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https://www.readbyqxmd.com/read/28805341/treatment-options-for-severe-pulmonary-embolism-during-pregnancy-and-the-postpartum-period-a-systematic-review
#1
G Martillotti, F Boehlen, H Robert-Ebadi, N Jastrow, M Righini, M Blondon
BACKGROUND: Massive pulmonary embolism (PE) during pregnancy or the postpartum period is a rare but dramatic event. Our aim was to systematically review the evidence to guide its management. METHODS: We searched Pubmed, Embase, conference proceedings and the RIETE registry for published cases of severe (submassive/massive) PE treated with thrombolysis, percutaneous or surgical thrombectomy and/or with ECMO, occurring during pregnancy or within 6 weeks of delivery...
August 14, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28802551/a-survey-of-submassive-pulmonary-embolism-treatment-preferences-among-medical-and-endovascular-physicians
#2
Bedros Taslakian, Daanish Chawala, Akhilesh K Sista
PURPOSE: To determine treatment preferences among endovascular and medical physicians who manage acute submassive pulmonary embolism (PE). MATERIALS AND METHODS: From July through August 2016, 83 sites across the United States were surveyed, and 60 completed the survey. Endovascular and medical physicians were asked to rate their predilection for catheter-directed thrombolysis (CDT) on a 5-point scale and for systemic thrombolysis (ST) as "yes" or "no" in seven case scenarios of submassive PE...
August 9, 2017: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/28794825/interventional-radiology-treatment-for-pulmonary-embolism
#3
REVIEW
Miguel A De Gregorio, Jose A Guirola, Celia Lahuerta, Carolina Serrano, Ana L Figueredo, William T Kuo
Venous thromboembolism (VTE) is an illness that has a potentially life-threatening condition that affects a large percentage of the global population. VTE with pulmonary embolism (PE) is the third leading cause of death after myocardial infarction and stroke. In the first three months after an acute PE, there is an estimated 15% mortality among submassive PE, and 68% mortality in massive PE. Current guidelines suggest fibrinolytic therapy regarding the clinical severity, however some studies suggest a more aggressive treatment approach...
July 28, 2017: World Journal of Radiology
https://www.readbyqxmd.com/read/28694671/substantial-hepatic-necrosis-is-prognostic-in-fulminant-liver-failure
#4
Paul Ndekwe, Marwan S Ghabril, Yong Zang, Steven A Mann, Oscar W Cummings, Jingmei Lin
AIM: To evaluate if any association existed between the extent of hepatic necrosis in initial liver biopsies and patient survival. METHODS: Thirty-seven patients with fulminant liver failure, whose liver biopsy exhibited substantial necrosis, were identified and included in the study. The histological and clinical data was then analyzed in order to assess the relationship between the extent of necrosis and patient survival, with and without liver transplantation...
June 21, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28650086/systemic-thrombolysis-catheter-directed-thrombolysis-and-anticoagulation-for-intermediate-risk-pulmonary-embolism-a-simulation-modeling-analysis
#5
Christopher Kabrhel, Ayman Ali, Jin Choi, Chin Hur
OBJECTIVES: Decision-making around the use of thrombolysis for patients with intermediate-risk (submassive) PE remains challenging. Studies indicate favorable clinical outcomes with systemic thrombolytics (IV tPA), but the risk of major bleeding and hemorrhagic stroke is a deterrent. Catheter-directed thrombolysis (CDT) may be a preferable strategy, as it has been shown to have a lower risk of bleeding than systemic thrombolysis. However, a three-arm randomized control study comparing IV tPA, CDT, and anticoagulation alone, with long-term follow up, would be costly and is unlikely to be performed...
June 26, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28628412/stratification-imaging-and-management-of-acute-massive-and-submassive-pulmonary-embolism
#6
REVIEW
Akhilesh K Sista, William T Kuo, Mark Schiebler, David C Madoff
While pulmonary embolism (PE) causes approximately 100 000-180 000 deaths per year in the United States, mortality is restricted to patients who have massive or submassive PEs. This state of the art review familiarizes the reader with these categories of PE. The review discusses the following topics: pathophysiology, clinical presentation, rationale for stratification, imaging, massive PE management and outcomes, submassive PE management and outcomes, and future directions. It summarizes the most up-to-date literature on imaging, systemic thrombolysis, surgical embolectomy, and catheter-directed therapy for submassive and massive PE and gives representative examples that reflect modern practice...
July 2017: Radiology
https://www.readbyqxmd.com/read/28625110/ultrasound-facilitated-catheter-directed-low-dose-fibrinolysis-in-elderly-patients-with-pulmonary-embolism-a-seattle-ii-sub-analysis
#7
Brett J Carroll, Samuel Z Goldhaber, Ping-Yu Liu, Gregory Piazza
Elderly patients with acute pulmonary embolism (PE) have higher mortality than non-elderly patients, but receive systemic fibrinolysis less frequently. In this sub-analysis of the SEATTLE II trial, we evaluated the efficacy and safety of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis in elderly patients with submassive and massive PE. We compared patients ⩾65 years old with those <65 years old. Eligible patients had proximal PE and a right ventricular-to-left ventricular (RV/LV) diameter ratio ⩾0...
June 1, 2017: Vascular Medicine
https://www.readbyqxmd.com/read/28571513/a-pulmonary-embolism-response-team-initial-experiences-and-future-directions
#8
REVIEW
Emily K Zern, Michael N Young, Kenneth Rosenfield, Christopher Kabrhel
Acute pulmonary embolism (PE) is a common cardiovascular condition resulting in significant morbidity and mortality. Consensus recommendations suggest risk stratification of patients into three main categories: high-risk or 'massive' PE, intermediate-risk or 'submassive' PE, and low-risk PE. Given the relative dearth of prospective, randomized clinical trials delineating optimal selection of the diverse medical, interventional, and surgical treatment approaches, clinical care requires a multidisciplinary expert approach to patients with PE...
June 2017: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/28466280/endovascular-management-of-massive-and-submassive-acute-pulmonary-embolism-current-trends-in-risk-stratification-and-catheter-directed-therapies
#9
REVIEW
Ethan C Kosova, Kush R Desai, Daniel R Schimmel
PURPOSE OF REVIEW: Acute pulmonary embolism (PE) is a common condition associated with high morbidity and mortality. Prior studies have evaluated the role of systemic fibrinolysis and catheter-directed therapy (CDT) in the management of PE. In this review, we examine current data on risk stratification and the appropriate allocation of systemic fibrinolysis and CDT in acute PE patients with elevated risk of adverse outcomes. RECENT FINDINGS: Classification of pulmonary embolism is based on risk of adverse events, and relies on clinical parameters, imaging findings, and biomarkers...
June 2017: Current Cardiology Reports
https://www.readbyqxmd.com/read/28460762/acute-pulmonary-thromboembolism-epidemiology-predictors-and-long-term-outcome-a-single-center-experience
#10
U M Nagamalesh, V S Prakash, K C Karthik Naidu, S Sarthak, Anupama V Hegde, T Abhinay
INTRODUCTION: Acute pulmonary thromboembolism (PTE) is a life-threatening disease. Mortality in PTE still remains very high in spite of progress in diagnostic tools. Mortality rate is about 30% in patients with unrecognized acute PTE. METHODS: It is a single center observational study of 31 consecutive patients who were hospitalized in the Department of Cardiology at MS Ramaiah Memorial hospital between January 1, 2010 and June 2015. All the patients confirmed with diagnosis of acute PTE by CT scan (either HRCT or CTPA) were included in the study...
March 2017: Indian Heart Journal
https://www.readbyqxmd.com/read/28454823/randomized-trial-of-inhaled-nitric-oxide-to-treat-acute-pulmonary-embolism-the-inope-trial
#11
RANDOMIZED CONTROLLED TRIAL
Jeffrey A Kline, Cassandra L Hall, Alan E Jones, Michael A Puskarich, Ronald A Mastouri, Tim Lahm
BACKGROUND: The study hypothesis is that administration of inhaled nitric oxide (NO) plus oxygen to subjects with submassive pulmonary embolism (PE) will improve right ventricular (RV) systolic function and reduce RV strain and necrosis, while improving patient dyspnea, more than treatment with oxygen alone. METHODS: This article describes the rationale and protocol for a registered (NCT01939301), nearly completed phase II, 3-center, randomized, double-blind, controlled trial...
April 2017: American Heart Journal
https://www.readbyqxmd.com/read/28428435/bet-1-a-glass-half-full-thrombolysis-for-the-treatment-of-submassive-pulmonary-embolism
#12
Liam Barrett, Dan Horner
A short-cut review was carried out to establish whether thrombolysis in addition to therapeutic anticoagulation could be of benefit in submassive (intermediate risk) pulmonary embolism (PE). 64 directly relevant papers were found using the reported search strategy. Of these, three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that there is insufficient evidence to support the routine use of adjuvant thrombolytic therapy at any dose for patients with submassive PE...
May 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28419620/comparison-of-emergency-department-patients-to-inpatients-receiving-a-pulmonary-embolism-response-team-pert-activation
#13
Erin K Deadmon, Nicholas J Giordano, Kenneth Rosenfield, Rachel Rosovsky, Blair Alden Parry, Rasha Fahad Al-Bawardy, Yuchiao Chang, Christopher Kabrhel
OBJECTIVES: The development of pulmonary embolism response teams (PERTs) has been widely adopted nationally with the goal of providing multidisciplinary care to patients with high-risk PE. Most PERT activations originate from the emergency department (ED), while others are from the intensive care unit (ICU) or inpatient floors. It is unclear if ED PERT activations differ from non-ED PERT activation in terms of presentation, management, and outcome. METHODS: We enrolled a consecutive cohort of patients for whom PERT was activated at an urban academic medical center...
April 17, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28411694/predictors-of-failure-and-complications-of-catheter-directed-interventions-for-pulmonary-embolism
#14
Efthymios D Avgerinos, Adham N Abou Ali, Nathan L Liang, Elizabeth Genovese, Michael J Singh, Michel S Makaroun, Rabih A Chaer
OBJECTIVE: Catheter-directed interventions (CDIs) are increasingly performed for acute pulmonary embolism (PE) as they are presumed to provide similar therapeutic benefits to systemic thrombolysis while decreasing the dose of thrombolytic required and the associated risks. This study aimed to identify factors associated with CDI failure and to describe anticipated complications. METHODS: Consecutive patients who underwent CDI for massive or submassive PE between 2009 and 2015 were identified; outcomes and complications were retrospectively collected...
May 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/28401327/pulmonary-embolism-response-teams
#15
REVIEW
Maya Serhal, Ihab S Haddadin, Gustavo A Heresi, Deborah A Hornacek, Mehdi H Shishehbor, John R Bartholomew
Pulmonary embolism (PE) is a common thrombotic event that is variable in its presentation. Depending on the patients' risk for mortality, guidelines provide several treatment strategies including thrombolysis, catheter-directed therapies, pulmonary embolectomy, anticoagulation, and inferior vena cava filters. However, there is considerable disagreement between guidelines regarding the optimal treatment strategy for patients, particularly for those with intermediate-risk PE. In order to provide rapid and individualized care, PE response teams (PERT) have been developed...
April 11, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28379592/severe-hepatocytotoxicity-linked-to-denosumab
#16
S Malnick, Y Maor, E Melzer, N N Ziv-Sokolowskaia, M G Neuman
OBJECTIVE: Denosumab (Prolia, Amgen, Thousand Oaks, CA, USA) is a fully human antibody to the receptor activator of nuclear factor-KB ligand (RANKL). We present a case of submassive hepatic necrosis with evidence implicating cytokine induction resulting from an immune reaction to denosumab. CASE REPORT: A 72-year-old lady presented with elevated liver enzymes. One month previously, she received a s/c administration of 60 mg of denosumab. Viral hepatitis A, B and C and human herpes viruses 6-7 were negative as were routine autoimmune serology...
March 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28289497/interventional-therapy-for-pulmonary-embolism
#17
REVIEW
Alan B Lumsden, Erik Suarez
Patients with pulmonary embolism (PE) present with highly variable clinical symptoms and often have accompanying comorbidities. Timely diagnosis and treatment are critical to help prevent recurrence and increased morbidity/mortality. While open surgical thrombectomy was once reserved only for those with massive PE and hemodynamic compromise, it has been reevaluated with a focus on careful patient selection and early intervention. Lately, there has been increased interest in catheter-based interventions and in combining these with an open surgical component to decrease the magnitude of the intervention-for example, direct placement of large-bore thrombectomy devices directly into the right ventricle via sternotomy or subxiphoid approaches...
October 2016: Methodist DeBakey Cardiovascular Journal
https://www.readbyqxmd.com/read/28265125/pulmonary-embolism-the-astute-interventional-radiology-clinician
#18
REVIEW
Akhilesh K Sista
There has been a resurgence of interest in defining the optimal treatment for severe pulmonary embolism (PE), fueled by pivotal and provocative trials, new catheter-based medical devices, and growing evidence of deleterious short- and long-term outcomes. In this environment, and especially given the multidisciplinary nature of PE care, the interventional radiologist (IR) needs to become an astute, disease-specific expert. This review article describes the following "steps" an IR can take to reach this level: (1) understand PE stratification and epidemiology; (2) recognize the treatment goals for massive PE; (3) recognize the wide range of attitudes toward therapeutic escalation for submassive PE; (4) recognize what we do not know about the treatment of submassive PE and the limitations of current studies; (5) know the literature surrounding inferior vena cava filter insertion for severe PE; (6) integrate into the longitudinal care of the patient; and (7) be at the leading edge of new trials and technologies...
March 2017: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/28261509/spontaneous-heparin-induced-thrombocytopenia-and-venous-thromboembolism-following-total-knee-arthroplasty
#19
Kevin Baker, Ming Y Lim
A 72-year-old Caucasian woman was admitted for an elective left total knee arthroplasty. Her surgery was uncomplicated and she was discharged to a rehabilitation facility. Twelve days later, she developed acute shortness of breath followed by a syncopal episode. She was hypoxic and cyanotic, requiring hospitalization and intubation, and was subsequently diagnosed with bilateral submassive pulmonary emboli and bilateral lower extremity deep vein thrombosis. She was started on unfractionated heparin infusion...
2017: Case Reports in Hematology
https://www.readbyqxmd.com/read/28231022/caution-regarding-catheter-directed-thrombolysis-chronic-thromboembolic-pulmonary-hypertension-mistaken-for-acute-submassive-pulmonary-embolism
#20
Timothy M Fernandes, Victor G Pretorius, Nick H Kim
No abstract text is available yet for this article.
April 15, 2017: American Journal of Respiratory and Critical Care Medicine
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