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Massive and submassive pulmonary embolism

Timothy J Fuller, Christopher M Paprzycki, Muhammad H Zubair, Lala R Hussain, Brian A Kuhn, Matthew H Recht, Patrick E Muck
BACKGROUND: Interventional strategies for massive and submassive Pulmonary Embolism (smPE) have historically included either systematic intravenous thrombolytic alteplase (IV TPA) or surgical embolectomy, both of which are associated with significant morbidity and mortality. However, with the advent of endovascular techniques, recent studies have suggested that an endovascular approach to the treatment of acute smPE may be both safe and effective with excellent outcomes. The purpose of this study was to evaluate the outcomes of patients who have undergone catheter directed thrombolysis (CDT) for smPE at our institution in an effort to determine the safety of the procedure...
September 22, 2016: Annals of Vascular Surgery
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
J J Edelman, N Okiwelu, K Anvardeen, P Joshi, B Murphy, L H Sanders, M A Newman, J Passage
BACKGROUND: Massive pulmonary embolism is a poorly tolerated condition. Treatment options in this condition include anticoagulation and primary reperfusion therapy - systemic thrombolysis, catheter based treatments or surgical embolectomy. There is little data on the relative efficacy of each treatment. METHODS: The preoperative characteristics and outcomes of patients referred for surgical embolectomy between 2000-2014 was reviewed. Echocardiography was performed in the majority of patients before and after surgery...
May 12, 2016: Heart, Lung & Circulation
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
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
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
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
Gunchan Paul, Birinder S Paul, Parshotam L Gautam, Bishav Mohan, Shruti Sharma
Among the spectrum of venous thrombo-embolic disease, acute pulmonary embolism accounts for the most life threatening manifestations with mortality exceeding 50%. It can affect many patient populations across various disciplines, hence immediate attention and aggressive treatment is crucial. With the advancement of technologies, various catheter-based devices are available to treat massive or submassive PE. In this paper we report two patients of acute pulmonary embolism with neurological issues where the life threatening emergency was successfully managed by utilizing endovascular directed thrombolytic reperfusion therapy...
July 2015: International Journal of Health Sciences
Mark G Davies, Hosam F El-Sayed
Acute pulmonary embolism (PE) continues to carry a high mortality if not recognized early and treated aggressively. Rapid recognition and diagnosis remains the mainstay of all efforts. Risk stratification early is paramount to guide therapy and achieve successful outcomes. Pulmonary emboli can generally be classified as massive, submassive, or stable. Fibrinolysis and/or surgical embolectomy are recommended for the treatment of the patient with massive PE to rescue the patient and restore hemodynamic stability...
February 2016: Annals of Vascular Surgery
Yang Hyun Cho, Kiick Sung, Wook Sung Kim, Dong Seop Jeong, Young Tak Lee, Pyo Won Park, Duk-Kyung Kim
BACKGROUND: Although current guidelines for pulmonary embolism (PE) treatment recommend surgical embolectomy when thrombolysis is contraindicated or has failed, their clinical outcomes rarely have been compared directly. METHODS: After excluding patients aged under 18 years and those with submassive or non-massive PE, 45 consecutive patients (median age, 68 years; 62% female; 31% experienced cardiac arrest before PE treatment onset; 33% had cancer diagnosis history; and 29% received extracorporeal membrane oxygenation [ECMO]) who underwent only thrombolysis (TL group; n=19) or surgical embolectomy (SE group; n=26, including 4 who had failed thrombolysis) for acute massive PE from 2000 to 2013 at Samsung Medical Center were enrolled to assess cardiac mortality as primary outcome...
January 15, 2016: International Journal of Cardiology
Hesham R Omar
INTRODUCTION: Electrocardiographic (ECG) abnormalities are seen in 70%-80% of patients with acute pulmonary embolism (APE). Rarely, APE presents with ST-segment elevation (STE) in leads V1-V4, mimicking ST-segment elevation myocardial infarction (STEMI). Herein, we describe a case of APE presenting with STE in V1-V3, along with a comprehensive review of the literature. METHODS: We reviewed Pubmed/Medline indexed articles from 1950 to 2014 reporting cases of APE presenting with STE in V1-V3 or V4 (V1-V3/V4)...
September 15, 2015: European Heart Journal. Acute Cardiovascular Care
Gregory Piazza, Benjamin Hohlfelder, Michael R Jaff, Kenneth Ouriel, Tod C Engelhardt, Keith M Sterling, Noah J Jones, John C Gurley, Rohit Bhatheja, Robert J Kennedy, Nilesh Goswami, Kannan Natarajan, John Rundback, Immad R Sadiq, Stephen K Liu, Narinder Bhalla, M Laiq Raja, Barry S Weinstock, Jacob Cynamon, Fakhir F Elmasri, Mark J Garcia, Mark Kumar, Juan Ayerdi, Peter Soukas, William Kuo, Ping-Yu Liu, Samuel Z Goldhaber
OBJECTIVES: This study conducted a prospective, single-arm, multicenter trial to evaluate the safety and efficacy of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis, using the EkoSonic Endovascular System (EKOS, Bothell, Washington). BACKGROUND: Systemic fibrinolysis for acute pulmonary embolism (PE) reduces cardiovascular collapse but causes hemorrhagic stroke at a rate exceeding 2%. METHODS: Eligible patients had a proximal PE and a right ventricular (RV)-to-left ventricular (LV) diameter ratio ≥0...
August 24, 2015: JACC. Cardiovascular Interventions
Rishi K Wadhera, Gregory Piazza
Pulmonary embolism (PE) is a common cardiovascular condition that represents a spectrum of disorders with a gradient of increased risk of adverse outcomes. The U.S. Surgeon General estimated that approximately 100,000 to 180,000 PE-related deaths occur in the United States annually, and that PE is the most preventable cause of death among hospitalized patients. Risk stratification is critical to identify the patients who may benefit from advanced therapy. This review will provide an overview of PE pathophysiology, evidence-based risk stratification strategies for patients with acute PE, a summary of traditional and novel oral anticoagulant options, and an in-depth discussion on the utilization of advanced therapeutic options, including systemic fibrinolysis, catheter-based pharmacomechanical therapy, and surgical embolectomy...
January 2016: Cardiology in Review
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