What are the risk factors for pulmonary embolism (PE)?

From the Guidelines

Pulmonary embolism risk factors include previous PE or DVT, heart rate >100 beats/min, surgery or immobilization within the past four weeks, haemoptysis, active cancer, clinical signs of DVT, and alternative diagnosis less likely than PE, as identified by clinical prediction scores such as Wells’ rule and Revised Geneva score 1. These risk factors are crucial in identifying patients at high risk of developing pulmonary embolism, which can lead to significant morbidity and mortality if left untreated.

Key Risk Factors

• Previous PE or DVT
• Heart rate >100 beats/min
• Surgery or immobilization within the past four weeks
• Haemoptysis
• Active cancer
• Clinical signs of DVT
• Alternative diagnosis less likely than PE The clinical prediction scores, such as Wells’ rule and Revised Geneva score, can help stratify patients into different risk categories, guiding further diagnostic and therapeutic management 1.

Clinical Prediction Scores

• Wells’ rule: assigns points for each risk factor, with a total score indicating the likelihood of PE
• Revised Geneva score: also assigns points for each risk factor, with a total score indicating the likelihood of PE It is essential to note that these risk factors and clinical prediction scores should be used in conjunction with clinical judgment and other diagnostic tools to accurately diagnose and manage pulmonary embolism 1.

Importance of Clinical Judgment

• Clinical judgment is crucial in interpreting the results of clinical prediction scores and other diagnostic tests
• Other diagnostic tools, such as imaging studies and laboratory tests, should be used in conjunction with clinical prediction scores to confirm the diagnosis of PE By understanding these risk factors and using clinical prediction scores, healthcare providers can identify high-risk patients and implement preventive measures, such as early mobilization, anticoagulant prophylaxis, and lifestyle modifications, to reduce the risk of pulmonary embolism and improve patient outcomes 1.

From the Research

Risk Factors for Pulmonary Embolism (PE)

The risk factors for pulmonary embolism (PE) are not explicitly stated in the provided studies, but the following information can be inferred:

• PE is a potentially life-threatening disorder most commonly seen in debilitated patients with other common medical problems 2
• Immobility is a significant risk factor, as PE often occurs as a consequence of deep venous thrombosis (DVT) in this setting 2
• Other risk factors can be inferred from the patient populations discussed in the studies, such as:
  • Cancer 3
  • Hemodynamic instability 4, 5, 6
  • Cardiovascular instability 5
  • Advanced age 4
  • Renal impairment 4
  • High bleeding risk 4, 5
  • Extremes of body weight 4

Patient Populations at Risk

Certain patient populations are at higher risk for PE and its complications, including:

• Patients with hemodynamic instability 4, 5, 6
• Patients with intermediate-risk PE 5
• Patients with cancer and thrombosis 3
• Patients with a history of DVT or PE 2
• Patients with limited mobility or those who have undergone recent surgery 2

Diagnostic and Therapeutic Considerations

The diagnosis and treatment of PE involve a range of considerations, including:

• Clinical assessment and simple investigations 2
• Imaging tests such as ventilation/perfusion lung scans or computerized tomography pulmonary angiograms 2, 4, 3
• Anticoagulation treatment with low molecular weight heparin or fondaparinux 4, 3
• Thrombolytic therapy for patients with high-risk PE or those who are hemodynamically unstable 4, 5, 6
• Surgical embolectomy or catheter-based thrombus removal for patients who are not candidates for thrombolytic therapy 4, 5, 6