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well's score embolism

David R Vinson, Dustin W Ballard, Dustin G Mark, Jie Huang, Mary E Reed, Adina S Rauchwerger, David H Wang, James S Lin, Mamata V Kene, Tamara S Pleshakov, Dana K Sax, Jordan M Sax, D Ian McLachlan, Cyrus K Yamin, Clifford J Swap, Hilary R Iskin, Ridhima Vemula, Bethany S Fleming, Andrew R Elms, Drahomir Aujesky
INTRODUCTION: The Pulmonary Embolism Severity Index (PESI) is a validated prognostic score to estimate the 30-day mortality of emergency department (ED) patients with acute pulmonary embolism (PE). A simplified version (sPESI) was derived but has not been as well studied in the U.S. We sought to validate both indices in a community hospital setting in the U.S. and compare their performance in predicting 30-day all-cause mortality and classification of cases into low-risk and higher-risk categories...
September 24, 2016: Thrombosis Research
Deng-Wei Chou, Shu-Ling Wu, Kuo-Mou Chung, Shu-Chen Han, Bruno Man-Hon Cheung
OBJECTIVES: Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care. METHODS: The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed...
October 1, 2016: Clinics
Erin R Weeda, Philip S Wells, W Frank Peacock, Gregory J Fermann, Christopher W Baugh, Veronica Ashton, Concetta Crivera, Peter Wildgoose, Jeff R Schein, Craig I Coleman
We sought to compare length-of-stay (LOS), total hospital costs, and readmissions among pulmonary embolism (PE) patients treated with rivaroxaban versus parenterally bridged warfarin. We identified adult PE (primary diagnostic code = 415.1x) patients in the Premier Database (11/2012-9/2015), and included those with ≥1 PE diagnostic test on days 0-2. Rivaroxaban users (allowing ≤2 days of prior parenteral therapy) were 1:1 propensity score matched to patients parenterally bridged to warfarin. LOS, total costs, and readmission for venous thromboembolism (VTE) or major bleeding within the same or subsequent 2 months were compared between cohorts...
October 18, 2016: Internal and Emergency Medicine
K Ye, X Lu, W Li, M Yin, X Liu, J Qin, G Liu, M Jiang
OBJECTIVE: To evaluate the technical aspects and short-term clinical results of stent placement for chronic occlusion of a filter-bearing inferior vena cava (IVC) in patients with severe post-thrombotic syndrome (PTS). METHODS: A retrospective analysis of 24 patients with severe PTS associated with occlusion of a filter-bearing IVC treated by stent placement was conducted at a single institution from January 2010 to December 2014. Patient-reported quality of life and limb Villalta scores were evaluated before and after treatment by questionnaire and clinical examination, respectively...
October 14, 2016: European Journal of Vascular and Endovascular Surgery
Michael T Booker, John O Johnson
PURPOSE: Optimizing the utilization of CT pulmonary angiogram (CTPA) for the diagnosis and workup of acute chest pain can provide an opportunity to reduce unnecessary radiation and health care system expense. METHODS: An attempt to improve CTPA utilization began by measuring overall department and clinician-specific utilization. This was bolstered by retrospectively evaluating patient charts for pulmonary embolism scoring criteria and D-dimer utilization so as to better understand gaps in diagnostic workup...
October 4, 2016: Journal of the American College of Radiology: JACR
Zihao Yan, Ivan K Ip, Ali S Raja, Anurag Gupta, Joshua M Kosowsky, Ramin Khorasani
Purpose To determine the frequency of, and yield after, provider overrides of evidence-based clinical decision support (CDS) for ordering computed tomographic (CT) pulmonary angiography in the emergency department (ED). Materials and Methods This HIPAA-compliant, institutional review board-approved study was performed at a tertiary care, academic medical center ED with approximately 60 000 annual visits and included all patients who were suspected of having pulmonary embolism (PE) and who underwent CT pulmonary angiography between January 1, 2011, and August 31, 2013...
September 30, 2016: Radiology
Shayna Sarosiek, Denis Rybin, Janice Weinberg, Peter A Burke, George Kasotakis, J Mark Sloan
Importance: Trauma patients admitted to the hospital are at increased risk of bleeding and thrombosis. The use of inferior vena cava (IVC) filters in this population has been increasing, despite a lack of high-quality evidence to demonstrate their efficacy. Objective: To determine if IVC filter insertion in trauma patients affects overall mortality. Design, Setting, and Participants: This retrospective cohort study used stratified 3:1 propensity matching to select a control population similar to patients who underwent IVC filter insertion at Boston Medical Center (a level I trauma center at Boston University School of Medicine) between August 1, 2003, and December 31, 2012...
September 28, 2016: JAMA Surgery
Fatih Seker, Johannes Pfaff, Marcel Wolf, Silvia Schönenberger, Simon Nagel, Christian Herweh, Mirko Pham, Martin Bendszus, Markus A Möhlenbruch
PURPOSE: The impact of thrombus length on recanalization in IV thrombolysis for acute intracranial artery occlusion has been well studied. Here we analyzed the influence of thrombus length on the number of thrombectomy maneuvers needed for recanalization, intraprocedural complications, recanalization success, and clinical outcome after mechanical thrombectomy. METHODS: We retrospectively analyzed angiographic and clinical data from 72 consecutive patients with acute occlusion of the M1 segment of the middle cerebral artery who were treated with mechanical thrombectomy using stent retrievers...
September 15, 2016: Journal of Neurointerventional Surgery
Poul Henning Madsen, Søren Hess
Basic knowledge of pulmonary embolism is relevant to most practicing physicians. Many medical specialties care for patients with increased risk of pulmonary embolism, why recognition of relevant symptoms, a thorough medical history, assessment of the clinical condition of the patient and possibly referral to a relevant facility should be a part of the skills of all clinicians. Sudden onset dyspnea, chest pain, syncope and hemoptysis are essential symptoms of pulmonary embolism, and in most of these patients basic investigations like arterial blood gas analysis, electrocardiogram, chest x-ray and biochemical analyses are appropriate...
September 13, 2016: Advances in Experimental Medicine and Biology
Pierre Tannous, Zubin Mukadam, Chetan Kammari, Harsha Banavasi, Ayman O Soubani
OBJECTIVE/BACKGROUND: The use of computed tomography pulmonary angiography (CTPA) in the emergency department (ED) for patients suspected to have pulmonary embolism (PE) has been steadily rising in the last 2decades. However, there are limited studies that specifically address the use of CTPA in the ED for cancer patients suspected to have PE. The objective of this study is to assess the rate of positive PE by CTPA in the ED in cancer patients and the variables that are associated with positive results...
September 2, 2016: Hematology/oncology and Stem Cell Therapy
Andreas Goette, Jose L Merino, Michael D Ezekowitz, Dmitry Zamoryakhin, Michael Melino, James Jin, Michele F Mercuri, Michael A Grosso, Victor Fernandez, Naab Al-Saady, Natalya Pelekh, Bela Merkely, Sergey Zenin, Mykola Kushnir, Jindrich Spinar, Valeriy Batushkin, Joris R de Groot, Gregory Y H Lip
BACKGROUND: Edoxaban, an oral factor Xa inhibitor, is non-inferior for prevention of stroke and systemic embolism in patients with atrial fibrillation and is associated with less bleeding than well controlled enoxaparin-warfarin therapy. Few safety data about edoxaban in patients undergoing electrical cardioversion are available. METHODS: We did a multicentre, prospective, randomised, open-label, blinded-endpoint evaluation trial in 19 countries with 239 sites comparing edoxaban 60 mg per day with enoxaparin-warfarin in patients undergoing electrical cardioversion of non-valvular atrial fibrillation...
August 26, 2016: Lancet
Jonas Oldgren, Ziad Hijazi, Johan Lindbäck, John H Alexander, Stuart J Connolly, John W Eikelboom, Michael D Ezekowitz, Christopher B Granger, Elaine M Hylek, Renato D Lopes, Agneta Siegbahn, Salim Yusuf, Lars Wallentin
BACKGROUND: -Atrial fibrillation (AF) is associated with increased but variable risk of stroke. Our aim was to validate the recently developed biomarker-based ABC-stroke risk score and compare its performance with the CHA2DS2VASc and ATRIA risk scores. METHODS: -ABC-stroke score includes Age, Biomarkers (NT-proBNP and high-sensitivity [hs] troponin [cTn]), and Clinical history (prior stroke). This validation was based on 8,356 patients, 16,137 person-years of follow-up, and 219 adjudicated stroke or systemic embolic (SE) events in anticoagulated patients with AF in the RE-LY study...
August 28, 2016: Circulation
Damian Kocur, Miłosz Zbroszczyk, Nikodem Przybyłko, Mariusz Hofman, Tomasz Jamróz, Jan Baron, Piotr Bażowski, Stanisław Kwiek
OBJECTIVE: We report our experience with endovascular coiling of anterior communicating artery aneurysms with special consideration of angiographic and clinical outcomes and periprocedural complications. MATERIALS AND METHODS: The analysis included treatment results of 28 patients with ruptured and unruptured aneurysms. The aneurysm size ranged from 1.8 to 9.8 mm (mean 5.2, SD 1.7). Clinical examinations with the use of modified Rankin Score and angiographic outcomes were evaluated initially post-embolization and at a minimum follow-up of six months...
October 2016: Neuroradiology Journal
Daniel Ortiz, Maharaj Singh, Arshad Jahangir, Suhail Allaqaband, Jayant Khitha, Tanvir K Bajwa, Mark W Mewissen
OBJECTIVES: This study aimed to compare the association of access site complications and the use of unfractionated heparin versus bivalirudin during subinguinal peripheral vascular intervention. BACKGROUND: Compared to unfractionated heparin, bivalirudin has been associated with fewer bleeding complications in patients undergoing percutaneous coronary intervention but more ischemic events. The safety and efficacy of direct thrombin inhibitors in peripheral vascular interventions is not well defined...
August 16, 2016: Catheterization and Cardiovascular Interventions
Octavio Meneghelli Gonçalves, Francisco Cesar Carnevale, Airton Mota Moreira, Alberto Azoubel Antunes, Vanessa Cristina Rodrigues, Miguel Srougi
PURPOSE: The purpose of the study was to compare safety and efficacy outcomes following prostate artery embolization (PAE) for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with 100-300 versus 300-500 μm tris-acryl gelatin microspheres. MATERIALS AND METHODS: Patients were prospectively treated between August 2011 and June 2013 to receive PAE with 100-300 μm (group A) or 300-500 μm (group B) tris-acryl gelatin microspheres...
October 2016: Cardiovascular and Interventional Radiology
Jeffrey A Kline, Dawn Neumann, Cassandra L Hall, Jacob Capito
BACKGROUND: Many clinicians use a global visual interpretation of patient appearance to decide if a patient looks sick or not. For patients with suspected acute pulmonary embolism (PE), we tested the relationship between visual appearance of a happy patient facial affect and probability of PE+ on CT pulmonary angiography (CTPA). METHODS: Eligible patients were selected by usual care to undergo CTPA, the criterion standard for PE+ or PE-. Prior to CTPA result, trained study personnel obtained physician pretest probability using the gestalt method (visual analogue scale, 0%-100%), the Wells score (0-12) and physicians' impression of whether the patient smiled during the initial examination (smile+)...
August 2, 2016: Emergency Medicine Journal: EMJ
Anahi Perlas, Vincent W S Chan, Scott Beattie
BACKGROUND: This propensity score-matched cohort study evaluates the effect of anesthetic technique on a 30-day mortality after total hip or knee arthroplasty. METHODS: All patients who had hip or knee arthroplasty between January 1, 2003, and December 31, 2014, were evaluated. The principal exposure was spinal versus general anesthesia. The primary outcome was 30-day mortality. Secondary outcomes were (1) perioperative myocardial infarction; (2) a composite of major adverse cardiac events that includes cardiac arrest, myocardial infarction, or newly diagnosed arrhythmia; (3) pulmonary embolism; (4) major blood loss; (5) hospital length of stay; and (6) operating room procedure time...
October 2016: Anesthesiology
Sagar S Gandhi, Joseph V Blas, Stewart Lee, John F Eidt, Christopher G Carsten
OBJECTIVE: Blunt thoracic aortic injuries (BTAIs) have historically been treated with open surgery; thoracic endovascular aortic repair (TEVAR), however, is rapidly becoming the standard of care for all grades of injury. Previous studies have shown successful, conservative management of low-grade (I and II) BTAI, but limited literature exists regarding nonoperative management (NOM) for high-grade BTAI. The purpose of this study was to evaluate NOM for grade III BTAI compared with TEVAR...
July 22, 2016: Journal of Vascular Surgery
Thanawat Vongchaiudomchoke, Thananya Boonyasirinant
BACKGROUND: Acute pulmonary embolism (PE) is associated with a variety of non-specific clinical manifestations. Using diagnostic algorithms that are based on internationally recognized guidelines, pulmonary computed tomography angiography (CTA) serves as the gold standard diagnostic imaging tool in PE. However; inappropriate use of pulmonary CTA may lead to unnecessary radiation exposure, contrast exposure, and cost. Based on our review of the literature, there is no existing data regarding prevalence and appropriate use of pulmonary CTA in suspected acute PE in Thailand...
January 2016: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
James P Byrne, Stephanie A Mason, David Gomez, Christopher Hoeft, Haris Subacius, Wei Xiong, Melanie Neal, Farhad Pirouzmand, Avery B Nathens
BACKGROUND: Patients with severe traumatic brain injury (sTBI) are at high risk for developing venous thromboembolism (VTE). Nonetheless, pharmacologic VTE prophylaxis is often delayed out of concern for precipitating extension of intracranial hemorrhage (ICH). The purpose of this study was to compare the effectiveness of early vs late VTE prophylaxis in patients with sTBI, and to characterize the risk of subsequent ICH-related complication. STUDY DESIGN: Adults with isolated sTBI (head Abbreviated Injury Scale score ≥3 and total Glasgow Coma Scale score ≤8) who received VTE prophylaxis with low-molecular-weight or unfractionated heparin were derived from the American College of Surgeons Trauma Quality Improvement Program (2012 to 2014)...
October 2016: Journal of the American College of Surgeons
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