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Pulmonary embolism treatment

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https://www.readbyqxmd.com/read/28213377/interventional-treatment-of-pulmonary-embolism
#1
David M Dudzinski, Jay Giri, Kenneth Rosenfield
Pulmonary embolism (PE) is a serious and prevalent cause of vascular disease. Nevertheless, optimal treatment for many phenotypes of PE remains uncertain. Treating PE requires appropriate risk stratification as a first step. For the highest-risk PE, presenting as shock or arrest, emergent systemic thrombolysis or embolectomy is reasonable, while for low-risk PE, anticoagulation alone is often chosen. Normotensive patients with PE but with indicia of right heart dysfunction (by biomarkers or imaging) constitute an intermediate-risk group for whom there is controversy on therapeutic strategy...
February 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28212912/pulmonary-embolism-in-the-postanesthesia-care-unit-a-case-study
#2
Debbie Smith, Jackie Murauski
Pulmonary embolism (PE) is a complication that can occur at any time during the perioperative period. The patient undergoing surgery to repair a hip fracture is at a high risk of developing a PE due to venous thrombosis, tissue, or fat emboli. The signs and symptoms of a PE are often nonspecific and can be obscured in the patient receiving or recovering from general anesthesia. This case study describes the presentation, diagnosis, and treatment of a patient experiencing a pulmonary embolism in the postanesthesia care unit (PACU) after surgery to repair a hip fracture...
February 2017: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/28210989/net-clinical-benefit-of-dabigatran-vs-warfarin-in-venous-thromboembolism-analyses-from-re-cover-%C3%A2-re-cover%C3%A2-ii-and-re-medy%C3%A2
#3
Martin Feuring, Sam Schulman, Henry Eriksson, Ajay J Kakkar, Sebastian Schellong, Stefan Hantel, Elke Schueler, Jörg Kreuzer, Samuel Z Goldhaber
The direct oral anticoagulants, e.g., dabigatran etexilate (DE), are effective and well tolerated treatments for venous thromboembolism (VTE). Net clinical benefit (NCB) is a useful concept in weighing potential benefits against potential harm of comparator drugs. The NCB of DE vs. warfarin in VTE treatment was compared. Post-hoc analyses were performed on pooled data from the 6-month RE-COVER® and RE-COVER™ II trials, and data from the RE-MEDY™ trial (up to 36 months), to compare the NCB of DE (150 mg twice daily) and warfarin [target international normalized ratio (INR) 2...
February 16, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28208203/acute-pulmonary-embolism-after-discharge-duration-of-therapy-and-follow-up-testing
#4
Cecilia Becattini, Laura Franco, Giancarlo Agnelli
Pulmonary embolism (PE) is a frequent cause of death and serious disability with a risk extending far beyond the acute phase of the disease. Anticoagulant treatment reduces the risk for death and recurrent VTE after a first PE. The optimal duration of anticoagulation after a first episode of PE remains controversial and should be made on an individual basis, balancing the estimated risk for recurrence without anticoagulant treatment against bleeding risk under anticoagulation. Current recommendations on duration of anticoagulation are based on a 3% per year risk of major bleeding expected during long-term warfarin treatment...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28208201/catheter-based-approaches-for-the-treatment-of-acute-pulmonary-embolism
#5
Victor F Tapson, David Jimenez
Except when contraindicated, anticoagulation should be initiated when pulmonary embolism (PE) is strongly suspected and the bleeding risk is perceived to be low, even if the evaluation has not been completed. Low-risk patients with acute PE are simply continued on anticoagulation. Severely ill patients with high-risk (massive) PE require aggressive therapy, and if the bleeding risk is acceptable, systemic thrombolysis should be considered. However, despite clear evidence that parenteral thrombolytic therapy leads to more rapid clot resolution than anticoagulation alone, the risk of major bleeding including intracranial bleeding is significantly higher with thrombolytic therapy...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28208199/systemic-thrombolytic-therapy-for-acute-pulmonary-embolism-who-is-a-candidate
#6
Stavros V Konstantinides, Stefano Barco
Pulmonary embolism (PE) is a major cause of both acute and long-term morbidity for a large number of patients worldwide, and massive PE is frequently fatal. Right ventricular (RV) dysfunction is a key determinant of prognosis in the acute phase of PE. Patients with clinically overt RV failure, that is, with cardiogenic shock or persistent hypotension at presentation (acute high-risk PE), are clearly in need of immediate reperfusion treatment with systemic thrombolysis or, alternatively, surgical or catheter-directed techniques...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28208198/the-pulmonary-embolism-response-team-what-is-the-ideal-model
#7
Josanna Rodriguez-Lopez, Richard Channick
Treatment of patients with intermediate- and high-risk pulmonary embolism (PE) is a controversial area. Many therapeutic options exist, and deciding on appropriate treatment can be difficult. In addition, multiple specialties are often involved in the care of PE patients. To better organize the response to serious PE patients, several hospitals and academic centers across the United States, spearheaded by Massachusetts General Hospital, have created pulmonary embolism response teams (PERTs). The goal of a PERT is to have a single multidisciplinary team of experts in thromboembolic disease, who can respond rapidly to patients with acute PE, and offer consultation with the full spectrum of therapeutic options...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28208194/risk-stratification-for-proven-acute-pulmonary-embolism-what-information-is-needed
#8
Deisy Barrios, Roger D Yusen, David Jiménez
Classification of risk drives treatment decisions for patients with acute symptomatic pulmonary embolism (PE). High-risk patients with acute symptomatic PE have hemodynamic instability (i.e., shock or hypotension present), and treatment guidelines suggest systemically administered thrombolytic therapy in this setting. Normotensive PE patients at low risk for early complications (low-risk PE) might benefit from treatment at home or early discharge, while normotensive patients with preserved systemic arterial pressure deemed as having a high risk for PE-related adverse clinical events (intermediate-high-risk PE) might benefit from close observation and consideration of escalation of therapy...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28206731/thrombus-resolution-and-right-ventricular-functional-recovery-using-ultrasound-accelerated-thrombolysis-in-acute-massive-and-submassive-pulmonary-embolism
#9
Evren Ozcinar, Mehmet Cakici, Nur Dikmen Yaman, Cagdas Baran, Anar Aliyev, Bahadir Inan, Serkan Durdu, Ahmet R Akar, Mustafa Sirlak
BACKGROUND: This study aims to evaluate the efficacy and safety of ultrasound-accelerated catheter- directed thrombolysis (UACDT) in the treatment of massive and submassive pulmonary embolism (PE). METHODS: We conducted a prospective, observational cohort study of consequtive patients with massive or submassive PE treated with low-dose UACDT using EKOS EkoSonic® system at single center from May 2014 until April 2015. Overall, thirty-eight patients (median age, 64...
February 15, 2017: International Angiology: a Journal of the International Union of Angiology
https://www.readbyqxmd.com/read/28204834/-pulmonary-embolism
#10
M Hecker, N Sommer, A Hecker, D Bandorski, M A Weigand, G A Krombach, E Mayer, D Walmrath
Pulmonary embolism is a potentially fatal disorder and frequently seen in critical care and emergency medicine. Due to a high mortality rate within the first few hours, the accurate initiation of rational diagnostic pathways in patients with suspected pulmonary embolism and timely consecutive treatment is essential. In this review, the current European guidelines on the diagnosis and therapy of acute pulmonary embolism are presented. Special focus is put on a structured patient management based on the individual risk of early mortality...
February 15, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28202221/elastoplasty-as-a-promising-novel-technique-vertebral-augmentation-with-an-elastic-silicone-based-polymer
#11
Alessandro Gasbarrini, Riccardo Ghermandi, Yunus Emre Akman, Marco Girolami, Stefano Boriani
OBJECTIVE: Percutaneous vertebroplasty with polymethylmethacrylate (PMMA) restores the stiffness and the strength of fractured vertebral bodies, but changes the pattern of the stress transfer. This effect may cause a secondary fracture of the adjacent vertebrae. Elastoplasty has emerged as a new technique to overcome this complication. The aim of this study is to retrospectively evaluate the clinical results of the elastoplasty procedure. MATERIALS AND METHODS: Thirthy nine patients (9 males, 30 females, 87 spinal levels) were clinically evaluated pre and postoperatively in terms of pain relief, leakage and silicone embolism...
February 12, 2017: Acta Orthopaedica et Traumatologica Turcica
https://www.readbyqxmd.com/read/28198719/rivaroxaban-for-treatment-of-pulmonary-embolism-while-receiving-electroconvulsive-therapy
#12
Emily Shao, Rachael Moore, John Linnane
No abstract text is available yet for this article.
February 15, 2017: Journal of ECT
https://www.readbyqxmd.com/read/28197219/factors-determining-altered-perfusion-after-acute-pulmonary-embolism-assessed-by-quantified-single-photon-emission-computed-tomography-perfusion-scan
#13
Marc Meysman, Hendrik Everaert, Walter Vincken
AIM OF THE STUDY: The aim of the study was to analyze the evolution of perfusion (Q)-defects in patients treated for acute pulmonary embolism (PE), correlation with baseline parameters and evaluation of recurrence risk. METHODS: This is a single-center prospective observational cohort study in symptomatic normotensive PE. Comparison of the ventilation/perfusion single-photon emission computed tomography (V/Q-SPECT) acquired at baseline with a quantified SPECT (Q-SPECT) repeated at 1 week and 6 months...
January 2017: Annals of Thoracic Medicine
https://www.readbyqxmd.com/read/28196033/thromboembolic-disease-in-patients-with-metastatic-femoral-lesions-a-comparison-between-prophylactic-fixation-and-fracture-fixation
#14
Arun Aneja, Jimmy J Jiang, Anna Cohen-Rosenblum, Hue L Luu, Terrance D Peabody, Samer Attar, T David Luo, Rex C Haydon
BACKGROUND: We are not aware of any previous studies that have compared the rate of venous thromboembolic events in patients who underwent prophylactic intramedullary nailing because of an impending fracture with the rate in patients who underwent intramedullary nailing after a pathological fracture. The objective of the present study was to determine if the rate of venous thromboembolic events varies between patients who are managed with prophylactic fixation and those who are managed with fixation after a pathological fracture...
February 15, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28195640/subcutaneous-unfractionated-heparin-for-the-initial-treatment-of-venous-thromboembolism
#15
REVIEW
Lindsay Robertson, James Strachan
BACKGROUND: Venous thromboembolism (VTE) is a prevalent and serious condition. Its medical treatment requires anticoagulation, usually with either unfractionated or low molecular weight heparin (LMWH). Administration of unfractionated heparin (UFH) is usually intravenous (IV) but can be subcutaneous as well. This is an update of a review first published in 2009. OBJECTIVES: To assess the effects of subcutaneous UFH versus intravenous UFH, subcutaneous LMWH or any other anticoagulant drug for the initial treatment of venous thromboembolism...
February 14, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28194291/internal-jugular-and-subclavian-vein-thrombosis-in-a-case-of-ovarian-cancer
#16
Hiroto Moriwaki, Nana Hayama, Shouko Morozumi, Mika Nakano, Akari Nakayama, Yoshiomi Takahata, Yuusuke Sakaguchi, Natsuki Inoue, Toshiki Kubota, Akiko Takenoya, Yoshiko Ishii, Haruka Okubo, Souta Yamaguchi, Tsuyoshi Ono, Toshiaki Oharaseki, Mamoru Yoshikawa
Central venous catheter insertion and cancer represent some of the important predisposing factors for deep venous thrombosis (DVT). DVT usually develops in the lower extremities, and venous thrombosis of the upper extremities is uncommon. Early diagnosis and treatment of deep venous thrombosis are of importance, because it is a precursor of complications such as pulmonary embolism and postthrombotic syndrome. A 47-year-old woman visited our department with painful swelling on the left side of her neck. Initial examination revealed swelling of the region extending from the left neck to the shoulder without any redness of the overlying skin...
2017: Case Reports in Otolaryngology
https://www.readbyqxmd.com/read/28193193/observation-management-of-pulmonary-embolism-and-agreement-with-claims-based-and-clinical-risk-stratification-criteria-in-united-states-patients-a-retrospective-analysis
#17
Elaine Nguyen, Craig I Coleman, W Frank Peacock, Philip S Wells, Erin R Weeda, Veronica Ashton, Concetta Crivera, Peter Wildgoose, Jeff R Schein, Thomas J Bunz, Gregory J Fermann
BACKGROUND: Guidelines suggest observation stays are appropriate for pulmonary embolism (PE) patients at low-risk for early mortality. We sought to assess agreement between United States (US) observation management of PE and claims-based and clinical risk stratification criteria. METHODS: Using US Premier data from 11/2012 to 3/2015, we identified adult observation stay patients with a primary diagnosis of PE, ≥1 PE diagnostic test claim and evidence of PE treatment...
February 13, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/28192733/prospective-long-term-results-complications-and-risk-factors-in-pelvic-organ-prolapse-treatment-with-vaginal-mesh
#18
Inés M Laso-García, Miguel A Rodríguez-Cabello, Miguel A Jiménez-Cidre, Andrea Orosa-Andrada, David Carracedo-Calvo, Luis López-Fando, Francisco J Burgos-Revilla
OBJECTIVE: To assess the long-term results and complications of pelvic organ prolapse treatment with transvaginal mesh. STUDY DESIGN: Prospective observational study of 75 women who underwent surgery between 2005 and 2008 by the same surgeon. 44 patients (58,7%) underwent concomitant treatment of stress urinary incontinence. Anatomical criterion for failure was prolapse grade >I in any compartment. Analysis of functional features consisted of an assessment of urinary, sexual, and defecation symptoms, and pelvic pain...
February 6, 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/28188086/two-intermittent-vismodegib-dosing-regimens-in-patients-with-multiple-basal-cell-carcinomas-mikie-a-randomised-regimen-controlled-double-blind-phase-2-trial
#19
Brigitte Dréno, Rainer Kunstfeld, Axel Hauschild, Scott Fosko, David Zloty, Bruno Labeille, Jean-Jacques Grob, Susana Puig, Frank Gilberg, Daniel Bergström, Damian R Page, Gary Rogers, Dirk Schadendorf
BACKGROUND: Vismodegib, a first-in-class Hedgehog-pathway inhibitor, is approved for use in adults with advanced basal-cell carcinoma. Patients with multiple basal-cell carcinomas, including those with basal-cell nevus (Gorlin) syndrome, need extended treatment. We assessed the safety and activity of two long-term intermittent vismodegib dosing regimens in patients with multiple basal-cell carcinomas. METHODS: In this randomised, regimen-controlled, double-blind, phase 2 trial, we enrolled adult patients with multiple basal-cell carcinomas, including those with basal-cell nevus syndrome, who had one or more histopathologically confirmed and at least six clinically evident basal-cell carcinomas...
February 7, 2017: Lancet Oncology
https://www.readbyqxmd.com/read/28187061/bronchopulmonary-disease-caused-by-flagellated-protozoa-infection-in-15-chinese-children
#20
Jinrong Liu, Shaogang Li, Huimin Li, Yimu Fan, Haiming Yang, Hui Xu, Yuelin Shen, Shunying Zhao
BACKGROUND: Bronchopulmonary disease caused by flagellated protozoa infection (BPFP) is thought to be rare in children but may be an emerging or underestimated disease, especially in developing countries. METHODS: In this study, we retrospectively reviewed records of 15 patients who presented with a cough, wheezing, or bronchopulmonary disease of unknown causes at admission and were finally diagnosed with BPFP from January 2014 to January 2015 were enrolled. Protozoa were observed in bronchoalveolar lavage fluid by light microscopy...
December 13, 2016: Pediatric Infectious Disease Journal
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