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https://www.readbyqxmd.com/read/30039233/management-of-venous-thromboembolism-in-pregnancy
#1
REVIEW
Annemarie E Fogerty
PURPOSE OF REVIEW: This manuscript addresses the risks for venous thromboembolism (VTE) during pregnancy and the associated challenges of both diagnosis and treatment. RECENT FINDINGS: The obstacles to diagnosis given lack of specificity of typical biomarkers to predict VTE in pregnancy, as well as the unique fetal and bleeding risks introduced by managing massive pulmonary embolism (PE) with thrombolytics or thrombectomy are highlighted. VTE during pregnancy and the postpartum window occurs at a 6-10-fold higher rate compared with age-matched peers and is a major cause of morbidity and mortality...
July 23, 2018: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29895520/clinical-update-on-thrombolytic-use-in-pulmonary-embolism-a-focus-on-intermediate-risk-patients
#2
Hannah Eberle, Raquel Lyn, Tamara Knight, Emily Hodge, Mitchell Daley
PURPOSE: Current literature on clinical controversies surrounding the use of thrombolytic agents in patients with intermediate-risk pulmonary embolism (PE) is reviewed. SUMMARY: PE is a major cause of morbidity and mortality. When used in conjunction with anticoagulation, thrombolysis has been shown to reduce hemodynamic decompensation in select patients, but thrombolytic therapy is associated with high risks of bleeding and intracranial hemorrhage and its role in treating patients with intermediate-risk PE remains controversial...
September 1, 2018: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/29718846/high-risk-pulmonary-embolism-assessed-by-transthoracic-echocardiography-a-case-report
#3
Jiahong Wu, Jing Zhang, Fangfang Yang, Chuanbao Li, Mei Ni
RATIONALE: Acute pulmonary embolism (APE) as a life-threatening illness may present with a wide range of manifestations. APE was diagnosed using computed tomographic pulmonary angiography (CTPA); however, transthoracic echocardiography (TTE) can reveal hemodynamic status. Early thrombolysis is the most effective therapy for the treatment of massive pulmonary embolism. PATIENTS CONCERNS: Herein, we report a case of high-risk APE with a wide range of manifestations, including chest pain, dyspnea, low-blood pressure, and syncope...
May 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28595772/prevention-of-early-complications-and-late-consequences-after-acute-pulmonary-embolism-focus-on-reperfusion-techniques
#4
Stavros V Konstantinides, Stefano Barco
Pulmonary embolism (PE) is a major cause of acute cardiovascular mortality and long-term morbidity. Right ventricular (RV) dysfunction is the key determinant of prognosis in the acute phase of PE, and residual RV dysfunction is associated with the development of post-PE functional impairment, chronic thromboembolic disease, and higher costs of treatment over the long term. Patients with clinically overt RV failure, i.e. hemodynamic collapse at presentation (high-risk PE), necessitate immediate thrombolytic treatment to relieve the obstruction in the pulmonary circulation; surgical or catheter-directed removal of the thrombus can be an alternative option...
April 2018: Thrombosis Research
https://www.readbyqxmd.com/read/28440519/-prevention-diagnosis-and-treatment-of-perioperative-complications-of-bariatric-and-metabolic-surgery
#5
Haifu Wu, Ming Zhong, Di Zhou, Chenye Shi, Heng Jiao, Wei Wu, Xinxia Chang, Jing Cang, Hua Bian
Surgical operation in treating obesity and type 2 diabetes is popularizing rapidly in China. Correct prevention and recognition of perioperation-related operative complications is the premise of ensuring surgical safety. Familiar complications of the operation include deep venous thrombosis, pulmonary artery embolism, anastomotic bleeding, anastomotic fistula and marginal ulcer. The prevention of deep venous thrombosis is better than treatment. The concrete measures contain physical prophylaxis (graduated compression stocking and intermittent pneumatic compression leg sleeves) and drug prophylaxis (unfractionated heparin and low molecular heparin), and the treatment is mainly thrombolysis or operative thrombectomy...
April 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/28248408/prognostic-importance-of-central-thrombus-in-hemodynamically-stable-patients-with-pulmonary-embolism
#6
MULTICENTER STUDY
Aysegul Senturk, Savas Ozsu, Serap Duru, Ebru Cakır, Sevinc Sarinc Ulaslı, Ezgi Demirdogen, Servet Kayhan, Aygul Guzel, Fatih Yakar, Serdar Berk
BACKGROUND: The association between mortality and localization of central thrombus in hemodynamically stable patients with pulmonary embolism (PE) is unclear. Sufficient data are not available to help clinicians to select between low molecular weight heparin (LMWH), unfractionated heparin (UFH) and thrombolytics for the management of central thrombus. The present study aims to investigate whether central thrombus in the pulmonary artery affects 30-day mortality rate, and to compare the outcomes of different treatment approaches in patients with central thrombus...
2017: Cardiology Journal
https://www.readbyqxmd.com/read/28090232/efficacy-and-safety-of-thrombolytic-therapy-in-acute-submassive-pulmonary-embolism-follow-up-study
#7
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/27990080/systemic-thrombolysis-for-pulmonary-embolism-a-review
#8
Colleen Martin, Kristine Sobolewski, Patrick Bridgeman, Daniel Boutsikaris
The authors review the evidence behind the use of thrombolytic therapy in patients with massive or submassive pulmonary embolism. Concurrent heparin therapy and the management of bleeding episodes are also discussed.
December 2016: P & T: a Peer-reviewed Journal for Formulary Management
https://www.readbyqxmd.com/read/27790495/acute-right-heart-failure-in-a-patient-with-right-heart-thrombus-and-pulmonary-thromboembolism
#9
Mohammad Mostafa Ansari-Ramandi, Samaneh Ansari-Ramandi, Nasim Naderi
Right Heart Thrombus (RiHT) management is really controversial, and appropriate guidelines are not present for the management. In patients referring with RiHT and Pulmonary Embolism (PE), there are three ways of managing these patients. Out of the three, one is thrombectomy, which is with high risk taking in mind the comorbidities these patients have. The other is using thrombolytic which, in many cases is contraindicated or with high risk. The other less effective way is full anticoagulation. It is really controversial to choose between these ways of management and no clear approach is present...
September 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27188093/-update-on-current-care-guideline-venous-thromboembolism-vte-deep-venous-thrombosis-and-pulmonary-embolism
#10
(no author information available yet)
Key recommendations in management of VTE include prompt and systematic diagnostics based on clinical probability, D-dimer testing and imaging studies, and individualized antithrombotic treatment. Outpatient management is encouraged for patients with favourable prognosis. Interventions such as thrombolysis, venous stenting and inferior vena cava filters are limited to specific subgroups of patients. The duration of anticoagulation is tailored by balancing the risks of VTE recurrence and bleeding. Without contraindications, the minimal duration of anticoagulation is 3 months...
2016: Duodecim; Lääketieteellinen Aikakauskirja
https://www.readbyqxmd.com/read/27129723/catheter-directed-ultrasound-accelerated-thrombolysis-may-be-life-saving-in-patients-with-massive-pulmonary-embolism-after-failed-systemic-thrombolysis
#11
Saim Sag, Omer Fatih Nas, Aysel Aydin Kaderli, Bulent Ozdemir, İbrahim Baran, Cuneyt Erdoğan, Sumeyye Gullulu, Bahattin Hakyemez, Ali Aydinlar
The treatment options for high risk acute pulmonary embolism (PE) patients with failed systemic thrombolytic treatment (STT) is limited. The clinical use of catheter directed thrombolysis with the EkoSonic Endovascular System (EKOS) in this population has not been evaluated before. Catheter directed thrombolysis is an effective treatment modality for high risk PE patients with failed STT. Thirteen consecutive patients with failed STT were included in the study. EKOS catheters were placed and tissue plasminogen activator (t-PA) in combination with unfractionated heparin were given...
October 2016: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/27113394/rheolytic-thrombectomy-in-patient-with-acute-pulmonary-embolism-heparin-induced-thrombocytopenia-and-recent-stoke-when-percutaneous-treatment-is-the-only-therapeutic-alternative
#12
Marco Zuin, Gianluca Rigatelli, Loris Roncon
To report the combined use of rheolytic thrombectomy (RT) and inferior vena cava (IVC) filter placement in the setting of acute pulmonary embolism (PE), heparin-induced thrombocytopenia (HIT) type II (HIT-II) and recent ischemic stroke. A 66-year-old man with an HIT-II and recent ischemic stroke was referred to our institution from a secondary regional center for acute PE and left deep vein thrombosis (DVT), confirmed at chest computed tomography (CT) and lower limb ultrasound, respectively. RT was attempted because intravenous heparin anticoagulation was contraindicated by the patient's medical history while recent ischemic stroke contraindicated thrombolysis...
April 25, 2016: Perfusion
https://www.readbyqxmd.com/read/27000611/successful-management-of-cardiac-arrest-due-to-pulmonary-embolus-using-extracorporeal-membrane-oxygenation-and-ultrasound-accelerated-catheter-directed-thrombolysis
#13
Vikas Sharma, Howard D Goldberg, Dmitriy Zubkus, Larry L Shears, David J Kaczorowski
Here we present the case of a patient that suffered a cardiac arrest due to pulmonary embolus. The patient was resuscitated using extracorporeal membrane oxygenation and treated with ultrasound-accelerated catheter-directed thrombolysis during support on extracorporeal membrane oxygenation, with an excellent outcome. This case demonstrates that the use of extracorporeal membrane oxygenation and ultrasound-accelerated catheter-directed thrombolysis can be highly effective for managing select patients with pulmonary embolus and cardiac arrest...
April 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/26934891/recent-advances-in-the-management-of-pulmonary-embolism-focus-on-the-critically-ill-patients
#14
Guy Meyer, Antoine Vieillard-Baron, Benjamin Planquette
The aim of this narrative review is to summarize for intensivists or any physicians managing "severe" pulmonary embolism (PE) the main recent advances or recommendations in the care of patients including risk stratification, diagnostic algorithm, hemodynamic management in the intensive care unit (ICU), recent data regarding the use of thrombolytic treatment and retrievable vena cava filters and finally results of direct oral anticoagulants. Thanks to the improvements achieved in the risk stratification of patients with PE, a better therapeutic approach is now recommended from diagnosis algorithm and indication to admission in ICU to indication of thrombolysis and general hemodynamic support in patients with shock...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/26867832/antithrombotic-therapy-for-vte-disease-chest-guideline-and-expert-panel-report
#15
Clive Kearon, Elie A Akl, Joseph Ornelas, Allen Blaivas, David Jimenez, Henri Bounameaux, Menno Huisman, Christopher S King, Timothy A Morris, Namita Sood, Scott M Stevens, Janine R E Vintch, Philip Wells, Scott C Woller, Lisa Moores
BACKGROUND: We update recommendations on 12 topics that were in the 9th edition of these guidelines, and address 3 new topics. METHODS: We generate strong (Grade 1) and weak (Grade 2) recommendations based on high- (Grade A), moderate- (Grade B), and low- (Grade C) quality evidence. RESULTS: For VTE and no cancer, as long-term anticoagulant therapy, we suggest dabigatran (Grade 2B), rivaroxaban (Grade 2B), apixaban (Grade 2B), or edoxaban (Grade 2B) over vitamin K antagonist (VKA) therapy, and suggest VKA therapy over low-molecular-weight heparin (LMWH; Grade 2C)...
February 2016: Chest
https://www.readbyqxmd.com/read/26806235/efficacy-of-retrievable-inferior-vena-cava-filter-placement-in-the-prevention-of-pulmonary-embolism-during-catheter-directed-thrombectomy-for-proximal-lower-extremity-deep-vein-thrombosis
#16
Seul-Hee Lee, Hyun-Kyu Kim, Jeung-Kee Hwang, Sang-Dong Kim, Sun Cheol Park, Ji-Il Kim, Yong-Sung Won, Sang-Seob Youn, In-Sung Moon
BACKGROUND: Inferior vena cava (IVC) filter placement is not indicated for thrombolytic interventional treatment for deep vein thrombosis (DVT). We analyzed the efficacy and feasibility of retrievable IVC filter placement for the preventive management of embolic shedding during catheter-directed thrombectomy (CDT) for DVT of lower extremity. METHODS: Seventy patients (35 males and 35 females) who underwent retrievable IVC filter placement to prevent thrombus dislodgement during CDT in all symptomatic DVT with thrombus age suspected within 4 weeks of the lower extremity between March 2008 and January 2014 were included in this study...
May 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/26791064/trends-in-pulmonary-embolism-outcomes-are-we-really-making-progress
#17
EDITORIAL
Stavros V Konstantinides
No abstract text is available yet for this article.
January 19, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/26791063/trends-in-the-management-and-outcomes-of-acute-pulmonary-embolism-analysis-from-the-riete-registry
#18
David Jiménez, Javier de Miguel-Díez, Ricardo Guijarro, Javier Trujillo-Santos, Remedios Otero, Raquel Barba, Alfonso Muriel, Guy Meyer, Roger D Yusen, Manuel Monreal
BACKGROUND: Despite advances in hospital management in recent years, it is not clear whether mortality after acute pulmonary embolism (PE) has decreased over time. OBJECTIVES: This study describes the trends in the management and outcomes of acute symptomatic PE. METHODS: We identified adults with acute PE enrolled in the registry between 2001 and 2013. We assessed temporal trends in length of hospital stay and use of pharmacological and interventional therapies...
January 19, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/26780738/guidance-for-the-treatment-of-deep-vein-thrombosis-and-pulmonary-embolism
#19
REVIEW
Michael B Streiff, Giancarlo Agnelli, Jean M Connors, Mark Crowther, Sabine Eichinger, Renato Lopes, Robert D McBane, Stephan Moll, Jack Ansell
This guidance document focuses on the diagnosis and treatment of venous thromboembolism (VTE). Efficient, cost effective diagnosis of VTE is facilitated by combining medical history and physical examination with pre-test probability models, D dimer testing and selective use of confirmatory imaging. Clinical prediction rules, biomarkers and imaging can be used to tailor therapy to disease severity. Anticoagulation options for acute VTE include unfractionated heparin, low molecular weight heparin, fondaparinux and the direct oral anticoagulants (DOACs)...
January 2016: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/26726087/anticoagulant-therapy-in-a-pregnant-woman-with-may-thurner-syndrome
#20
Masaki Goto, Shin-Ichiro Miura, Tomohiko Yamamoto, Yusuke Fukuda, Takashi Kuwano, Ibuki Kimura, Ayako Sanui, Shingo Miyamoto, Keijiro Saku
A 39-year-old woman with a 9-week abdominal pregnancy noted pain in her lower abdomen and left leg. Since successive thrombi were observed extending from the left common iliac vein to the popliteal vein along with a thrombus in the left pulmonary artery, we diagnosed her with pulmonary thromboembolism with deep venous thrombosis (DVT). May-Thurner syndrome may have contributed to DVT in the left leg when the left iliac vein was compressed by the right iliac artery. She underwent anticoagulant therapy with heparin, followed by the subcutaneous injection of heparin at home after discharge...
2016: Internal Medicine
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