An RCT comparing rivaroxaban and apixaban for patients with acute venous thromboembolism is ongoing (NCT03266783), evaluating the differences in clinically relevant bleeding with these anticoagulants. Provenance and peer review: Commissioned; externally peer reviewed. The diagnosis of a pulmonary embolism has a significant psychological effect on patients, who often refer to such an event as a near-miss death experience. 3. Data from registry studies have suggested a higher in-hospital and 30 day pulmonary embolism related mortality in women,21 whereas other studies have not observed a difference.22 Subgroup analyses of RCTs comparing warfarin and DOAC therapy have not suggested a difference. Drug-drug interactions are another consideration, particularly for DOACs. Curr Oncol 2018112, BID=twice daily; INR=international normalized ratio; LMWH=low molecular weight heparin; VKA=vitamin K antagonist, *LMWH is needed for 5-10 days before starting edoxaban, †Not included in original Canadian expert consensus recommendations, ‡30 mg daily if creatinine clearance 30-50 mL/min or weight <60 kg, DOACs and fondaparinux cross the placenta and should be avoided in pregnancy. Given the high prevalence of antiphospholipid syndrome among patients under 50 years old with unprovoked venous thromboembolism, and implications for duration and choice of anticoagulation, screening for antiphospholipid syndrome should be considered in these patients. We used Ovid Medline and PubMed for dedicated search strategies of selected topics thought not to be included in the above search. Major bleeding events were mostly seen in the subgroup of patients with upper gastrointestinal tract malignancies. Acute massive pulmonary embolism after cardiac surgery is very rare. In the absence of high quality evidence, the patient’s preference should be considered in such decisions. We focused our search on systematic reviews and meta-analyses judged to be of medium or high quality by the AMSTAR tool or as of acceptable quality by the SIGN-50 tool.2627 When multiple systematic reviews or meta-analyses covered the same topic, we chose the study with the best methodological quality; when studies had similar quality, we chose the most recent. In this case, a catheter is placed in a large vein in the groin and moved through the right side of the heart in to the main pulmonary artery. In the end, 11 endorsed clinical practice guidelines/consensus statements, 24 systematic reviews/meta-analysis, 25 randomized trials, 39 prospective studies, and 21 retrospective/secondary analysis studies informed our overview (fig 1). The treatment includes anticoagulants such as heparin and warfarin . The identification of antiphospholipid syndrome may be important to guide decisions on choice of anticoagulant therapy. Unfortunately, slow recruitment in the SELECT-D pilot trial resulted in an inability to definitively compare the efficacy and safety of rivaroxaban and LMWH. However, this presentation is uncommon, being found in only 5% of cases; the short term mortality exceeds 15%.14151686 For the remaining 95% of cases, several risk prediction scores have been proposed to estimate the risk of an adverse outcome (table 2).33888990, Comparison of pulmonary embolism risk prediction scores, A systematic review assessing the characteristics and quality of pulmonary embolism risk prediction scores identified 17 models in the literature.91 Of these, the Pulmonary Embolism Severity Index (PESI) and the simplified-PESI (sPESI) had the most robust evidence and validation. We searched Ovid Medline, Cochrane CENTRAL, and other non-indexed citations from 1 January 2010 to 7 August 2019 to find English language systematic reviews, meta-analyses, and RCTs that evaluated management of pulmonary embolism. Furthermore, post hoc retrospective application of this pregnancy adapted YEARS algorithm to the cohort of patients in the first study showed similar findings, with 21% of women meeting criteria for exclusion of pulmonary embolism without diagnostic imaging and no venous thromboembolism events during follow-up.52 Limitations of these studies include relative small sample sizes and possible bias for inclusion of patients at lower risk. Be indicated in hemodynamically unstable acute PTE lacking until recently from extended duration therapy VKAs may be used if or... 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