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Submassive PE

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
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
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
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
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)...
June 30, 2016: Annals of Thoracic Surgery
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
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
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
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...
2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
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
Jung-Wan Yoo, Ho Cheol Choi, Seung Jun Lee, Yu Ji Cho, Jong Deog Lee, Ho Cheol Kim
BACKGROUND: Although systemic thrombolysis (ST) or catheter-directed therapy (CDT) is performed in patients with acute massive or submassive pulmonary embolism (PE), clinical data comparing between both therapies remain limited. We compared clinical outcomes between ST and CDT in patients with acute massive and submassive PE. METHODS: From January 2005 to June 2015, clinical outcomes of patients with acute massive or submassive PE receiving ST or CDT were evaluated and compared retrospectively...
June 2016: American Journal of Emergency Medicine
Christopher Kabrhel, Rachel Rosovsky, Richard Channick, Michael R Jaff, Ido Weinberg, Thoralf Sundt, David M Dudzinski, Josanna Rodriguez-Lopez, Blair A Parry, Savanah Harshbarger, Yuchiao Chang, Kenneth Rosenfield
BACKGROUND: Integrating newly developed tests and treatments for severe pulmonary embolism (PE) into clinical care requires coordinated multispecialty collaboration. To meet this need, we developed a new paradigm: a multidisciplinary Pulmonary Embolism Response Team (PERT). In this report, we provide the first longitudinal analysis of patients treated by a PERT. METHODS: Our PERT includes specialists in cardiovascular medicine and surgery, emergency medicine, hematology, pulmonary/critical care, and radiology, and is organized as a rapid response team...
August 2016: Chest
Mohsen Sharifi
Treatment of pulmonary embolism (PE) is variable amongst different and even the same institutions. With the introduction of different forms of thrombolysis, catheter based interventions, and new oral anticoagulants, the treatment and decision-making process has become more complex. The different forms of classification of PE into massive, submassive, severe, moderate, intermediate high risk, intermediate low risk, and low risk have only added to this complexity. The main two reasons for such classifications have been to aid in assessment of patient prognosis and in the intent to carefully select patients who are high risk and would benefit from thrombolysis...
May 2016: Current Treatment Options in Cardiovascular Medicine
Mohamed Teleb, Mateo Porres-Aguilar, Javier E Anaya-Ayala, Carlos Rodriguez-Castro, Mateo Porres-Muñoz, Debabrata Mukherjee
Submassive (intermediate risk) pulmonary embolism (PE) continues to be a significantly morbid disease process that remains unrecognized, inadequately risk stratified and suboptimally treated. Appropriate early clinical and imaging-based risk stratification represents the cornerstone for adequate therapeutic decision making, particularly for the selection of candidates who may benefit the most from systemic thrombolysis. The relevance of estimating clinical prognostic scores, in combination with imaging data, for accurate assessment of right ventricular function and laboratory biomarkers, indicative of myocardial injury for identification of normotensive patients at intermediate risk for an adverse short-term outcome are emphasized in this review...
April 2016: Therapeutic Advances in Cardiovascular Disease
Ashraf Mostafa, Alexandros Briasoulis, Tesfaye Telila, Kevin Belgrave, Cindy Grines
The presentation of acute pulmonary thromboembolism (PE) can be highly variable resulting in diagnostic challenges and management difficulties. Current guidelines suggest that therapy must be adjusted based on the severity of PE presentation. Systemic thrombolysis is the standard therapy for acute massive PE; however, systemic thrombolysis carries an estimated 20% risk of major hemorrhage, including a 3% to 5% risk of hemorrhagic stroke. There are data supporting the use of catheter-directed therapy (CDT) in massive and submassive PE, but past studies have limited its use to patients in whom systemic thrombolysis has either failed or was contraindicated...
March 15, 2016: American Journal of Cardiology
Sarah Rachel Pywell, Christopher Daniel Smith, Piero Reynolds
Acute pulmonary embolism (PE) is associated with a wide variation in patient outcome ranging from completely asymptomatic to cardiac failure and death. This presents a challenge to clinicians in ensuring the correct treatment for individual patients is given and that adverse events secondary to treatment complications are minimised. The evidence for those with massive PEs and non-massive PEs is clear for and against the use of thrombolysis, respectively. However, in those with 'sub-massive' PE there is no clear consensus on whether there is a treatment benefit...
2015: BMJ Case Reports
Caglar Ozmen, Ali Deniz, Rabia Eker Akilli, Onur Sinan Deveci, Caglar Emre Cagliyan, Halil Aktas, Aziz İnan Celik, Ayca Acikalin Akpinar, Nezihat Rana Disel, Hüseyin Tugsan Balli, İsmail Hanta, Mesut Demir, Ayhan Usal, Mehmet Kanadasi
Pulmonary embolism (PE) is a potentially life-threatening condition and the fact that 90% of PE originate from lower limb veins highlights the significance of early detection and treatment of deep vein thrombosis. Massive/high risk PE involving circulatory collapse or systemic arterial hypotension is associated with an early mortality rate of approximately 50%, in part from right ventricular (RV) failure. Intermediate risk/submassive PE, on the other hand, is defined as PE-related RV dysfunction, troponin and/or B-type natriuretic peptide elevation despite normal arterial pressure...
2016: International Heart Journal
Neşe Dursunoğlu, Dursun Dursunoğlu, Ali İhsan Yıldız, Simin Rota
OBJECTIVE: Right ventricular dysfunction (RVD) with myocardial damage may lead to fatal complications in patients with acute pulmonary embolism (PE). Cytoplasmic heart-type fatty acid-binding protein (HFABP) and the N-terminal fragment of its prohormone (NT-proBNP) are sensitive and specific biomarkers of myocardial damage. We evaluated RVD and cardiac biomarkers for myocardial damage and short-term mortality in patients with acute PE. METHODS: We analyzed 41 patients (24 females, 17 males) with confirmed acute PE prospective...
April 2016: Anatolian Journal of Cardiology
Suresh Vedantham
Venous thromboembolism (VTE) continues to represent a major source or mortality and morbidity. Although anticoagulation is the mainstay of therapy, adjunctive catheter-based interventions have shown substantial potential to improve clinically meaningful patient outcomes in patients with deep vein thrombosis (DVT), pulmonary embolism (PE), and the post-thrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) has been shown in a randomized trial to reduce the risk of PTS in patients with acute proximal DVT; data from a larger NIH trial is expected shortly...
2015: Hematology—the Education Program of the American Society of Hematology
Mark J Garcia
Acute, symptomatic pulmonary embolism (PE) in the massive and submassive categories continues to be a healthcare concern with significant risk for increased morbidity and mortality. Despite increased awareness and venous thromboembolism prophylaxis, endovascular treatment is still an important option for many of these patients. There are a variety of techniques and devices used for treating PE, but none have been evaluated as extensively as the EkoSonic endovascular system that is also currently the only FDA-approved device for the treatment of pulmonary embolism...
December 2015: Seminars in Interventional Radiology
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