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Unprovoked pulmonary embolism

F R Rosendaal
Venous thrombosis which mainly manifests as deep vein thrombosis of the leg or pulmonary embolism occurs in 1 per 1000 per year. It occurs due to interacting genetic, environmental and behavioral risk factors. The strongest risk factors are certain types of surgery and malignancies. Over the last decade many new risk factors for venous thrombosis have been identified. Venous thrombosis has a high recurrence rate, of around 5 % per year. Whereas clinically it would be most important to identify patients at risk of recurrence, only male sex and a previous unprovoked thrombosis are established determinants of recurrent thrombosis...
2016: Thrombosis Journal
Sam Schulman
During the past 7 years, results from phase III trials comparing nonvitamin antagonist K oral anticoagulants (NOACs) with vitamin K antagonists (VKAs) or with placebo, including 34,900 patients, have been published. Recent guidelines have been updated and now suggest treatment with NOACs rather than with VKA. Other updates in the guidelines concern the initial thrombolytic treatment for selected patients with deep vein thrombosis or pulmonary embolism as well as the possibility of withholding anticoagulation for minimal venous thromboembolism...
October 20, 2016: Seminars in Thrombosis and Hemostasis
Jay M Margolis, Steven Deitelzweig, Jeffrey Kline, Oth Tran, David M Smith, Concetta Crivera, Brahim Bookhart, Jeff Schein
PURPOSE: Using real-world data, this study compares inpatient length of stay (LOS) and costs for patients with a primary diagnosis of pulmonary embolism (PE) initiating treatment with oral anticoagulation with rivaroxaban versus warfarin. METHODS: Hospitalizations from MarketScan's Hospital Drug Database were selected from November 1, 2012, through December 31, 2013, for adults with a primary diagnosis of PE initiating treatment with rivaroxaban or warfarin. Warfarin patients were matched 1:1 to rivaroxaban patients using exact and propensity score matching...
October 14, 2016: Clinical Therapeutics
Yasuhiko Kubota, Stephanie J London, Mary Cushman, Alanna M Chamberlain, Wayne D Rosamond, Susan R Heckbert, Neil Zakai, Aaron R Folsom
BACKGROUND: The evidence of the association between chronic obstructive pulmonary disease (COPD) and venous thromboembolism (VTE) is limited. There is no study investigating the association of restrictive lung disease (RLD) and respiratory symptoms with VTE. OBJECTIVES: To investigate prospectively the association of lung function and respiratory symptoms with VTE. PATIENTS/METHODS: In 1987-1989, we assessed lung function using spirometry and obtained information on respiratory symptoms (cough, phlegm and dyspnea) in 14 654 participants aged 45-64, without a history of VTE or anticoagulant use, and followed them through 2,011...
October 1, 2016: Journal of Thrombosis and Haemostasis: JTH
P A Kyrle, M Kammer, L Eischer, A Weltermann, E Minar, M Hirschl, G Heinze, S Eichinger
BACKGROUND: The long-term recurrence risk (ltRR) of venous thromboembolism (VTE) is uncertain. Objective to assess the ltRR of patients with first unprovoked VTE. PATIENTS/METHODS: Patients were classified into 3 categories; distal deep-vein thrombosis (DVT), proximal DVT, or pulmonary embolism (PE), i.e. PE associated with DVT or isolated PE. Patients with major thrombophilia or antithrombotic therapy were excluded. End point was recurrent symptomatic VTE. RESULTS: 839 patients were followed for a median of 7...
October 2, 2016: Journal of Thrombosis and Haemostasis: JTH
Letizia Marconi, Laura Carrozzi, Ferruccio Aquilini, Alessandro Celi, Francesco Pistelli, Antonio Palla
Benefits and harms of long-term anticoagulant therapy (AT) after acute pulmonary embolism (PE) are poorly known. The aim of this study was to investigate the outcome of patients with PE treated with AT for 5 years according to American College of Chest Physicians (ACCP) guidelines.Patients with both unprovoked and secondary PE were consecutively enrolled in a "real life" study. After a 12-month AT, they continued or stopped the treatment according to ACCP guidelines, and were followed-up for 5 years. Outcomes were all-cause mortality, recurrence, and fatal recurrence under AT...
August 2016: Medicine (Baltimore)
Marja K Puurunen, Philimon N Gona, Martin G Larson, Joanne M Murabito, Jared W Magnani, Christopher J O'Donnell
BACKGROUND: Reports of the crude incidence of venous thromboembolism (VTE) in Western countries vary widely. Data regarding risk factors, incidence and recurrence of VTE from deeply-phenotyped community-based cohort studies are needed. OBJECTIVES: To study the incidence, associated mortality, and predisposing factors of VTE in the prospective, longitudinal community-based Framingham Heart Study. PATIENTS/METHODS: The study sample consisted of the Framingham Heart Study Original, Offspring, Third Generation, and Omni cohorts (N=9754)...
September 2016: Thrombosis Research
Marcello Di Nisio, Nick van Es, Harry R Büller
Deep vein thrombosis and pulmonary embolism, collectively referred to as venous thromboembolism, constitute a major global burden of disease. The diagnostic work-up of suspected deep vein thrombosis or pulmonary embolism includes the sequential application of a clinical decision rule and D-dimer testing. Imaging and anticoagulation can be safely withheld in patients who are unlikely to have venous thromboembolism and have a normal D-dimer. All other patients should undergo ultrasonography in case of suspected deep vein thrombosis and CT in case of suspected pulmonary embolism...
June 30, 2016: Lancet
Michał Nowak, Katarzyna Królak-Nowak, Aleksandra Sobolewska-Włodarczyk, Jakub Fichna, Marcin Włodarczyk
Venous thromboembolism (VTE) is a multifactorial disease manifesting as either deep vein thrombosis or pulmonary embolism. Its prevalence makes VTE a significant issue for both the individual - as a negative factor influencing the quality of life and prognosis - and the society due to economic burden. VTE is the third most common vascular disorder in Western countries, after myocardial infarction and stroke, making it a major cause of in-hospital mortality, responsible for 5%-10% of hospital deaths. Despite many studies conducted, only 50%-60% provoking factors have been identified, while the remaining 40%-50% have been classified as idiopathic or unprovoked...
2016: Vascular Health and Risk Management
Anja Boc, Nina Vene, Katarina Košmelj, Alenka Mavri
Asymptomatic pulmonary embolism (PE) is present in at least one-third of patients with deep venous thrombosis (DVT). However, knowledge about its influence on the prognosis of patients is limited. The aim of this study was to assess the prognostic impact of asymptomatic PE in patients with DVT and to explore risk factors for recurrent venous thromboembolic events. A total of 200 consecutive patients with the first episode of objectively confirmed DVT without symptoms of PE were included. All patients underwent ventilation-perfusion scintigraphy within 48 hours of DVT confirmation...
June 23, 2016: Seminars in Thrombosis and Hemostasis
Prajwal Dhakal, Krishna Gundabolu, Vijaya R Bhatt
Venous thromboembolism (VTE) is associated with significant morbidity and mortality. Factors such as the presence of transient risk factors for VTE, risk of bleeding, and location of deep vein thrombosis (DVT) determine the duration of anticoagulation. Extended anticoagulation is offered to patients with unprovoked pulmonary embolism (PE) or proximal DVT and a low risk of bleeding. Anticoagulation for 3 months is advised in patients with provoked DVT or PE, high risk of bleeding, and isolated distal or upper extremity DVT...
June 5, 2016: Clinical and Applied Thrombosis/hemostasis
Lee Joseph, John R Bartholomew
Venous thromboembolism (VTE), which includes deep venous thrombosis and pulmonary embolism, is a major public health problem associated with increased morbidity and mortality. Despite the high recurrence risk associated with unprovoked VTE, extended anticoagulation remains controversial. Oral antithrombotic agents for extended VTE treatment comprise the vitamin K antagonists, aspirin, and the direct oral anticoagulants (also known as target-specific oral anticoagulants and formerly known as the new or novel oral anticoagulants) including rivaroxaban, dabigatran, apixaban, and edoxaban...
May 31, 2016: Journal of Cardiovascular Pharmacology and Therapeutics
Saad Elias, Ron Hoffman, Gleb Saharov, Benjamin Brenner, Yona Nadir
BACKGROUND: Monthly or seasonal changes in the incidence of venous thromboembolism (VTE) were previously reported; however, the mechanism of such variability is not completely understood. METHODS: In the present retrospective single-center analysis, consecutive patients with proximal deep vein thrombosis and/or pulmonary embolism (PE) diagnosed between January 2009 and December 2013 were evaluated. RESULTS: The study population included 1496 patients, 48% men, mean age 63 ± 18 years...
September 2016: Clinical and Applied Thrombosis/hemostasis
Endri Gjonbrataj, Ji Na Kim, Juarda Gjonbrataj, Hye In Jung, Hyun Jung Kim, Won-Il Choi
Background/Aims: This study aimed to investigate the risk factors associated with provoked pulmonary embolism (PE). Methods: This retrospective cohort study included 237 patients with PE. Patients that had transient risk factors at diagnosis were classified as having provoked PE, with the remaining patients being classified as having unprovoked PE. The baseline clinical characteristics and factors associated with coagulation were compared. We evaluated the risk factors associated with provoked PE...
April 21, 2016: Korean Journal of Internal Medicine
M Sanz de la Garza, A Lopez, M Sitges
Intense endurance exercise could be associated with multiple thrombogenic risk factors, including dehydration, hemoconcentration, inflammation, and injuries. Despite an increasing number of reported cases of deep venous thrombosis (DVT) in athletes that is raising awareness in the medical community, the prevalence is not well established and evidenced-based guidelines for management of this clinical scenario are lacking. We present an episode of unprovoked DVT and multiple pulmonary embolisms with severe right ventricular dysfunction in a male runner...
March 31, 2016: Scandinavian Journal of Medicine & Science in Sports
Ghazi S Alotaibi, Cynthia Wu, Ambikaipakan Senthilselvan, M Sean McMurtry
BACKGROUND: Venous thromboembolism is a major cause of morbidity and mortality, and comprehensive studies profiling the epidemiology and pattern of health services use are needed. In this study we provide contemporary estimates of venous thromboembolism incidence and case fatality over the past decade. METHODS: We developed a population-based venous thromboembolism dataset by linking 6 administrative health databases in Alberta, Canada from April 1, 2002 to March 31, 2012...
August 2016: American Journal of Medicine
Gualtiero Palareti, Benilde Cosmi, Emilia Antonucci, Cristina Legnani, Nicoletta Erba, Angelo Ghirarduzzi, Daniela Poli, Sophie Testa, Alberto Tosetto, Vittorio Pengo, Paolo Prandoni
In the D-dimer and ULtrasonography in Combination Italian Study (DULCIS), serial D-dimer measurement in combination with assessment of residual thrombosis (in patients with deep vein thrombosis (DVT)) identified patients who safely discontinued anticoagulation after an unprovoked venous thromboembolism (VTE).In this subgroup analysis, the value of D-dimer tests was assessed in patients with isolated pulmonary embolism (PE) compared with those with DVT, with or without PE (DVT/PE). The DULCIS database was reanalysed in relation to this target...
May 2016: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Constantin von Zur Mühlen, Thomas Koeck, Eric Schiffer, Christine Sackmann, Petra Zürbig, Ingo Hilgendorf, Jochen Reinöhl, Jennifer Rivera, Andreas Zirlik, Christoph Hehrlein, Harald Mischak, Christoph Bode, Karlheinz Peter
PURPOSE: Early and accurate detection of deep vein thrombosis (DVT) is an important clinical need. Based on the hypothesis that urinary peptides may hold information on DVT in conjunction with pulmonary embolism (PE), the study was aimed at identifying such peptide biomarkers using capillary electrophoresis coupled mass spectrometry. EXPERIMENTAL DESIGN: Patients with symptoms of unprovoked/idiopathic DVT and/or PE were examined by doppler-sonography or angio-computed tomography...
May 2016: Proteomics. Clinical Applications
N van der Bijl, F A Klok, M V Huisman, A de Roos, L J M Kroft
UNLABELLED: Essentials Patients with unprovoked pulmonary embolism (PE) are at increased risk of arterial thromboembolism. Coronary and thoracic aorta calcium were evaluated in patients with and without (unprovoked) PE. No association was found between (unprovoked) PE and coronary or aortic calcification. Assessment of both calcium scores on computed tomography pulmonary angiography was highly reproducible. SUMMARY: Objective To evaluate the potential association between (unprovoked) pulmonary embolism (PE) and the presence and extent of coronary artery calcium (CAC) and thoracic aorta calcium (TAC)...
May 2016: Journal of Thrombosis and Haemostasis: JTH
Wei Huang, Robert J Goldberg, Frederick A Anderson, Alexander T Cohen, Frederick A Spencer
Venous thromboembolism (VTE) has multiple risk factors and tends to recur. Despite the benefits of anticoagulation, the prevalence of, and case-fatality rate associated with, recurrent VTE remains a concern after an acute episode; it is particularly high during the acute treatment phase. We sought to quantify the magnitude, identify predictors, and develop risk score calculator of recurrence within 3 years after first-time VTE. This was a population-based surveillance study among residents of central Massachusetts (MA), USA, diagnosed with an acute first-time pulmonary embolism and/or lower-extremity deep vein thrombosis from 1999 to 2009 in hospital and ambulatory settings in all 12 central MA hospitals...
April 2016: Journal of Thrombosis and Thrombolysis
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