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Submassive PE

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https://www.readbyqxmd.com/read/28214482/catheter-directed-ultrasound-assisted-thrombolysis-is-a-safe-and-effective-treatment-for-pulmonary-embolism-even-in-high-risk-patients
#1
Kristen A Lee, Andrew Cha, Mark H Kumar, Combiz Rezayat, Clifford M Sales
OBJECTIVE: We sought to assess the early success and safety of catheter-directed, ultrasound-assisted (CDUA) thrombolysis for acute pulmonary embolism (PE) in patients deemed to be "high risk" for thrombolytic therapy. METHODS: A retrospective evaluation of patients who underwent CDUA pulmonary thrombolysis in our practice during 39 months is reported. There were 91 patients considered, all of whom presented with acute PE as diagnosed by computed tomography angiography...
March 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/28208201/catheter-based-approaches-for-the-treatment-of-acute-pulmonary-embolism
#2
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/28208195/echocardiography-in-the-risk-assessment-of-acute-pulmonary-embolism
#3
Talal Dahhan, Fawaz Alenezi, Zainab Samad, Sudarshan Rajagopal
Acute pulmonary embolism (PE) is a major cause of morbidity and mortality and is classified as massive (high risk), submassive (intermediate risk), or nonmassive (low risk) based on the hemodynamic status and clinical characteristics of the patient. At this time, the management of patients with submassive PE remains controversial and approaches for improving risk assessment are critical. In this review, we discuss several echocardiographic methods to assess right heart function that may aid in the risk assessment of patients with acute PE...
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
#4
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/28153347/impact-of-pulmonary-arterial-clot-location-on-pulmonary-embolism-treatment-and-outcomes-90%C3%A2-days
#5
C Charles Jain, Yuchiao Chang, Christopher Kabrhel, Jay Giri, Richard Channick, Josanna Rodriguez-Lopez, Rachel P Rosovsky, Annemarie Fogerty, Kenneth Rosenfield, Michael R Jaff, Ido Weinberg
Pulmonary embolism (PE) is common and management is based on risk stratification. The significance of clot location in submassive and massive PE is unclear. Data from a prospectively gathered database of submassive and massive PE were used for analysis. Available data included patient presentation, diagnostics, treatment, and outcome. Comparisons were made according to clot location: central or peripheral. A multivariable model was used for composite outcome of death or right ventricular (RV) strain at 90 days...
December 6, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/28145042/safety-of-catheter-directed-thrombolysis-for-massive-and-submassive-pulmonary-embolism-results-of-a-multicenter-registry-and-meta-analysis
#6
Tyler L Bloomer, Georges E El-Hayek, Michael C McDaniel, Breck C Sandvall, Henry A Liberman, Chandan M Devireddy, Gautam Kumar, Pete P Fong, Wissam A Jaber
OBJECTIVES: To evaluate the safety and efficacy of catheter-directed thrombolysis (CDT) in the treatment of acute pulmonary embolism (PE). BACKGROUND: The use of CDT for the treatment of acute submassive and massive PE is increasing in frequency. However, its safety and efficacy have not been well elucidated. METHODS: This study is made of two parts: one is a two-center registry of acute PE patients treated with CDT. The safety outcome evaluated was any major complication including fatal, intracranial (ICH), intraocular, or retroperitoneal hemorrhage or any overt bleeding requiring transfusion or surgical repair...
February 1, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28121338/a-meta-analysis-of-efficacy-and-safety-of-catheter-directed-interventions-in-submassive-pulmonary-embolism
#7
B-H Lou, L-H Wang, Y Chen
OBJECTIVE: Catheter-directed interventions, such as catheter-directed thrombolysis (CDT), are becoming a popular therapeutic option for patients with hemodynamically stable pulmonary embolism (PE) and right ventricle (RV) dysfunction (submassive PE). We wished to quantitatively assess therapeutic efficacy and safety of catheter-directed interventions in submassive PE. MATERIALS AND METHODS: PubMed, Embase, Cochrane and Scopus were searched for studies on catheter-directed interventions and submassive PE...
January 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28090232/efficacy-and-safety-of-thrombolytic-therapy-in-acute-submassive-pulmonary-embolism-follow-up-study
#8
Santosh Kumar Sinha, Mohit Sachan, Amit Goel, Karandeep Singh, Vikas Mishra, Mukesh Jitendra Jha, Ashutosh Kumar, Nasar Abdali, Mohammad Asif, Mahamdula Razi, Umeshwar Pandey, Ramesh Thakur, Chandra Mohan Varma, Vinay Krishna
BACKGROUND: Thrombolysis in acute submassive pulmonary embolism (PE) remains controversial. So we studied impact of thrombolytic therapy in acute submassive PE in terms of mortality, hemodynamic status, improvement in right ventricular function, and safety in terms of major and minor bleeding. METHOD: A single-center, prospective, randomized study of 86 patients was conducted at LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, India. Patients received thrombolysis (single bolus of tenecteplase) with unfractionated heparin (UFH, group I) or placebo with UFH (group II)...
February 2017: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/27913777/risk-factors-for-major-bleeding-in-the-seattle-ii-trial
#9
Immad Sadiq, Samuel Z Goldhaber, Ping-Yu Liu, Gregory Piazza
Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis minimizes the risk of intracranial bleeding compared with systemic full-dose fibrinolytic therapy for pulmonary embolism (PE). However, major bleeding is nevertheless a potential complication. We analyzed the 150-patient SEATTLE II trial of submassive and massive PE patients to describe those who suffered major bleeding events following ultrasound-facilitated, catheter-directed, low-dose fibrinolysis and to identify risk factors for bleeding. Major bleeding was defined as GUSTO severe/life-threatening or moderate bleeds within 72 hours of initiation of the procedure...
February 2017: Vascular Medicine
https://www.readbyqxmd.com/read/27850656/1018-comparing-ct-scan-and-echocardiography-for-evaluation-of-right-heart-strain-in-submassive-pe
#10
David Wisa, Daniel Zapata, Maciej Walczyszyn, Khalid Gafoor, Habtamu Belete, Shalin Patel, Bushra Mina
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27630267/comparative-outcomes-of-ultrasound-assisted-thrombolysis-and-standard-catheter-directed-thrombolysis-in-the-treatment-of-acute-pulmonary-embolism
#11
COMPARATIVE STUDY
Nathan L Liang, Efthymios D Avgerinos, Luke K Marone, Michael J Singh, Michel S Makaroun, Rabih A Chaer
OBJECTIVES: The objective of this study was to compare the outcomes of patients undergoing ultrasound-accelerated thrombolysis (USAT) and standard catheter-directed thrombolysis (CDT) for the treatment of acute pulmonary embolism (PE). METHODS: The records of all patients in our institution having undergone CDT or USAT for massive or submassive PE from 2009 to 2014 were retrospectively reviewed. Standard statistical methods were used to compare characteristics and to assess for longitudinal change in outcomes...
August 2016: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/27609936/ultrasound-assisted-catheter-directed-thrombolysis-a-novel-and-promising-endovascular-therapeutic-modality-for-intermediate-risk-pulmonary-embolism
#12
Mohamed Teleb, Mateo Porres-Aguilar, Belinda Rivera-Lebron, Kyari Sumayin Ngamdu, Gehan Botrus, Javier E Anaya-Ayala, Debabrata Mukherjee
Intermediate-risk pulmonary embolism (PE), also known as submassive PE, occurs in a substantial group of patients and carries a significant mortality risk. With adequate risk stratification, catheter-directed techniques could be used as a therapeutic approach in the intermediate-risk PE. Ultrasound-assisted catheter-directed thrombolysis (UCDT) represents a novel endovascular technique with good clinical and safety outcomes. Ultrasound-assisted catheter-directed thrombolysis can achieve reduction in the thrombus burden and improvement of pulmonary hemodynamics and right ventricular (RV) dysfunction and/or dilatation, without major procedure-related complications, major bleeding, or hemorrhagic strokes...
September 7, 2016: Angiology
https://www.readbyqxmd.com/read/27503757/interobserver-and-intraobserver-agreement-on-qualitative-assessments-of-right-ventricular-dysfunction-with-echocardiography-in-patients-with-pulmonary-embolism
#13
Anthony J Weekes, Laura Oh, Gregory Thacker, Angela K Johnson, Michael Runyon, Geoffrey Rose, Thomas Johnson, Megan Templin, H James Norton
OBJECTIVES: To evaluate observer agreement using qualitative goal-directed echocardiographic criteria for right ventricular (RV) dysfunction prognostication in submassive pulmonary embolism (PE). METHODS: Two emergency physicians and 2 cardiologists independently reviewed 31 packets of goal-directed echocardiographic video clips consisting of at least 3 windows obtained by emergency physicians from normotensive patients with PE. Nine packets were repeated to assess for intraobserver agreement...
October 2016: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/27481877/catheter-directed-treatment-of-pulmonary-embolism-a-systematic-review-and-meta-analysis-of-modern-literature
#14
Alfonso J Tafur, Fadi E Shamoun, Salma I Patel, Denisse Tafur, Fabiola Donna, M Hassan Murad
We summarize the evidence for the safety and efficacy of catheter-directed thrombolysis (CDT) with and without ultrasound-assisted therapy for treating submassive and massive pulmonary embolism (PE) in a systematic review. The primary efficacy outcome was mortality. Outcomes were pooled across studies with the random-effects model. Twenty-four studies enrolled 700 patients in total; 653 received mechanical thromboembolectomy treatments for PE (mortality rate, 9% [95% confidence interval (CI), 6%-13%], P = ...
August 1, 2016: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/27373187/outcomes-after-surgical-pulmonary-embolectomy-for-acute-pulmonary-embolus-a-multi-institutional-study
#15
W Brent Keeling, Thor Sundt, Marzia Leacche, Yutaka Okita, Jose Binongo, Yi Lasajanak, Lishan Aklog, Omar M Lattouf
BACKGROUND: Surgical pulmonary embolectomy (SPE) has been sparingly used for the successful treatment of massive and submassive pulmonary emboli. To date, all data regarding SPE have been limited to single-center experiences. The purpose of this study was to document short-term outcomes after SPE for acute pulmonary emboli (PE) at four high-volume institutions. METHODS: A retrospective review of multiple local Society of Thoracic Surgeons databases of adults undergoing SPE from 1998 to 2014 for acute PE was performed (n = 214)...
November 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27318043/improved-early-right-ventricular-function-recovery-but-increased-complications-with-catheter-directed-interventions-compared-with-anticoagulation-alone-for-submassive-pulmonary-embolism
#16
Efthymios D Avgerinos, Nathan L Liang, Omar M El-Shazly, Catalyn Toma, Michael J Singh, Michel S Makaroun, Rabih A Chaer
OBJECTIVE: The purpose of this study was to determine the short-term and midterm outcomes of catheter-directed intervention (CDI) compared with anticoagulation (AC) alone in patients with submassive pulmonary embolism (sPE). METHODS: This was a retrospective review of all patients treated for sPE between January 2009 and October 2014. Two groups were identified on the basis of the therapy: AC and CDI. End points included complications, mortality, and change in echocardiographic parameters...
July 2016: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/27170484/mean-platelet-volume-and-mean-platelet-volume-platelet-count-ratio-in-risk-stratification-of-pulmonary-embolism
#17
Turker Yardan, Murat Meric, Celal Kati, Yildiray Celenk, Atilla Guven Atici
BACKGROUND AND OBJECTIVE: Recently, some of the hemogram parameters were reported to predict early death in acute pulmonary embolism (PE). The aim of this study was to investigate the role of mean platelet volume (MPV) and MPV/platelet count ratio (MPV/P), WBC and red cell distribution width (RDW) in risk stratification of patients with acute PE. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients with acute PE admitted to the Emergency Department...
2016: Medicina
https://www.readbyqxmd.com/read/27139009/resolution-of-a-mobile-right-atrial-thrombus-complicating-acute-pulmonary-embolism-with-low-dose-tissue-plasminogen-activator-in-a-patient-with-recent-craniotomy
#18
Amisha K Patel, Aarya Kafi, Antonio Bonet, Shelly M Shapiro, Scott S Oh, Michelle R Zeidler, Jaime Betancourt
Right heart thrombus in transit (RHTT) is a rare, severe form of venous thromboembolism that carries a high mortality rate. The optimal treatment for RHTT has not been well established. Thrombolysis is a therapeutic modality for RHTT but carries the risk of bleeding complications including intracranial hemorrhage. Low-dose thrombolysis has been shown to be effective in treating submassive pulmonary emboli without an increased risk in bleeding complications, but it has not been studied in patients with RHTT...
October 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27081754/catheter-directed-therapy-in-acute-pulmonary-embolism-with-right-ventricular-dysfunction-a-promising-modality-to-provide-early-hemodynamic-recovery
#19
Asli Gorek Dilektasli, Ezgi Demirdogen Cetinoglu, Nilufer Aylin Acet, Cuneyt Erdogan, Ahmet Ursavas, Guven Ozkaya, Funda Coskun, Mehmet Karadag, Ercument Ege
BACKGROUND Catheter-directed therapy (CDT) for pulmonary embolism (PE) is considered as an alternative to systemic thrombolysis (ST) in patients with hemodynamically unstable acute PE who are considered at high bleeding risk for ST. We aimed to evaluate the efficacy and safety of CDT in the management of acute PE with right ventricular dysfunction (RVD). The primary outcomes were mortality, clinical success, and complications. Secondary outcomes were change in hemodynamic parameters in the first 24 hours following the procedure...
April 15, 2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/27071316/current-controversies-in-thrombolytic-use-in-acute-pulmonary-embolism
#20
Brit Long, Alex Koyfman
BACKGROUND: Acute pulmonary embolism (PE) has an annual incidence of 100,000 cases in the United States and is divided into three categories: nonmassive, submassive, and massive. Several studies have evaluated the use of thrombolytics in submassive and massive PE. OBJECTIVE: Our aim was to provide emergency physicians with an updated review of the controversy about the use of thrombolytics in submassive and massive PE. DISCUSSION: Nonmassive PE is defined as PE in the setting of no signs of right ventricular strain (echocardiogram or biomarker) and hemodynamic stability...
July 2016: Journal of Emergency Medicine
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