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Pulmonary thrombolysis

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https://www.readbyqxmd.com/read/29915795/saddle-pulmonary-embolus-resulting-in-cardiovascular-collapse-requiring-extracorporeal-membrane-oxygenation-in-a-postoperative-patient-with-endometrial-cancer
#1
David Samuel, Gregory M Gressel, Sara Isani, Akiva P Novetsky, Nicole S Nevadunsky
Background: Venous thromboembolism after open gynecologic surgery is not uncommon, especially in the presence of other risk factors such as obesity, prolonged surgical time or gynecologic malignancy. Case: We present the case of a 62 y.o. patient who underwent open hysterectomy and surgical staging for uterine serous carcinoma. She was readmitted with lower extremity edema. During her workup, she underwent cardiovascular arrest secondary to saddle pulmonary embolus requiring cardiopulmonary resuscitation and extracorporeal membrane oxygenation...
May 2018: Gynecologic Oncology Reports
https://www.readbyqxmd.com/read/29909859/a-meta-analysis-of-outcomes-of-catheter-directed-thrombolysis-for-high-and-intermediate-risk-pulmonary-embolism
#2
REVIEW
Efthymios D Avgerinos, Zein Saadeddin, Adham N Abou Ali, Larry Fish, Catalin Toma, Maria Chaer, Belinda N Rivera-Lebron, Rabih A Chaer
OBJECTIVE: During the past few years, there has been a surge in the use of catheter-directed thrombolysis (CDT) for acute pulmonary embolism (PE), in the form of either standard CDT or ultrasound-assisted CDT (usCDT). This is a systematic review and meta-analysis of all published series on contemporary CDT for acute PE seeking to determine their clinical efficacy, stratifying by PE severity and CDT modality. METHODS: A comprehensive MEDLINE and Embase search was performed to identify studies that reported outcomes of CDT for acute PE published from 2009 to July 2017...
July 2018: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/29896249/the-effect-of-nitric-oxide-inhalation-on-heart-and-pulmonary-circulation-in-rabbits-with-acute-massive-pulmonary-embolism
#3
Zeming Zhang, Kun Pan, Lu Chen, Yancun Wang
The aim of the present study was to investigate the effect of nitric oxide inhalation (NOI) on cardiac troponin I (CTnI) levels and mean pulmonary arterial pressure (mPAP) in rabbits with acute massive pulmonary embolism (AMPE). Thirty rabbits were used as animal models for AMPE and received different treatments. A total of 4 h after successful modeling, the control group (CON, n=10) received conventional thrombolysis, whereas the treatment group (TRE, n=10) received conventional thrombolysis plus NOI. The experimental group (EXP, n=10) did not receive any treatments...
July 2018: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/29895520/clinical-update-on-thrombolytic-use-in-pulmonary-embolism-a-focus-on-intermediate-risk-patients
#4
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...
June 12, 2018: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/29893185/early-thrombolytic-failure-in-a-patient-with-massive-pulmonary-embolism-combined-with-multiple-organ-dysfunction-syndrome-what-next
#5
Furong Liu, Song Yang, Weishuo Liu, Baiyun Tang, Wenbo Zhang, Cheng Zhang, Wenwei Liao, Anbin Hu
Carbon monoxide (CO) poisoning, the most frequent type of poisoning, alters hemodynamics and creates tissue hypoxia that ultimately leads to thromboembolism. We herein describe a previously healthy 17-year-old male patient who developed acute CO poisoning while bathing in the same room as a gas heater. He was first treated with urokinase thrombolytic therapy at a local hospital, which proved ineffective. The patient was admitted to our hospital with unstable circulation and was diagnosed with massive pulmonary embolism combined with multiple organ dysfunction syndrome...
January 1, 2018: Journal of International Medical Research
https://www.readbyqxmd.com/read/29872632/catheter-directed-thrombolysis-combined-with-ecmo-for-massive-pulmonary-emboli
#6
J Lauren Lindsey, Rajay Jain, Vidula Vachharajani
This case report discusses a previously healthy young male who suffered an in hospital cardiac arrest, found to be secondary to massive pulmonary emboli (PE). This patient was not a candidate for PE dosing of tPA, but continued to have worsening cardiogenic shock and acute hypoxic respiratory failure. The decision was made to initiate venoarterial extracorporeal membrane oxygenation (VA ECMO) in combination with catheter assisted thrombolysis. With time, the sequelae of his disease process changed. Although his cardiogenic shock improved, the hypoxemia worsened, and the patient was transitioned from VA to venovenous (VV) ECMO, while managing further complications due to multiple episodes of cardiac arrest and severe coagulopathy with multiple, acute, life-threatening bleeding events...
2018: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/29872249/percutaneous-pulmonary-embolism-thrombectomy-and-thrombolysis-technical-tips-and-tricks
#7
REVIEW
Zlatko Devcic, William T Kuo
Catheter-directed therapy (CDT) is now acknowledged as a treatment option for select patients with acute massive or submassive pulmonary embolism (PE), and more patients are being considered for CDT if there is available expertise. Therefore, interventionalists should be aware of the variety of catheter-based treatment options, specific pitfalls to avoid during therapy, and the appropriate treatment endpoints. This article reviews currently available techniques and protocols for treating acute massive and submassive PE, with tips to safely and successfully perform percutaneous PE interventions...
June 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/29872248/catheter-directed-thrombolysis-for-submassive-pulmonary-embolism
#8
REVIEW
Matthew A Chiarello, Akhilesh K Sista
Acute pulmonary embolism (PE) is a leading cause of morbidity and mortality in the United States. PE associated with right ventricular strain, termed submassive or intermediate-risk PE, is associated with an increased rate of clinical deterioration and short-term mortality. Trials have demonstrated systemic thrombolytics may improve patient outcomes, but they carry a risk of major hemorrhage. Catheter-directed thrombolysis (CDT) may offer similar efficacy to and a lower risk of catastrophic hemorrhage than systemic thrombolysis...
June 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/29872246/intervention-in-massive-pulmonary-embolus-catheter-thrombectomy-thromboaspiration-versus-systemic-lysis-versus-surgical-thrombectomy
#9
REVIEW
John M Moriarty, Martin Edwards, Adam N Plotnik
Massive pulmonary embolus (PE), defined as hemodynamic shock from acute PE, is a life-threatening condition. Deaths from massive PE, especially when unsuspected, occur within minutes to hours of onset and as such prompt intervention can be lifesaving. Acute massive PE patients have traditionally been candidates for treatment with intravenous systemic thrombolysis to improve pulmonary artery pressure, arteriovenous oxygenation, and pulmonary perfusion in an effort to reduce mortality. However, patients with contraindications to systemic thrombolysis or those who have failed thrombolysis may benefit from other techniques including endovascular and surgical embolectomy...
June 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/29866478/the-new-bedside-rocky-score-to-predict-the-complications-in-patients-with-intermediate-risk-pulmonary-embolism
#10
Elena A Kochmareva, Valentin A Kokorin, Ivan G Gordeev
OBJECTIVE: Pulmonary embolism (PE) remains one of the leading causes of mortality among cardiovascular diseases. We aimed at investigating risk factors of PE complications in patients with intermediate risk and integrate them into a simple model for its' bedside prediction. METHODS: Among 173 patients with PE, 136 were classified as high or intermediate risk. Patients were retrospectively divided into groups of complicated (n = 44) or uncomplicated (n = 92) course...
June 1, 2018: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/29860923/a-systematic-review-of-paediatric-deep-venous-thrombolysis
#11
Mohamed Ah Taha, Andrew Busuttil, Roshan Bootun, Alun H Davies
Objectives The aim was to assess the effectiveness and safety of catheter-directed thrombolysis in children with deep venous thrombosis and to evaluate its long-term effect. Method and results EMBASE, Medline and Cochrane databases were searched to identify studies in which paediatric acute deep venous thrombosis patients received thrombolysis. Following title and abstract screening, seven cohort studies with a total of 183 patients were identified. Technical success was 82% and superior in regional rather than systemic thrombolysis (p < 0...
January 1, 2018: Phlebology
https://www.readbyqxmd.com/read/29849281/central-venous-catheter-directed-tissue-plasminogen-activator-in-massive-pulmonary-embolism
#12
Vishal Gulati, Jared Brazg
We present the case of an 88-year-old female who presented to the emergency department (ED) with suspected massive pulmonary embolism (PE) causing respiratory failure, right heart strain, and shock, who despite early and aggressive resuscitation with vasopressors and continuous peripheral infusion of tissue plasminogen activator (tPA), suffered a cardiac arrest in the ED. We describe the approach of a tPA bolus directed through a central venous catheter, resulting in return of spontaneous circulation and immediate improvement in physiologic parameters prior to confirmation of PE with computed tomography angiogram...
February 2018: Clinical practice and cases in emergency medicine
https://www.readbyqxmd.com/read/29848934/extracorporeal-membrane-oxygenation-improved-survival-in-patients-with-massive-pulmonary-embolism
#13
Donggyu Moon, Su Nam Lee, Ki-Dong Yoo, Min Seop Jo
BACKGROUND: Current guidelines for massive pulmonary embolism (PE) treatment recommend primary reperfusion therapy and the option of extracorporeal membrane oxygenation (ECMO). However, these recommendations might not be optimal for patients with poor prognoses who are in cardiogenic shock (CS) or require cardiopulmonary resuscitation (CPR). OBJECTIVE: Evaluate the impact of ECMO support on the clinical outcome of patients with massive PE complicated by CPR or CS...
May 2018: Annals of Saudi Medicine
https://www.readbyqxmd.com/read/29848540/pulmonary-embolism-and-infarction-with-a-paradoxical-thrombus-visualised-in-both-atria
#14
Hamza Zafar, Lisa Anderson, Andrew T Cox, Rachel Bastiaenen
A 59-year-old woman presented with a sudden onset of breathlessness and chest pain. An echocardiography and CT scan showed pulmonary embolism and infarction with a paradoxical thrombus visualised in both atria. For haemodynamically stable patients, the optimal management strategy is poorly defined. Three main strategies were considered: surgical thrombectomy, thrombolysis and anticoagulation. Surgery with reversal of anticoagulation may lead to further coagulation and increased risk of bleeding complications...
May 30, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29843174/reperfusion-treatment-for-acute-pulmonary-embolism
#15
Rolf P Engelberger, Nils Kucher
Due to the manifold treatment options for the management of acute pulmonary embolism, state-of-the-art management requires risk stratification for choosing the adapted treatment for each patient. Reperfusion therapy is an integral part of therapy for patients with pulmonary embolism at high risk for mortality, but its role in patients with intermediate risk pulmonary embolism is more debated. The largest amount of evidence exists for systemic thrombolysis, which is an efficient therapy, but at the prize of an increased bleeding risk...
May 2018: Hämostaseologie
https://www.readbyqxmd.com/read/29806658/ultrasound-assisted-catheter-directed-low-dose-thrombolysis-for-the-treatment-of-acute-intermediate-high-risk-pulmonary-embolism
#16
Jakub Stępniewski, Grzegorz Kopeć, Wojciech Magoń, Dorota Sobczyk, Piotr Musiałek, Piotr Podolec
No abstract text is available yet for this article.
May 28, 2018: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/29804743/management-of-tunneled-cuffed-catheter-related-right-atrial-thrombosis-in-hemodialysis-patients
#17
Hongliu Yang, Feng Chen, He Jiao, Han Luo, Yang Yu, Hyokyoung G Hong, Yi Li, Ping Fu, Tianlei Cui
OBJECTIVES: Catheter-related right atrial thrombosis (CRAT) is an underreported but potentially life-threatening complication associated with the use of tunneled-cuffed catheters among hemodialysis (HD) patients. Because little is known about the evidence-based guidelines for the optimal management of CRAT among HD patients, this article reports findings based on 20 patients diagnosed with CRAT after catheter replacement and anticoagulation treatment. METHODS: The article retrospectively reviews the hospital records of 20 HD patients treated in the West China Hospital with diagnosis of CRAT from March 2013 to May 2016...
May 24, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29804522/thrombolysis-for-venous-thromboembolism-during-pregnancy-a-literature-review
#18
Vy T Ho, Anahita Dua, Kedar Lavingia, Kara Rothenberg, Christina Rao, Sapan S Desai
BACKGROUND: Pregnancy is a hypercoagulable state, conferring an increased risk of venous thromboembolism (VTE). However, treatment algorithms for deep venous thrombosis and pulmonary embolism are based on studies of nonpregnant patients. METHODS: A literature review of cases in which thrombolysis was used for the treatment of VTE during pregnancy was conducted using the PubMed (National Institutes of Health) database. RESULTS: A PubMed database search of English language articles for reports of thrombolysis for the treatment of VTE in pregnancy identified 215 cases, including 183 cases of systemic thrombolysis, 19 cases of catheter-directed thrombolysis, and 13 cases of mechanical thrombectomy...
January 1, 2018: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29803279/pulmonary-embolism-in-children
#19
REVIEW
Sarah Ramiz, Madhvi Rajpurkar
Pulmonary embolism (PE) in children is a rare condition with potential for high mortality. PE incidence is increasing owing to increased survival of children with predisposing conditions, increased use of central venous catheters, and improved awareness and recognition. Although pediatric PE is distinct from adult PE, management guidelines in children are extrapolated from the adult data. Treatment includes thrombolysis or thrombectomy, and pharmacologic anticoagulation. Ongoing clinical trials are evaluating the use of direct oral anticoagulants in children...
June 2018: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/29786477/the-impact-of-a-multi-specialty-team-for-high-risk-pulmonary-embolism-on-resident-and-fellow-education
#20
Ayman Elbadawi, Colin Wright, Dhwani Patel, Yu Lin Chen, Justin Mazzillo, Pamela Cameron, Geoffrey D Barnes, Scott J Cameron
The impact of the Pulmonary Embolism Response Team (PERT) model on trainee physician education and autonomy over the management of high risk pulmonary embolism (PE) is unknown. A resident and fellow questionnaire was administered 1 year after PERT implementation. A total of 122 physicians were surveyed, and 73 responded. Even after 12 months of interacting with the PERT consultative service, and having formal instruction in high risk PE management, 51% and 49% of respondents underestimated the true 3-month mortality for sub-massive and massive PE, respectively, and 44% were unaware of a common physical exam finding in patients with PE...
May 1, 2018: Vascular Medicine
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