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pulmonary embolism guidelines

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https://www.readbyqxmd.com/read/28328524/paramagnetic-micro-particles-as-a-tool-for-rapid-quantification-of-apixaban-dabigatran-edoxaban-and-rivaroxaban-in-human-plasma-by-uhplc-ms-ms
#1
Martin H J Wiesen, Cornelia Blaich, Thomas Streichert, Guido Michels, Carsten Müller
BACKGROUND: Assessment of the anticoagulant activity of direct oral anticoagulants (DOACs) is justified in special clinical situations. Here, we evaluated two independent extraction methods and developed a multi-analyte ultra-high performance liquid chromatography tandem mass (UHPLC-MS/MS) method for the quantification of apixaban, dabigatran, edoxaban and rivaroxaban in human plasma. METHODS: Routine extraction based on protein precipitation with acetonitrile and subsequent centrifugation was compared to sample clean-up using commercial paramagnetic micro-particles and subsequent magnetic depletion...
March 22, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28325091/nuts-and-bolts-of-running-a-pulmonary-embolism-response-team-results-from-an-organizational-survey-of-the-national-pert%C3%A2-consortium-members
#2
Geoffrey Barnes, Jay Giri, D Mark Courtney, Soophia Naydenov, Todd Wood, Rachel Rosovsky, Kenneth Rosenfield, Christopher Kabrhel
OBJECTIVES: Pulmonary embolism response teams (PERT) are developing rapidly to operationalize multi-disciplinary care for acute pulmonary embolism patients. Our objective is to describe the core components of PERT necessary for newly developing programs. METHODS: An online organizational survey of active National PERT™ Consortium members was performed between April and June 2016. Analysis, including descriptive statistics and Kruskal-Wallis tests, was performed on centers self-reporting a fully operational PERT program...
March 22, 2017: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/28290648/deep-venous-thrombosis-and-pulmonary-embolism-current-therapy
#3
Jason Wilbur, Brian Shian
Pulmonary embolism and deep venous thrombosis are the two most important manifestations of venous thromboembolism (VTE), which is the third most common life-threatening cardiovascular disease in the United States. Anticoagulation is the mainstay of VTE treatment. Most patients with deep venous thrombosis or low-risk pulmonary embolism can be treated in the outpatient setting with low-molecular-weight heparin and a vitamin K antagonist (warfarin) or direct-acting oral anticoagulants. Inpatient treatment of VTE begins with parenteral agents, preferably low-molecular-weight heparin...
March 1, 2017: American Family Physician
https://www.readbyqxmd.com/read/28282004/five-year-retrospective-review-of-blunt-renal-injuries-at-a-level-i-trauma-center
#4
Jessica Burns, Megan Brown, Zakaria I Assi, Eric J Ferguson
We report the experience of a Level I trauma center in the management of blunt renal injury during a 5-year period, with special attention to those treated using angiography with embolization. The institutional trauma registry was queried for all patients with blunt renal injury between September 1, 2009 and August 30, 2014. Each injury was graded using the American Association for the Surgery of Trauma guidelines. Patients that underwent angiography with embolization were reviewed for case-specific information including imaging findings, treatment, materials used, clinical course, and mortality...
February 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28275618/extracorporeal-life-support-for-refractory-ventricular-tachycardia
#5
REVIEW
Sujatha P Bhandary, Nicholas Joseph, James P Hofmann, Theodosios Saranteas, Thomas J Papadimos
Extracorporeal life support (ECLS) is a very effective bridging therapy in patients with refractory ventricular tachycardia (VT) associated with cardiogenic shock. A moribund patient in extremis, is not amenable to optimization by standard ACC/AHA guidelines. New approaches and novel salvage techniques are necessary to improve outcomes in patients with refractory clinical settings such as malignant ventricular arrhythmias, cardiac arrest, cardiogenic shock and/or pulmonary failure until further management options are explored...
February 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28262243/pitfalls-in-the-diagnostic-management-of-pulmonary-embolism-in-pregnancy
#6
Cécile Tromeur, Liselotte M van der Pol, Frederikus A Klok, Francis Couturaud, Menno V Huisman
Women are at increased risk of venous thromboembolism (VTE) during pregnancy and VTE remains one of the main causes of maternal mortality in developed countries (Konstantinides SV, et al. Eur Heart J 2014; 35(43):3033-69, 69a-69k). Although an accurate diagnosis of acute pulmonary embolism (PE) in pregnant patients is thus of crucial importance, the diagnostic management of suspected PE is challenging for this specific patient category. As D-dimer levels increase physiologically throughout pregnancy, the optimal D-dimer threshold to rule out PE during pregnancy remains unknown...
March 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28246560/saddle-pulmonary-embolism-with-thrombus-in-transit-across-a-patent-foramen-ovale
#7
Fitzgerald Shepherd, Ashley White-Stern, Oloruntobi Rahaman, Damian Kurian, Karen Simon
This is the case of a 25-year-old obese man who presented with acute shortness of breath, chest pain, and palpitations. Of note, he lives a sedentary lifestyle and was recently hospitalized for incision and drainage of a left foot abscess. On presentation he was tachypnoeic, tachycardiac, and hypoxic but blood pressure was stable. Laboratory studies were significant for elevated D-dimer and mildly increased troponin. On further investigation he was found to have a saddle pulmonary embolism with massive clot burden...
2017: Case Reports in Cardiology
https://www.readbyqxmd.com/read/28242032/indications-complications-and-outcomes-of-inferior-vena-cava-filters-a-retrospective-study
#8
Andrew Wassef, Wendy Lim, Cynthia Wu
INTRODUCTION: Inferior vena cava filters are used to prevent embolization of a lower extremity deep vein thrombosis when the risk of pulmonary embolism is thought to be high. However, evidence is lacking for their benefit and guidelines differ on the recommended indications for filter insertion. The study aim was to determine the reasons for inferior vena cava filter placement and subsequent complication rate. MATERIALS AND METHODS: A retrospective cohort of patients receiving inferior vena cava filters in Edmonton, Alberta, Canada from 2007 to 2011...
February 20, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28229301/safety-and-efficacy-of-postoperative-pharmacologic-thromboprophylaxis-with-enoxaparin-after-pancreatic-surgery
#9
Hajime Imamura, Tomohiko Adachi, Amane Kitasato, Takayuki Tanaka, Akihiko Soyama, Masaaki Hidaka, Fumihiko Fujita, Mitsuhisa Takatsuki, Tamotsu Kuroki, Susumu Eguchi
PURPOSE: Pharmacologic thromboprophylaxis is recommended for preventing pulmonary embolism according to some abdominal surgery guidelines. However, few reports have so far described pharmacologic thromboprophylaxis after pancreatic surgery. In addition, concern remains regarding postoperative bleeding due to pharmacologic thromboprophylaxis. We investigated the safety and efficacy of enoxaparin, a low-molecular-weight heparin, as postoperative pharmacologic thromboprophylaxis after pancreatic surgery...
February 22, 2017: Surgery Today
https://www.readbyqxmd.com/read/28228201/five-year-retrospective-review-of-blunt-renal-injuries-at-a-level-i-trauma-center
#10
Jessica Burns, Megan Brown, Zakaria I Assi, Eric J Ferguson
We report the experience of a Level I trauma center in the management of blunt renal injury during a 5-year period, with special attention to those treated using angiography with embolization. The institutional trauma registry was queried for all patients with blunt renal injury between September 1, 2009 and August 30, 2014. Each injury was graded using the American Association for the Surgery of Trauma guidelines. Patients that underwent angiography with embolization were reviewed for case-specific information including imaging findings, treatment, materials used, clinical course, and mortality...
February 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28208204/thrombophilic-evaluation-in-patients-with-acute-pulmonary-embolism
#11
Scott M Stevens, Jack E Ansell
Patients with acute pulmonary embolism (PE) are often tested for thrombophilias, which are hereditary and acquired conditions that predispose to thrombosis. If a hereditary condition is identified, then testing is often performed on members of the patient's family. Testing for these conditions can be complex, as the presence of acute thrombosis and antithrombotic therapies can make the results of many tests unreliable. Many risk factors for thrombosis exist that are not routinely assessed by laboratory testing, and it is likely that many hereditary thrombophilia conditions remain to be discovered...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28208200/massive-pulmonary-embolism-extracorporeal-membrane-oxygenation-and-surgical-pulmonary-embolectomy
#12
Aaron Weinberg, Victor F Tapson, Danny Ramzy
Massive pulmonary embolism (PE) refers to large emboli that cause hemodynamic instability, right ventricular failure, and circulatory collapse. According to the 2016 ACCP Antithrombotic Guidelines, therapy for massive PE should include systemic thrombolytic therapy in conjunction with anticoagulation and supportive care. However, in patients with a contraindication to systemic thrombolytics or in those who fail the above interventions, extracorporeal membrane oxygenation (ECMO) and/or surgical embolectomy may be used to improve oxygenation, achieve hemodynamic stability, and successfully treat massive PE...
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
#13
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/28208194/risk-stratification-for-proven-acute-pulmonary-embolism-what-information-is-needed
#14
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/28208193/approach-to-suspected-acute-pulmonary-embolism-should-we-use-scoring-systems
#15
Marc Righini, Grégoire Le Gal, Henri Bounameaux
Modern diagnostic strategies for pulmonary embolism diagnosis almost all rely on an initial assessment of the pretest probability. Clinical prediction rules are decision-making tools using combinations of easily available clinical predictors to define the probability of a disease. The assessment of the clinical probability of pulmonary embolism has an important impact on the diagnostic strategy and on therapeutic management. Clinical prediction rules provide accurate and reproducible estimates of clinical probability...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28204834/-pulmonary-embolism
#16
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...
March 2017: Der Anaesthesist
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/28184368/prevention-of-hospital-acquired-venous-thromboembolism-in-children-a-review-of-published-guidelines
#18
REVIEW
E Vincent S Faustino, Leslie J Raffini
Venous thromboembolism, which includes deep venous thrombosis and pulmonary embolism, is a potentially preventable condition in children. In adults, pharmacologic prophylaxis has been shown to significantly reduce the incidence of venous thromboembolism in distinct patient cohorts. However, pediatric randomized controlled trials have failed to demonstrate the efficacy of pharmacologic prophylaxis against thrombosis associated with central venous catheters, the most important risk factor for venous thromboembolism in children...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28183196/the-application-of-current-proposed-venous-thromboembolism-risk-assessment-model-for-ambulatory-patients-with-cancer
#19
Hikmat Abdel-Razeq, Asem Mansour, Salwa S Saadeh, Mahmoud Abu-Nasser, Mohammad Makoseh, Murad Salam, Alaa Abufara, Yousef Ismael, Alaa Ibrahim, Ghaleb Khirfan, Mohammad Ibrahim
Venous thromboembolism (VTE) is a commonly encountered problem in patients with cancer. In recent years, cancer treatment paradigm has shifted with most therapy offered in ambulatory outpatient settings. Excess of half VTEs in patients with cancer occur in outpatient settings without prior hospitalization, where current practice guidelines do not recommend routine prophylaxis. Risk assessment models (RAMs) for VTE in such patients were recently introduced. This study aims to assess the practical application of one of these models in clinical practice...
January 1, 2017: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/28174293/cancer-and-venous-thromboembolic-disease-a-review
#20
Eoin Donnellan, Alok A Khorana
Venous thromboembolism (VTE), including deep-vein thrombosis and pulmonary embolism, represents a major cause of morbidity and mortality in cancer patients. Patients with cancer are six times more likely to develop VTE than their noncancer counterparts, and VTE is the second leading cause of death in cancer patients. Despite the publication of major consensus guidelines setting out recommendations for thromboprophylaxis in cancer patients, there remains a gulf between these guidelines and clinical practice...
February 2017: Oncologist
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