAC) advisory panel.Lancet Oncol. 2019 Oct;20(10):e566-e581. doi: 10.1016/S1470-2045(19)30336-5. Epub 2019 Sep 3. Review.

Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer. Giancarlo G Agnelli New England Journal of Medicine 382(17) 2020-23 0028-4793

Antithrombotic Therapy for VTE Disease, CHEST Guideline and Expert Panel Report, Chest, February 2016, Vol 149, No.2

Management of Pulmonary Embolism: An Update.,  J Am Coll Cardiol 2016;67:976-990

Massive pulmonary embolism (haemodynamically  unstable PE) — diagnosis and management , NHS, Feb 2015

Systemic Thrombolysis for Pulmonary Embolism: A Review, P T. 2016 Dec; 41(12): 770–775. 

Alteplase For Pulmonary Embolism (PE) , UHN, Jan 2015

2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. Farge D, Frere C, Connors JM, Ay C, Khorana AA, Munoz A, Brenner B, Kakkar A, Rafii H, Solymoss S, Brilhante D, Monreal M, Bounameaux H, Pabinger I, Douketis J; International Initiative on Thrombosis and Cancer (ITAC) advisory panel. Lancet Oncol. 2019 Oct;20(10):e566-e581. doi: 10.1016/S1470-2045(19)30336-5. Epub 2019 Sep 3. Review

Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event: systematic review and meta-analysis. Khan F, Rahman A, Carrier M, Kearon C, Weitz JI, Schulman S, Couturaud F, Eichinger S, Kyrle PA, Becattini C, Agnelli G, Brighton TA, Lensing AWA, Prins MH, Sabri E, Hutton B, Pinede L, Cushman M, Palareti G, Wells GA, Prandoni P, Büller HR, Rodger MA; MARVELOUS Collaborators. BMJ. 2019 Jul 24;366:l4363. doi: 10.1136/bmj.l4363.

PMID: 31340984

CONCLUSIONS: In patients with a first episode of unprovoked VTE who completed at least three months of anticoagulant treatment, the risk of recurrent VTE was 10% in the first year after treatment, 16% at two years, 25% at five years, and 36% at 10 years, with 4% of recurrent VTE events resulting in death. These estimates should inform clinical practice guidelines, enhance confidence in counselling patients of their prognosis, and help guide decision making about long term management of unprovoked VTE.


Comparison of the unstructured clinician gestalt, the wells score, and the revised Geneva score to estimate pretest probability for suspected pulmonary embolism. Penaloza A, Verschuren F, Meyer G, Quentin-Georget S, Soulie C, Thys F, Roy PM. Ann Emerg Med. 2013 Aug;62(2):117-124.e2. doi: 10.1016/j.annemergmed.2012.11.002. Epub 2013 Feb 21. PMID: 23433653.

Comparison of YEARS and Adjust-Unlikely D-dimer Testing for Pulmonary Embolism in the Emergency Department. de Wit K, Al-Haimus F, Hu Y, Ikesaka R, Chan N, Ibrahim Q, Klyn J, Clayton N, Germini F. Ann Emerg Med. 2022 Nov 10:S0196-0644(22)01118-0. doi: 10.1016/j.annemergmed.2022.09.014. Epub ahead of print. PMID: 36371248.

Results: One thousand seven hundred three patients were included, median age 62 (50, 74), 58% female, PE prevalence 8.0%. YEARS sensitivity for PE diagnosis was 92.6% (87.0, 96.0%) and specificity 45.0% (42.5, 47.5%). Adjust-Unlikely sensitivity was 100.0% (97.2, 100.0%) and specificity 32.4% (30.1, 34.8%). Posttest probability of PE in the group of patients with PE excluded by D-dimer between 500 ng/ml and the adjusted limit was 2.8% (1.6, 5.1%) for YEARS and 0.0% (0.0, 2.6%) for the "Adjust-Unlikely" rule.

Conclusion: The "Adjust-Unlikely" rule would modestly reduce imaging and identify all cases of PE. YEARS would substantially reduce imaging but miss 1 in 14 cases of PE.

YEARS Algorithm Versus Wells' Score: Predictive Accuracies in Pulmonary Embolism Based on the Gold Standard CT Pulmonary Angiography. Abdelaal Ahmed Mahmoud M Alkhatip A, Donnelly M, Snyman L, Conroy P, Hamza MK, Murphy I, Purcell A, McGuire D. Crit Care Med. 2020 Feb 19. doi: 10.1097/CCM.0000000000004271. [Epub ahead of print] PMID: 32079894

MEASUREMENTS AND MAIN RESULTS: Of 794 scans, 78 (9.8%) were positive for pulmonary embolism. The YEARS algorithm was more sensitive than the Wells' score (97.44% vs 74.36%) but was less specific (13.97% vs 33.94%). Furthermore, the diagnostic odds ratio of YEARS was higher than Wells' score (6.27 vs 1.48). YEARS provides better negative predictive value (98% vs 92.4%), and both scores have poor positive predictive value (10.9%).


Both scores successfully exclude pulmonary embolism, although YEARS has a better negative predictive value. Both exhibit poor positive predictive value.

Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability. Kearon C, de Wit K, Parpia S, Schulman S, Afilalo M, Hirsch A, Spencer FA, Sharma S, D'Aragon F, Deshaies JF, Le Gal G, Lazo-Langner A, Wu C, Rudd-Scott L, Bates SM, Julian JA; PEGeD Study Investigators. N Engl J Med. 2019 Nov 28;381(22):2125-2134. doi: 10.1056/NEJMoa1909159.PMID: 31774957

CONCLUSIONS: A combination of a low C-PTP and a d-dimer level of less than 1000 ng per milliliter identified a group of patients at low risk for pulmonary embolism during follow-up. (Funded by the Canadian Institutes of Health Research and others; PEGeD ClinicalTrials.gov number, NCT02483442.).

Comparison of the age-adjusted and clinical probability-adjusted D-dimer to exclude pulmonary embolism in the emergency department, Am J Emerg Med. 2018 Jul 30. pii: S0735-6757(18)30633-8. doi: 10.1016/j.ajem.2018.07.053. 

Conclusion: The clinical probability-adjusted rule appears to exclude PE in a greater proportion of patients, with a very small reduction in the negative predictive value.

Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. YEARS study group. Lancet. 2017 Jul 15;390(10091):289-297. doi: 10.1016/S0140-6736(17)30885-1. Epub 2017 May 23. Erratum in: Lancet. 2017 Jul 15;390(10091):230

Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism, N Engl J Med. 2019 Mar 21;380(12):1139-1149. doi: 10.1056/NEJMoa1813865.

CONCLUSIONS: Pulmonary embolism was safely ruled out by the pregnancy-adapted YEARS diagnostic algorithm across all trimesters of pregnancy. CT pulmonary angiography was avoided in 32 to 65% of patients.

Outcomes following a negative computed tomography pulmonary angiography according to pulmonary embolism prevalence: a meta‐analysis of the management outcome studies, Belzile D, Jacquet S, Bertoletti L, Lacasse Y1 Lambert C, Lega JC, Provencher S, J Thromb Haemost. 2018 Jun;16(6):1107-1120. doi: 10.1111/jth.14021. Epub 2018 May 17.

Conclusions : The negative predictive value of CTPA for VTE varies according to pretest prevalence of PE, and is likely to be insufficient to safely rule out VTE as a stand‐alone diagnostic test amongst patients at the highest pretest probability of VTE. Prospective studies are required to validate the appropriate diagnostic algorithm for this subgroup of patients. Subgroup analyses suggested that the cumulative occurrence of VTE was related to pretest prevalence of PE, as VTE occurred in 1.8% (95% CI, 0.5–3.7%), 1.4% (95% CI, 0.7–2.3%), 1.0% (95% CI, 0.5–1.8%) and 8.1% (95% CI, 3.5–14.5%) of subgroups of patients with a PE prevalence < 20%, 20–29%, 30–39% and ≥ 40%, respectively.

Performance of the 4-Level Pulmonary Embolism Clinical Probability Score (4PEPS) in the diagnostic management of pulmonary embolism: An external validation study. Stals MAM, Beenen LFM, Coppens M, et al. Thromb Res. 2023 Sep 20;231:65-75. doi: 10.1016/j.thromres.2023.09.010. (Original study)

PERC Score: 

Prospective multicenter evaluation of the pulmonary embolism rule-out criteria, J Thromb Haemost. 2008 May;6(5):772-80. doi: 10.1111/j.1538-7836.2008.02944.x. Epub 2008 Mar 3


PESI Score:


Calculateur Score simplifié

D-dimères selon l’âge : Age-Adjusted D-Dimer Cutoff Levels to Rule Out Pulmonary Embolism, The ADJUST-PE Study, JAMA. 2014;311(11):1117-1124. doi:10.1001/jama.2014.2135

Investigation supplémentaire

Cancer Screening in Patients with Unprovoked Thromboembolism: How to do it and Who Benefits? Ferreira F, Pereira J, Lynce A, Nunes Marques J, Martins A. Cureus. 2020 Feb 10;12(2):e6934. doi: 10.7759/cureus.6934. PMID: 32051805; PMCID: PMC7011576. 

Traitement externe

Outpatient versus inpatient treatment for acute pulmonary embolism. Yoo HHB, Nunes-Nogueira VS, Fortes Villas Boas PJ, Broderick C. Cochrane Database of Systematic Reviews 2022, Issue 5. Art. No.: CD010019. DOI: 10.1002/14651858.CD010019.pub4. Accessed 01 February 2024.

Outpatient treatment of pulmonary embolism. Bellou E, Keramida E, Karampinis I, Dimakakos E, Misthos P, Demertzis P, Hardavella G. Breathe (Sheff). 2020 Sep;16(3):200069. doi: 10.1183/20734735.0069-2020. PMID: 33447272; PMCID: PMC7792861.

Outpatient Management of Pulmonary Embolism, ACEP Now, Lauren Westafer, DO, MPH | June 15, 2021