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Clinics in Chest Medicine

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https://www.readbyqxmd.com/read/30122190/venous-thromboembolism-an-evolving-entity
#1
EDITORIAL
Peter S Marshall, Wassim H Fares
No abstract text is available yet for this article.
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122189/surgical-management-of-acute-and-chronic-pulmonary-embolism
#2
REVIEW
Barbara L LeVarge, Cameron D Wright, Josanna M Rodriguez-Lopez
Surgical pulmonary embolectomy and pulmonary thromboendarterectomy are well-established treatment strategies for patients with acute and chronic pulmonary embolism, respectively. For both procedures, techniques and outcomes have evolved considerably over the past decades. Patients with massive and submassive acute pulmonary embolism are at risk for rapid decline owing to right ventricular failure and shock. When thrombus is proximal, embolectomy can rapidly restore cardiac function. Chronic thromboembolic pulmonary hypertension is a more complex disease that requires skilled, careful dissection of the arterial wall, including vascular intima...
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122188/catheter-based-therapies-for-pulmonary-emboli
#3
REVIEW
Jeffrey S Pollak
More aggressive therapy for acute pulmonary embolism beyond anticoagulation is indicated in patients at higher risk for mortality and morbidity, namely those suffering from massive and possibly submassive disease. Catheter-based thrombolysis, catheter-based mechanical thrombus debulking, or combinations of these offer opportunities for rapid clot reduction and clinical improvement with a lower bleeding risk than systemic thrombolysis and perhaps greater efficacy. Optimal low-dose regimens for direct thrombolysis have not been defined just as optimal techniques and devices for mechanical therapy have not been developed, underscoring the need for further work...
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122187/inferior-vena-cava-filters-why-who-and-for-how-long
#4
REVIEW
Brian P Holly, Brian Funaki, Mark L Lessne
Vena cava filters are implantable devices that are placed to trap thrombus originating in the lower extremities and prevent it from migrating to the lungs. In general, inferior vena cava (IVC) filters are indicated for patients who cannot receive anticoagulation. Other indications for IVC filtration are less clear, and guidelines vary. All patients who have a retrievable IVC filter should be followed, and the removal of the IVC filter should be considered once its indication is lost.
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122186/endovascular-and-open-surgery-for-deep-vein-thrombosis
#5
REVIEW
Cassius Iyad Ochoa Chaar, Afsha Aurshina
The surgical treatment of deep venous thrombosis (DVT) has significantly evolved and is focused on different strategies of early thrombus removal in the acute phase and deep venous recanalization or bypass in the chronic phase. Along with the use of anticoagulation agents, endovascular techniques based on catheter-directed thrombolysis and pharmacomechanical thrombectomy have been increasingly used in patients with acute extensive DVT. Patient selection is crucial to provide optimal outcomes and minimize complications...
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122185/pulmonary-embolism-response-team-inpatient-structure-outpatient-follow-up-and-is-it-the-current-standard-of-care
#6
REVIEW
Rachel Rosovsky, Jorge Borges, Christopher Kabrhel, Kenneth Rosenfield
Pulmonary Embolism Response Teams (PERTs) are being created around the United States to immediately and simultaneously bring together multiple specialists to determine the best course of action and coordinate clinical care for patients with severe pulmonary embolism (PE). The organization and structure of each PERT will depend on local clinical demands and resources. Creating a follow up clinic for PE patients after discharge from the hospital is an essential component of any PERT program. PERT programs, which have come together to form the PERT Consortium®, are changing the landscape of PE treatment and may represent a new standard of care...
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122184/chronic-thromboembolic-pulmonary-hypertension-an-update
#7
REVIEW
Jean M Elwing, Anjali Vaidya, William R Auger
Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive pulmonary vascular disease with significant morbidity. It is a result of an alternate natural history in which there is limited resolution of thromboemboli with pulmonary artery obstruction leading to pulmonary hypertension (PH). CTEPH requires a thorough clinical assessment including pulmonary hemodynamics and radiologic evaluation in addition to consultation with an expert center. Surgical intervention remains the optimal management strategy...
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122183/hypercoagulability-in-pulmonary-hypertension
#8
REVIEW
Isabel S Bazan, Wassim H Fares
Pulmonary hypertension (PH) is divided into varied pathophysiological and etiologic groupings, as classified by the World Health Organization (WHO). Pulmonary arterial hypertension (PAH), which falls under WHO group 1 PH, is a progressive and potentially fatal disease characterized by a vasoconstrictive, proliferative, and thrombotic phenotype, which leads to increased pulmonary artery pressure, right heart failure, and death. Pathologically, in situ thromboses are found in the small distal pulmonary arteries...
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122182/an-update-on-the-novel-and-direct-oral-anticoagulants-and-long-term-anticoagulant-therapy
#9
REVIEW
Mia Djulbegovic, Alfred Ian Lee
The mainstay of treatment of venous thromboembolism (VTE) is anticoagulation. Direct oral anticoagulants (DOAC) have revolutionized anticoagulation management, although their efficacy and safety in specialized populations such as antiphospholipid syndrome, advanced renal disease, cancer thrombosis, and geriatric patients remain uncertain. Concerns about bleeding risks of DOACs persist despite reassuring data in the literature and the development of specific antidotes. In this article, the authors present an overview of the basic pharmacology of DOACs and discuss their use in acute VTE, secondary VTE prevention, and specialized VTE patient populations and discuss therapeutic monitoring and reversal in the event of major bleeding...
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122181/aggressive-treatment-of-intermediate-risk-patients-with-acute-symptomatic-pulmonary-embolism
#10
REVIEW
David Jimenez, Behnood Bikdeli, Peter S Marshall, Victor Tapson
Contemporary studies of acute pulmonary embolism (PE) have evaluated the role of thrombolytics in intermediate-risk PE. Significant findings are that thrombolytic therapy may prevent hemodynamic deterioration and all-cause mortality but increases major bleeding. Benefits and harms are finely balanced with no convincing net benefit from thrombolytic therapy among unselected patients. Among patients with intermediate risk PE, additional prognostic factors or subtle hemodynamic changes might alter the risk-benefit assessment in favor of thrombolytic therapy before obvious hemodynamic instability...
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122180/management-of-low-risk-pulmonary-embolism
#11
REVIEW
Ebtesam Attaya Islam, Richard E Winn, Victor Test
Pulmonary embolism remains a leading cause of morbidity and mortality in the United States. However, with improved recognition and diagnosis, the risk of death diminishes. The diagnosis depends on the clinician's suspicion. Pulmonary emboli are categorized into low, intermediate, or high risk based on the scoring scales and patients' hemodynamic stability versus instability. Imaging plus biomarkers help stratify patients according to risk. With the advent of the computed tomography multidetector scanners, the improved imaging has increased the detection of subsegmental and incidental pulmonary emboli...
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122179/the-value-of-bedside-echocardiogram-in-the-setting-of-acute-and-chronic-pulmonary-embolism
#12
REVIEW
David W Lee, Kavitha Gopalratnam, Hubert James Ford, Lisa J Rose-Jones
Echocardiography is valuable in the evaluation and risk stratification of patients with acute and chronic pulmonary embolism (PE). Patients with acute PE who have echocardiographic evidence of right ventricular dilatation and/or right ventricular dysfunction have a worse prognosis. A minority of patients with acute PE can develop chronic thromboembolic pulmonary hypertension. Patients with chronic thromboembolic pulmonary hypertension often have echocardiographic evidence of elevated pulmonary arterial pressures, right ventricular hypertrophy, right ventricular dysfunction, and/or left ventricular impaired relaxation...
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122178/challenges-and-changes-to-the-management-of-pulmonary-embolism-in-the-emergency-department
#13
REVIEW
Chris Moore, Katelyn McNamara, Rachel Liu
The diagnosis and treatment of pulmonary embolism (PE) remains one of the great challenges of emergency medicine. The symptoms of PE are myriad, common, and nonspecific. Undertesting risks missing a potentially life-threatening illness, whereas overtesting adds cost, false-positive diagnoses, incidental findings, and potential adverse impacts from contrast and radiation. Once diagnosed, the severity of PE can range from truly insignificant to deadly, and treatment must be tailored appropriately to the situation...
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122177/pregnancy-and-pulmonary-embolism
#14
REVIEW
Christopher Deeb Dado, Andrew Tobias Levinson, Ghada Bourjeily
Venous thromboembolism (VTE), referring to both deep vein thrombosis and pulmonary embolism, is a leading cause of death in the developed world during pregnancy. This increased risk is attributed to the Virchow triad, inherited thrombophilias, along with other standard risk factors, and continues for up to 6 to 12 weeks postpartum. During the peripartum period, women should be risk stratified and preventive measures should be initiated based on their risk. Diagnostic tests and treatment strategies commonly used in VTE differ in pregnancy...
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122176/venous-thromboembolism-in-special-populations-preexisting-cardiopulmonary-disease-cirrhosis-end-stage-renal-disease-and-asplenia
#15
REVIEW
Quyen Nguyen, Belinda N Rivera-Lebron
Venous thromboembolism (VTE) is a common cause of morbidity and mortality. Presence of preexisting conditions, such as cardiopulmonary diseases, cirrhosis, renal dysfunction, and asplenia, commonly occurs in VTE patients. Moreover, these conditions often are risk factors for developing VTE. These preexisting conditions make VTE diagnosis and treatment challenging and worsen outcomes. Current guidelines do not include detailed features in the diagnosis and management of patients with preexisting conditions. This review discusses presence of VTE in patients with preexisting cardiopulmonary diseases, cirrhosis, renal dysfunction, and asplenia...
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122175/intraluminal-arterial-filling-defects-misdiagnosed-as-pulmonary-emboli-what-else-could-they-be
#16
REVIEW
Anastasiia A Rudkovskaia, Debabrata Bandyopadhyay
Pulmonary artery filling defects can be observed in various pathologic processes other than pulmonary embolism, for example, nonthrombotic pulmonary embolism with biological and nonbiological materials and intrinsic pulmonary artery lesions. They have also been described in rare conditions, such as fibrosing mediastinitis and congenital absence or stenosis of pulmonary artery, and some pulmonary parenchymal and airway malignancies. Misdiagnosis is common owing to the relative rarity of these conditions. Correct diagnosis is based on the appropriate clinical suspicion considering the unique clinical features, laboratory findings, and additional radiologic clues inferring a pathology other than pulmonary embolism...
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122174/diagnosis-of-deep-venous-thrombosis-and-pulmonary-embolism-new-imaging-tools-and-modalities
#17
REVIEW
Farbod Nicholas Rahaghi, Jasleen Kaur Minhas, Gustavo A Heresi
Imaging continues to be the modality of choice for the diagnosis of venous thromboembolic disease, particularly when incorporated into diagnostic algorithms. Improvement in imaging techniques as well as new imaging modalities and processing methods have improved diagnostic accuracy and additionally are being leveraged in prognostication and decision making for choice of intervention. In this article, we review the role of imaging in diagnosis and prognostication of venous thromboembolism. We also discuss emerging imaging approaches that may in the near future find clinical usefulness in improving diagnosis and prognostication as well as differentiating disease phenotypes...
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122173/prevention-of-deep-vein-thrombosis-and-pulmonary-embolism-in-high-risk-medical-patients
#18
REVIEW
Megan McCullough, Cyrus Kholdani, Roham T Zamanian
Venous thromboembolism accounts for significant morbidity and mortality in patients with acute medical illnesses requiring hospital admission. American College of Chest Physicians guidelines recommend prophylaxis with heparins as first line and mechanical methods as second line. The risk of major bleeding with anticoagulants is less than 1% and not significantly different between agents. Although data support the use of all heparins, there is a trend toward superiority of low-molecular-weight heparins (LMWHs)...
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/30122172/clinical-probability-tools-for-deep-venous-thrombosis-pulmonary-embolism-and-bleeding
#19
REVIEW
Eileen M Harder, Omkar Desai, Peter S Marshall
Overdiagnosis of venous thromboembolism is associated with increasing numbers of patient complications and health care burden. Multiple clinical tools exist to estimate the probability of pulmonary embolism and deep venous thrombosis. When used with d-dimer testing, these can further stratify venous thromboembolism risk to help inform the use of additional diagnostic testing. Although there are similar tools to estimate bleeding risk, these are not as well-validated and lack reliability.
September 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29779604/progress-in-the-treatment-of-patients-with-neuromuscular-and-nonmuscular-chest-wall-diseases
#20
EDITORIAL
F Dennis McCool, Joshua O Benditt
No abstract text is available yet for this article.
June 2018: Clinics in Chest Medicine
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