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https://www.readbyqxmd.com/read/29325495/management-of-cancer-associated-venous-thromboembolism-a-case-based-practical-approach
#1
Minna Voigtlaender, Florian Langer
In patients with solid tumours or haematological malignancies, venous thromboembolism (VTE) is a leading cause of death and significantly contributes to morbidity and healthcare resource utilization. Current practice guidelines recommend long-term anticoagulation with low-molecular-weight heparin (LMWH) as the treatment of choice for cancer-associated VTE, based on clinical trial data showing an overall improved safety and efficacy profile of LMWH compared to vitamin K antagonists. However, several open questions remain, e...
January 12, 2018: VASA. Zeitschrift Für Gefässkrankheiten
https://www.readbyqxmd.com/read/29324936/the-impact-of-lung-perfusion-scintigraphy-in-the-emergency-management-of-patients-with-suspected-pulmonary-embolism
#2
Cristina Ferrari, Alessandra Cimino, Giacomo Bianco, Francesca Iuele, Alessandra Di Palo, Margherita Fanelli, Artor Niccoli-Asabella, Giuseppe Rubini
OBJECTIVE: Pulmonary Embolism (PE) is an emergency condition that requires immediate treatment. As the symptoms and the risk factors are nonspecific, PE differential diagnosis is often required. Even if angio-CT is considered the gold standard for PE diagnosis, the frequent allergic condition and/or chronic renal failure of patients make, in most cases, not possible the use of contrast enhancement in emergency with even more increasing use of Lung Perfusion Scintigraphy (LPS), as a simple and fast examination with no preparation/contraindication...
September 2017: Hellenic Journal of Nuclear Medicine
https://www.readbyqxmd.com/read/29318176/venous-thromboembolism-within-professional-american-sport-leagues
#3
Meghan Bishop, Matthew Astolfi, Eric Padegimas, Peter DeLuca, Sommer Hammoud
Background: Numerous reports have described players in professional American sports leagues who have been sidelined with a deep vein thrombosis (DVT) or a pulmonary embolism (PE), but little is known about the clinical implications of these events in professional athletes. Purpose: To conduct a retrospective review of injury reports from the National Hockey League (NHL), Major League Baseball (MLB), the National Basketball Association (NBA), and the National Football League (NFL) to take a closer look at the incidence of DVT/PE, current treatment approaches, and estimated time to return to play in professional athletes...
December 2017: Orthopaedic Journal of Sports Medicine
https://www.readbyqxmd.com/read/29315455/home-versus-in-patient-treatment-for-deep-vein-thrombosis
#4
REVIEW
Richard Othieno, Emmanuel Okpo, Rachel Forster
BACKGROUND: Deep vein thrombosis (DVT) occurs when a blood clot blocks blood flow through a vein, which can occur after surgery, after trauma, or when a person has been immobile for a long time. Clots can dislodge and block blood flow to the lungs (pulmonary embolism (PE)), causing death. DVT and PE are known by the term venous thromboembolism (VTE). Heparin (in the form of unfractionated heparin (UFH)) is a blood-thinning drug used during the first three to five days of DVT treatment...
January 9, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29310357/risk-profile-management-and-outcomes-of-patients-with-venous-thromboembolism-attended-in-spanish-emergency-departments-the-espheria-registry
#5
Sonia Jimenez, Pedro Ruiz-Artacho, Marta Merlo, Coral Suero, Albert Antolin, José Ramón Casal, Marta Sanchez, Alejandra Ortega-Duarte, Mar Genis, Pascual Piñera
The objective of this study was to determine the clinical profile of and diagnostic and therapeutic approach to patients with venous thromboembolism (VTE) in Spanish Emergency Departments (EDs). Risk factors, adherence to clinical practice guidelines, and outcomes were also evaluated.Patients with VTE diagnosed in 53 Spanish EDs were prospectively and consecutively included. Demographic data, comorbidities, risk factors for VTE, index event characteristics, hemorrhagic risk, and mortality were evaluated. Adherence to clinical practice guidelines was assessed based on clinical probability scales, requests for determination of D-dimer, use of anticoagulant treatment before confirmation of diagnosis, and assessment of bleeding and prognostic risk...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29298088/echocardiogram-in-the-evaluation-of-hemodynamically-stable-acute-pulmonary-embolism-national-practices-and-clinical-outcomes
#6
David M Cohen, Michael Winter, Peter K Lindenauer, Allan J Walkey
RATIONALE: Societal guideline recommendations vary with regard to the role of routine trans-thoracic echocardiography (TTE) to screen for right ventricular strain in patients with hemodynamically-stable, acute pulmonary embolism (PE). OBJECTIVE: To characterize national patterns in use of early TTE for the evaluation of patients with hemodynamically-stable, acute PE, and determine associations between TTE use and patient outcomes. METHODS: Retrospective cohort study using Premier, Inc...
January 3, 2018: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/29248101/design-and-rationale-of-a-randomized-trial-comparing-standard-versus-ultrasound-assisted-thrombolysis-for-submassive-pulmonary-embolism
#7
Efthymios D Avgerinos, Abhisekh Mohapatra, Belinda Rivera-Lebron, Catalin Toma, Christopher Kabrhel, Larry Fish, Joan Lacomis, Iclal Ocak, Rabih A Chaer
BACKGROUND: Catheter-directed interventions for the treatment of patients with submassive pulmonary embolism (sPE) have shown promise in rapidly improving right-sided heart strain and preventing decompensation to massive pulmonary embolism. Among various catheter interventions, ultrasound-assisted thrombolysis (USAT) has attracted interest as potentially having more efficient lytic effect that could achieve thrombolysis faster and with a reduced lytic dose. However, based on clinical evidence, it is unclear whether USAT is superior to standard catheter-directed thrombolysis (SCDT)...
January 2018: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/29222261/symptomatic-subsegmental-pulmonary-embolism-to-treat-or-not-to-treat
#8
REVIEW
Marc Carrier, Fredrikus A Klok
The introduction of computed tomographic pulmonary angiography and its recent increasing availability has led to a significant rise in its use to help clinicians diagnose acute pulmonary embolism (PE). This has led to a significant increase in the incidence of PE diagnoses. Simultaneously, the case fatality rate of acute PE has been decreasing and no significant change in its mortality has been noted, suggesting that the additional PE diagnoses are less severe and these patients might not benefit from anticoagulation therapy...
December 8, 2017: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/29222259/controversies-in-venous-thromboembolism-to-treat-or-not-to-treat-superficial-vein-thrombosis
#9
REVIEW
Jan Beyer-Westendorf
The management of superficial vein thrombosis (SVT) is poorly defined and remains controversial overall. SVT has long been considered a benign, self-limited disease, but recent studies show that SVT carries a nonnegligible risk for recurrence, deep vein thrombosis, or pulmonary embolism. Current guidelines recommend the use of low-molecular-weight heparin or fondaparinux, but results of several surveys indicate that the majority of patients with SVT receive nonanticoagulant therapy only, which includes compression stockings or bandages, nonsteroidal anti-inflammatory drugs, topical application of heparin gel, or surgical interventions...
December 8, 2017: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/29215781/clinical-prediction-rules-for-mortality-in-patients-with-pulmonary-embolism-and-cancer-to-guide-outpatient-management-a-meta-analysis
#10
E Nguyen, J T Caranfa, G H Lyman, N M Kuderer, C Stirbis, M Wysocki, C I Coleman, E R Weeda, C G Kohn
Essentials Clinical prediction rules (CPRs) can stratify patients with pulmonary embolism (PE) and cancer. A meta-analysis was done to assess prognostic accuracy in CPRs for mortality in these patients. Eight studies evaluating ten CPRs were included in this study. CPRs should continue to be used with other patient factors for mortality risk stratification. SUMMARY: Background Cancer treatment is commonly complicated by pulmonary embolism (PE), which remains a leading cause of morbidity and mortality in these patients...
December 7, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/29206790/aspirin-for-prophylaxis-against-venous-thromboembolism-after-orthopaedic-oncologic-surgery
#11
Gregory M Mendez, Yash M Patel, Daniel A Ricketti, John P Gaughan, Richard D Lackman, Tae Won B Kim
BACKGROUND: Patients who undergo orthopaedic oncologic surgical procedures are at increased risk of developing a venous thromboembolism (VTE). Guidelines from surgical societies are shifting to include aspirin as a postoperative VTE prophylactic agent. The purpose of this study was to review our experience using aspirin as postoperative VTE prophylaxis for orthopaedic oncologic surgical procedures. METHODS: This study was a retrospective review of patients diagnosed with a primary malignant soft-tissue or bone tumor or metastatic carcinoma...
December 6, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29191822/systemic-thrombolysis-in-a-patient-with-massive-pulmonary-embolism-and-recent-glioblastoma-multiforme-resection
#12
Joshua Lampert, Behnood Bikdeli, Philip Green, Matthew R Baldwin
While trials of systemic thrombolysis for submassive and massive pulmonary embolism (PE) report intracranial haemorrhage (ICH) rates of 2%-3%, the risk of ICH in patients with recent brain surgery or intracranial neoplasm is unknown since these patients were excluded from these trials. We report a case of massive PE treated with systemic thrombolysis in a patient with recent neurosurgery for an intracranial neoplasm. We discuss the risks and benefits of systemic thrombolysis for massive PE in the context of previous case reports, prior cohort studies and trials, and current guidelines...
November 29, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29175415/multiple-overlapping-systematic-reviews-facilitate-the-origin-of-disputes-the-case-of-thrombolytic-therapy-for-pulmonary-embolism
#13
Nicoletta Riva, Livia Puljak, Lorenzo Moja, Walter Ageno, Holger Schünemann, Nicola Magrini, Alessandro Squizzato
OBJECTIVE: To explore disagreements in multiple systematic reviews (SRs) assessing the benefit-to-harm ratio of thrombolytic therapy in patients with intermediate-risk pulmonary embolism (PE). STUDY DESIGN AND SETTING: MEDLINE, EMBASE, CDSR and DARE were searched up to April 14, 2016. We included SRs and guidelines that evaluated thrombolytic therapy, compared to anticoagulation alone, in intermediate-risk PE. We calculated pooled risk ratio (RR) and absolute risk difference (RD), with interquartile range (IQR), for all-cause mortality, recurrent PE and major bleeding...
November 21, 2017: Journal of Clinical Epidemiology
https://www.readbyqxmd.com/read/29154971/preemptive-anticoagulation-in-patients-with-a-high-pretest-probability-of-pulmonary-embolism-are-guidelines-followed
#14
Laura Willoughby, Daniel M Adams, R Scott Evans, James F Lloyd, Scott M Stevens, Scott C Woller, Joseph R Bledsoe, Valerie T Aston, Emily L Wilson, C Gregory Elliott
BACKGROUND: Guidelines suggest anticoagulation of patients with high pretest probability of pulmonary embolism (PE) while awaiting diagnostic test results (preemptive anticoagulation). Data relevant to the practice of preemptive anticoagulation are not available. METHODS: We reviewed 3,500 consecutive patients who underwent CT pulmonary angiography (CTPA) at two EDs. We classified the pretest probability for PE using the revised Geneva Score (RGS) as low (RGS 0-3), intermediate (RGS 4-10), or high (RGS 11-18)...
November 15, 2017: Chest
https://www.readbyqxmd.com/read/29141890/british-thoracic-society-clinical-statement-on-pulmonary-arteriovenous-malformations
#15
Claire L Shovlin, Robin Condliffe, James W Donaldson, David G Kiely, Stephen J Wort
Pulmonary arteriovenous malformations (PAVMs) are structurally abnormal vascular communications that provide a continuous right-to-left shunt between pulmonary arteries and veins. Their importance stems from the risks they pose (>1 in 4 patients will have a paradoxical embolic stroke, abscess or myocardial infarction while life-threatening haemorrhage affects 1 in 100 women in pregnancy), opportunities for risk prevention, surprisingly high prevalence and under-appreciation, thus representing a challenging condition for practising healthcare professionals...
December 2017: Thorax
https://www.readbyqxmd.com/read/29135105/impact-of-abcb1-and-cyp2d6-polymorphisms-on-tamoxifen-treatment-outcomes-and-adverse-events-in-breast-cancer-patients
#16
Sona Argalacsova, Ondrej Slanar, Hana Bakhouche, Lubos Pertuzelka
PURPOSE: This study was designed to evaluate the effect of CYP2D6 and ABCB1 polymorphisms and co-medication on the outcomes and adverse events (AEs) of tamoxifen therapy. METHODS: In total, 258 women (187 postmenopausal and 71 premenopausal) with hormone positive breast carcinoma were retrospectively evaluated. CYP2D6 polymorphisms were evaluated with AmpliChip (Roche), and polymorphisms of ATP-binding cassettes B1 (P-glycoprotein) (ABCB1) rs2032582 and rs1045642 with restriction fragment length polymorphisms polymerase chain reaction (RFLP-PCR)...
September 2017: Journal of B.U.ON.: Official Journal of the Balkan Union of Oncology
https://www.readbyqxmd.com/read/29118862/thromboprophylaxis-and-mortality-among-patients-who-developed-venous-thromboembolism-in-seven-major-hospitals-in-saudi-arabia
#17
Fahad M Al-Hameed, Hasan M Al-Dorzi, Abdulelah I Qadhi, Amira Shaker, Farjah H Al-Gahtani, Fawzi F Al-Jassir, Galila F Zahir, Tarig S Al-Khuwaitir, Mohammed H Addar, Mohamed S Al-Hajjaj, Mohamed A Abdelaal, Essam Y Aboelnazar
INTRODUCTION: Venous thromboembolism (VTE) during hospitalization is a serious and potentially fatal condition. Despite its effectiveness, evidence-based thromboprophylaxis is still underutilized in many countries including Saudi Arabia. OBJECTIVE OF THE STUDY: Our objectives were to determine how often hospital-acquired VTE patients received appropriate thromboprophylaxis, VTE-associated mortality, and the percentage of patients given anticoagulant therapy and adherence to it after discharged...
October 2017: Annals of Thoracic Medicine
https://www.readbyqxmd.com/read/29112551/european-guidelines-on-perioperative-venous-thromboembolism-prophylaxis-inferior-vena-cava-filters
#18
Raquel Ferrandis Comes, Patrick Mismetti, Arash Afshari
: The indications for the use of an inferior vena cava filter (IVCF) in the context of deep venous thrombosis to prevent pulmonary embolism remain controversial. Despite wide use in clinical practice, great variation exists in national and international guidelines in regard to the indications. In addition, clinical practice is based on poor-quality data from trauma and bariatric surgery with a high incidence of complications. It is often difficult to assess their efficacy and lack of filter retrieval appears to be a substantial issue compared with a potential benefit by insertion of these devices...
February 2018: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29112548/european-guidelines-on-perioperative-venous-thromboembolism-prophylaxis-aspirin
#19
Jean-Yves Jenny, Ingrid Pabinger, Charles Marc Samama
: There is a good rationale for the use of aspirin in venous thromboembolism prophylaxis in some orthopaedic procedures, as already proposed by the 9th American College of Chest Physicians' guidelines (Grade 1C). We recommend using aspirin, considering that it may be less effective than or as effective as low molecular weight heparin for prevention of deep vein thrombosis and pulmonary embolism after total hip arthroplasty, total knee arthroplasty and hip fracture surgery (Grade 1C). Aspirin may be less effective than or as effective as low molecular weight heparins for prevention of deep vein thrombosis and pulmonary embolism after other orthopaedic procedures (Grade 2C)...
November 6, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29103574/update-on-perioperative-pulmonary-embolism-management-a-decision-support-tool-to-aid-in-diagnosis-and-treatment
#20
REVIEW
Alan M Smeltz, Lavinia M Kolarczyk, Robert S Isaak
Pulmonary embolism (PE) affects up to 1 in every 1000 people per year, one-third of whom do not survive. Moreover, perioperative presentation of PE is 5 times more likely than at other times and poses a unique set of challenges for both diagnosis and treatment. This article discusses several important aspects regarding the prevention, diagnosis, and management of perioperative PE, incorporating information from the most recent practice guidelines, emerging literature on medical therapy, and interventional therapies...
2017: Advances in Anesthesia
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