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Pregnancy and pulmonary embolism

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https://www.readbyqxmd.com/read/27913507/diagnosis-of-suspected-venous-thromboembolism
#1
Clive Kearon
The primary goal of diagnostic testing for venous thromboembolism (VTE) is to identify all patients who could benefit from anticoagulant therapy. Test results that identify patients as having a ≤2% risk of VTE in the next 3 months are judged to exclude deep vein thrombosis (DVT) or pulmonary embolism (PE). Clinical evaluation, with assessment of: (1) clinical pretest probability (CPTP) for VTE; (2) likelihood of important alternative diagnoses; and (3) the probable yield of D-dimer and various imaging tests, guide which tests should be performed...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27878206/new-findings-on-venous-thrombogenesis
#2
James R Byrnes, Alisa S Wolberg
Venous thrombosis (VT) is the third most common cause of cardiovascular death worldwide. Complications from VT and pulmonary embolism are the leading cause of lost disability-adjusted life years. Risks include genetic (e.g., non-O blood group, activated protein C resistance, hyperprothrombinemia) and acquired (e.g., age, surgery, cancer, pregnancy, immobilisation, female hormone use) factors. Pathophysiologic mechanisms that promote VT are incompletely understood, but involve abnormalities in blood coagulability, vessel function, and flow (so-called Virchow's Triad)...
November 23, 2016: Hämostaseologie
https://www.readbyqxmd.com/read/27766527/high-prevalence-of-congenital-thrombophilia-in-patients-with-pregnancy-related-or-idiopathic-venous-thromboembolism-pulmonary-embolism
#3
Makoto Ikejiri, Hideo Wada, Norikazu Yamada, Maki Nakamura, Naoki Fujimoto, Kaname Nakatani, Akimasa Matsuda, Yosihito Ogihara, Takeshi Matsumoto, Yuki Kamimoto, Tomoaki Ikeda, Naoyuki Katayama, Masaaki Ito
Congenital thrombophilia which is characterized by deficiencies in proteins such as antithrombin (AT), protein C (PC) and protein S (PS), is a major cause of venous thromboembolism (VTE). A total of 130 patients with VTE were evaluated for congenital thrombophilia based on the activity of AT, PC, or PS. Fifteen VTE patients with congenital AT deficiency (11.5 %), 16 with congenital PC deficiency (12.3 %) and eight with congenital PS deficiency (6.2 %) were diagnosed using DNA analysis. The frequency of congenital AT deficiency was significantly higher in subjects with pregnancy-related and idiopathic VTE than in those with VTE due to other causes, and congenital PC and PS deficiency were frequently associated with idiopathic VTE...
October 20, 2016: International Journal of Hematology
https://www.readbyqxmd.com/read/27764878/environmental-and-genetic-risk-factors-associated-with-venous-thromboembolism
#4
Marta Crous-Bou, Laura B Harrington, Christopher Kabrhel
Venous thromboembolism (VTE) includes deep vein thrombosis and pulmonary embolism, and a combination of environmental and genetic risk factors contributes to VTE risk. Within environmental risk factors, some are provoking (e.g., cancer, surgery, trauma or fracture, immobilization, pregnancy and the postpartum period, long-distance travel, hospitalization, catheterization, and acute infection) and others are nonprovoking (e.g., age, sex, race/ethnicity, body mass index and obesity, oral contraceptive or hormone therapy use, corticosteroid use, statin use, diet, physical activity, sedentary time, and air pollution)...
November 2016: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/27720446/use-of-clinical-prediction-rules-and-d-dimer-tests-in-the-diagnostic-management-of-pregnant-patients-with-suspected-acute-pulmonary-embolism
#5
L M Van der Pol, A T A Mairuhu, C Tromeur, F Couturaud, M V Huisman, F A Klok
Because pregnant women have an increased risk of venous thromboembolism (VTE) and at the same time normal pregnancy is associated with symptoms, mimicking those present in the setting of acute pulmonary embolism (PE), the latter diagnosis is frequently suspected in this patient category. Since imaging tests expose both mother and foetus to ionizing radiation, the ability to rule out PE based on non-radiological diagnostic tests is of paramount importance. However, clinical decision rules have only been scarcely evaluated in the pregnant population with suspected PE, while D-dimer levels lose diagnostic accuracy due to a physiological increase during normal pregnancy...
September 29, 2016: Blood Reviews
https://www.readbyqxmd.com/read/27673091/poster-335-pulmonary-embolism-and-other-challenges-associated-with-acute-spinal-cord-injury-during-pregnancy
#6
Jack M Smith, William McKinley
No abstract text is available yet for this article.
September 2016: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/27644095/optimizing-survival-outcomes-for-adult-patients-with-nontraumatic-cardiac-arrest
#7
Julianna Jung
Patient survival after cardiac arrest can be improved significantly with prompt and effective resuscitative care. This systematic review analyzes the basic life support factors that improve survival outcome, including chest compression technique and rapid defibrillation of shockable rhythms. For patients who are successfully resuscitated, comprehensive postresuscitation care is essential. Targeted temperature management is recommended for all patients who remain comatose, in addition to careful monitoring of oxygenation, hemodynamics, and cardiac rhythm...
October 2016: Emergency Medicine Practice
https://www.readbyqxmd.com/read/27512501/management-of-venous-thromboembolism-secondary-to-ovarian-hyperstimulation-syndrome-a-case-report-documenting-the-first-use-of-a-superior-vena-caval-filter-for-upper-limb-venous-thromboembolism-in-pregnancy-and-the-difficulties-and-complications-relating-to
#8
Nicola Mitchell-Jones, Michael McEwan, Mark Johnson
The management of venous thromboembolism and subsequent pulmonary embolism in pregnancy remains hugely challenging. In this case, we report the first use of a superior vena caval filter in pregnancy as an adjunct to pharmacological anticoagulation. This is the first reported use of a superior vena caval filter in pregnancy. We discuss the complexities of managing thromboembolism in pregnancy and the peri-partum period.
June 2016: Obstetric Medicine
https://www.readbyqxmd.com/read/27441306/investigating-for-pulmonary-embolism-in-pregnancy-five-year-retrospective-review-of-referrals-to-the-acute-medical-unit-of-a-large-teaching-hospital
#9
Elizabeth Janette Hamilton, Alistair Quentin Green, Jennifer Ann Cook, Henry Nash
This was a retrospective review of five years' data relating to patients referred to the Acute Medical Unit (AMU) of a large teaching hospital with suspected Pulmonary Embolism (PE) during pregnancy or 6 weeks postpartum. During this period, 210 patients in this group underwent half-dose perfusion scanning as investigation for possible PE and were managed via our ambulatory pathway. Pulmonary embolism was diagnosed in 5.2% of patients compared to 18% of non-pregnant patients identified in a previous audit. Half-dose Q scanning enabled exclusion of PE in almost 90% of patients without the need for further imaging...
2016: Acute Medicine
https://www.readbyqxmd.com/read/27412479/microparticles-reveal-cell-activation-during-ivf-a-possible-early-marker-of-a-prothrombotic-state-during-the-first-trimester
#10
Nina Olausson, Fariborz Mobarrez, Håkan Wallen, Eli Westerlund, Outi Hovatta, Peter Henriksson
Cell-derived microparticles (MPs) are known to be elevated in a number of diseases related to arterial and venous thromboembolism (VTE), such as acute myocardial infarction, VTE (deep-vein thrombosis and pulmonary embolism) and peripheral arterial disease. IVF-associated pregnancies have previously been shown to be associated with an increased incidence of VTE, mechanisms behind being unknown and sparsely studied. Our objective was to assess cell activation during IVF through analysis of MP levels and phenotype following ovarian stimulation...
August 30, 2016: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27396794/the-direct-factor-xa-inhibitor-rivaroxaban-passes-into-human-breast-milk
#11
Martin H J Wiesen, Cornelia Blaich, Carsten Müller, Thomas Streichert, Roman Pfister, Guido Michels
Thromboembolic disorders frequently require antithrombotic treatment during pregnancy and lactation. Vitamin K antagonists and heparins are the treatment options of choice in breastfeeding women. Factors including the route of administration, discomfort during treatment, and fetal and neonatal safety affect women's choices about anticoagulant therapy. Direct-acting oral anticoagulants (DOACs) have emerged as alternatives to these agents and may offer advantages compared with vitamin K antagonists. As breastfeeding women were excluded from clinical trials evaluating DOACs, no safety and efficacy data are available for these special patients and, crucially, estimates for infant exposure are lacking...
July 2016: Chest
https://www.readbyqxmd.com/read/27365558/preoperative-emboli-in-a-pregnant-woman-with-myxoma
#12
Freidoun Sabzi, Reza Faraji
The left atrium is the most common location of myxomas, which are benign tumors. Only a few cases of myxomas in pregnancies have been reported. Our thorough medical literature search showed only 17 reported cases in the course of pregnancy. Myxomas during pregnancy and in the preterm period constitute a serious phenomenon that can mimic an early sign of a life-threatening pathology like severe mitral stenosis. We describe a 33-year-old woman, who presented with acute dyspnea to a gynecology center and was referred to our hospital for further evaluation of pulmonary embolism...
July 2016: Iranian Journal of Medical Sciences
https://www.readbyqxmd.com/read/27349162/the-diagnostic-role-of-ventilation-perfusion-scans-versus-computed-tomography-pulmonary-angiography-in-obstetric-patients-investigated-for-pulmonary-embolism-at-wellington-hospital-from-2010-to-2012
#13
Sally Easther, Fali Langdana, Richard Beasley, Dushyant Maharaj, James Entwisle, Peter Abels
AIM: To develop best practice clinical guidelines for the use of ventilation/perfusion (V/Q) scanning and computed tomography perfusion angiography (CTPA) in pregnancy and the postpartum period. METHOD: Retrospective analysis of the clinical findings and radiologic investigation for pulmonary embolism (PE) in obstetric women at Wellington Hospital from 2010 to 2012. RESULTS: Fifty-four women were investigated for PE with a V/Q scan or CTPA, including 29 antenatal women and 25 postnatal women...
2016: New Zealand Medical Journal
https://www.readbyqxmd.com/read/27334082/-a-pregnant-patient-with-spontaneous-haemothorax-hereditary-haemorrhagic-telangiectasia-in-pregnancy
#14
S M Mourad, R Mies, T Frenzel, S Willems, E van der Heijden, L J Schultze Kool
BACKGROUND: The incidence of hereditary haemorrhagic telangiectasia (HHT - Osler-Weber-Rendu disease) in the Netherlands is 1:5000 but approximately 1:1300 in people from the Antilles. The disease is characterised by the development of telangiectasia and arteriovenous malformations (AVMs) that may result in serious morbidity and mortality. CASE DESCRIPTION: A 31-year-old primigravid patient consulted her general practitioner at 31 1/7 weeks gestational age with dyspnoea...
2016: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/27275041/amniotic-fluid-embolism
#15
REVIEW
Kiranpreet Kaur, Mamta Bhardwaj, Prashant Kumar, Suresh Singhal, Tarandeep Singh, Sarla Hooda
Amniotic fluid embolism (AFE) is one of the catastrophic complications of pregnancy in which amniotic fluid, fetal cells, hair, or other debris enters into the maternal pulmonary circulation, causing cardiovascular collapse. Etiology largely remains unknown, but may occur in healthy women during labour, during cesarean section, after abnormal vaginal delivery, or during the second trimester of pregnancy. It may also occur up to 48 hours post-delivery. It can also occur during abortion, after abdominal trauma, and during amnio-infusion...
April 2016: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/27229722/antiphospholipid-antibody-mediated-thrombotic-mechanisms-in-antiphospholipid-syndrome-towards-pathophysiology-based-treatment
#16
REVIEW
Md Asiful Islam, Fahmida Alam, Teguh Haryo Sasongko, Siew Hua Gan
Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by a persistently high titer of antiphospholipid antibodies (aPLs). In addition to pregnancy morbidity, arterial and/or venous thrombosis is another clinical feature of APS. Regardless of the type of APS, the thrombi formed by the induction of aPLs can lead to deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke and gangrene. Although the concept of APS was introduced approximately 32 years ago, its thrombogenic pathophysiology is still unclear...
2016: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/27192990/comparing-length-of-stay-between-patients-taking-rivaroxaban-and-conventional-anticoagulants-for-treatment-of-venous-thromboembolism
#17
Anish Desai, Amishi Desai, Rose Calixte, Malaygiri Aparnath, Alexander Hindenburg, Steve Salzman, Joseph P Mathew
BACKGROUND: Recent studies have demonstrated non-inferiority of rivaroxaban when compared to warfarin for the treatment of pulmonary embolism and deep venous thrombosis. Analysis of data from the EINSTEIN trials has demonstrated that patients who received rivaroxaban had a shorter length of stay (LOS) compared to those who received warfarin. However, these trials had strict inclusion and exclusion criteria, and were designed for a different primary outcome. Also, data from these closely monitored clinical trials may not reflect the daily practice of medicine...
August 2016: Lung
https://www.readbyqxmd.com/read/27135727/contraception-initiation-in-the-emergency-department-a-pilot-study-on-providers-knowledge-attitudes-and-practices
#18
Iyanna Liles, Lisa B Haddad, Eva Lathrop, Abigail Hankin
OBJECTIVES: Almost half of all pregnancies in the United States are unintended; these pregnancies are associated with adverse outcomes. Many reproductive-age females seek care in the emergency department (ED), are at risk of pregnancy, and are amenable to contraceptive services in this setting. Through a pilot study, we sought to assess ED providers' current practices; attitudes; and knowledge of emergency contraception (EC) and nonemergency contraception (non-EC), as well as barriers with respect to contraception initiation...
May 2016: Southern Medical Journal
https://www.readbyqxmd.com/read/27119048/diagnosing-pulmonary-embolism-in-pregnancy-are-biomarkers-and-clinical-predictive-models-useful
#19
Barbara V Parilla, Rachel Fournogerakis, Amy Archer, Suela Sulo, Lisa Laurent, Patricia Lee, Benazir Chhotani, Kathleen Hesse, Erik Kulstad
Objective The objective of this study was to evaluate whether trimester-specific D-dimer levels or the modified Wells score (MWS) is a useful risk stratification tool to exclude pregnant women at low risk of pulmonary embolism (PE) from diagnostic imaging. Study Design This is a prospective and retrospective cohort study. Pregnant women who underwent diagnostic imaging for suspected PE were prospectively enrolled. D-dimer serum levels were drawn, and a MWS was assigned. Pregnant women diagnosed with a PE before study launch who underwent diagnostic imaging and had a D-dimer level drawn were also evaluated...
April 2016: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/27090654/evaluation-of-pregnancy-associated-plasma-protein-a-levels-in-patients-with-chronic-obstructive-pulmonary-disease-and-associations-with-disease-severity
#20
Fahrettin Talay, Mehmet Tosun, Zehra Asuk Yaşar, Özlem Kar Kurt, Aysel Karği, Serkan Öztürk, Mehmet Fatih Özlü, Aytekin Alçelik
Chronic obstructive pulmonary disease (COPD) represents a systemic disorder characterized by chronic airflow limitation and an increased inflammatory response of the airways. Comorbidities are frequent in COPD and it is crucial to predict these in early stage for adequate management of COPD. Recent studies have reported that elevated levels of pregnancy-associated plasma protein-A (PAPP-A), a zinc-binding metalloproteinase, detected in patients with asthma, lung cancer, and pulmonary embolism and independently associated with cardiovascular events...
June 2016: Inflammation
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