· When deciding on references, consider whether the journal is high impact. References should also be within the last 5 years.

· References should be more related to practice guidelines and not clinical trials. We want to make sure that the presentation is clear on how to diagnose and treat PE related to current standards of practice. See below some links that may help.

· https://pmc.ncbi.nlm.nih.gov/articles/PMC7284001/

· https://www.hematology.org/education/clinicians/guidelines-and-quality-care/clinical-practice-guidelines/venous-thromboembolism-guidelines/treatment

· https://www.ncbi.nlm.nih.gov/books/NBK560551/

· https://www.nejm.org/doi/full/10.1056/NEJMcp2116489

· Often times a hematologist will be consulted to see a patient with newly diagnosed DVT or PE. This would be a good source to reference from the American Society of Hematology.

· Add 2 slides to the outline:

· Comparison of prior standards for diagnosing and treating PEs. Remember our audience will be practitioners in practice with 20+ years and novice practitioners.

· Populations for Special Considerations for treating PEs

· What happens if a patient cannot be treated with Heparin, etc? The standard treatments.

· Are there special considerations for cancer patients, older adults, etc.

· Add treatment education for patients.

SOLUTION

Pulmonary Embolism (PE): Diagnosis and Management – Updated Practice Guidelines

Slide 1: Title Slide

Title: Pulmonary Embolism: Evidence-Based Diagnosis and Management
Presenter’s name, credentials, institution
Date

Slide 2: Objectives

Understand current guidelines for diagnosing PE
Review updated treatment standards and how they compare to previous practices
Identify considerations for special populations
Discuss patient education strategies

Slide 3: Overview of Pulmonary Embolism

Definition of PE
Pathophysiology: Embolism originating from deep veins, primarily in legs
Clinical significance: High morbidity and mortality without prompt treatment

Slide 4: Epidemiology and Risk Factors

Incidence: Approx. 1 in 1000 adults annually
Risk factors: Immobility, recent surgery, cancer, hormonal therapy, obesity, previous DVT/PE, genetic predisposition

Slide 5: Clinical Presentation

Common symptoms: Dyspnea, pleuritic chest pain, cough, hemoptysis
Signs: Tachycardia, hypoxia, leg swelling (if DVT), syncope (severe PE)

Slide 6: Diagnosis – Current Guidelines

Use of Wells Score or Geneva Score to assess pretest probability
D-dimer testing in low to moderate risk
Imaging: CT Pulmonary Angiography (CTPA) as the gold standard
V/Q scan in patients contraindicated for contrast
Bedside echocardiography in hemodynamically unstable patients

Source: Konstantinides et al., 2020; ASH VTE Guidelines, 2020

Slide 7: Comparison to Prior Standards of Diagnosis and Treatment

Prior: Universal use of CTPA and empirical anticoagulation
Now: Risk stratification is emphasized to reduce unnecessary imaging and bleeding risk
Integration of clinical decision rules (e.g., Wells, PERC)
Shift from inpatient to outpatient treatment for low-risk PE

Source: NEJM, 2022; ASH Guidelines, 2020

Slide 8: Initial Management and Stabilization

Oxygen support and hemodynamic monitoring
Anticoagulation as the cornerstone of therapy (Heparin or DOACs)
Thrombolysis in massive/high-risk PE (hypotension, shock)

Slide 9: Anticoagulation Therapy

First-line: DOACs (Apixaban, Rivaroxaban) for most patients
Alternatives: LMWH (Enoxaparin) or IV Heparin (especially for unstable patients)
Warfarin: Still used with bridging in specific populations (e.g., mechanical valves)

Source: ASH VTE Guidelines, 2020; NEJM, 2022

Slide 10: What if Heparin Cannot Be Used?

Fondaparinux: Synthetic Xa inhibitor for patients with HIT
DOACs preferred if renal function allows
IVC filter: Reserved for patients with absolute contraindication to anticoagulation

Slide 11: Duration of Therapy

Provoked PE: 3 months
Unprovoked or recurrent: Extended therapy
Cancer-associated PE: LMWH or DOACs for at least 6 months

Slide 12: Special Populations for PE Treatment

Cancer patients: Prefer LMWH or DOACs (Apixaban/Rivaroxaban)
Older adults: Increased bleeding risk; careful DOAC dosing, monitor renal function
Pregnant women: LMWH is standard; DOACs contraindicated
Obese patients: Adjusted dosing based on actual or ideal body weight

Source: ASH, 2020; NCCN Guidelines for Cancer-Associated VTE

Slide 13: Monitoring and Follow-up

Monitor for bleeding, adherence, and recurrence
Labs: CBC, creatinine, liver enzymes
INR monitoring for Warfarin
Imaging only if symptoms worsen

Slide 14: Patient Education

Importance of adherence
Recognizing signs of bleeding or recurrence
Lifestyle changes: mobility, compression stockings, hydration
Medication interactions: NSAIDs, herbal supplements
Emergency instructions for chest pain, shortness of breath, hemoptysis

Slide 15: Summary

PE diagnosis now guided by validated clinical tools
DOACs are preferred for most cases
Special considerations are critical for high-risk populations
Patient education and close follow-up are key to successful outcomes

Slide 16: References

Konstantinides, S. V., et al. (2020). 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism. Eur Heart J, 41(4), 543–603. https://doi.org/10.1093/eurheartj/ehz405
American Society of Hematology. (2020). ASH Clinical Practice Guidelines on VTE. https://www.ncbi.nlm.nih.gov/books/NBK560551/
Piazza, G., & Goldhaber, S. Z. (2022). Diagnosis and management of pulmonary embolism. NEJM, 387(7), 664–674. https://www.nejm.org/doi/full/10.1056/NEJMcp2116489

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