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management of pulmonary embolism

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https://www.readbyqxmd.com/read/28640322/effectiveness-and-safety-of-rivaroxaban-versus-warfarin-for-treatment-and-prevention-of-recurrence-of-venous-thromboembolism
#1
Craig I Coleman, Craig Coleman, Thomas J Bunz, Alexander G G Turpie
The efficacy and safety or rivaroxaban versus enoxaparin/vitamin K antagonist for treatment and prevention recurrence of venous thromboembolism (VTE) was demonstrated in the randomised EINSTEIN trials. We assessed the effectiveness and safety of rivaroxaban versus warfarin in VTE patients managed in routine practice. Using US MarketScan claims from 1/2012-6/2015, we included adults with a primary diagnosis of deep vein thrombosis (DVT) or pulmonary embolism (PE) during a hospitalisation/emergency department visit, newly-initiated on rivaroxaban or warfarin within 30-days after the VTE and with ≥180-days of continuous medical/prescription benefits prior to the VTE (baseline)...
June 22, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28635085/venous-thromboembolism-management-in-northeast-melbourne-how-does-it-compare-to-international-guidelines-and-data
#2
Hui Yin Lim, Chong Chyn Chua, Mark Tacey, Matthew Sleeman, Geoffrey Donnan, Harshal Nandurkar, Prahlad Ho
BACKGROUND: Venous thromboembolism (VTE) is a major cause of morbidity and mortality with significant heterogeneity in its management, both within our local practice and international guidelines. AIMS: To provide a holistic evaluation of "real-world" Australian experience in the warfarin era, including how we compare to international guidelines. METHODS: Retrospective evaluation of VTE from July 2011 to December 2012 at two major hospitals in Melbourne, Australia...
June 21, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28629401/odontogenic-orbital-cellulitis-associated-with-cavernous-sinus-thrombosis-and-pulmonary-embolism-a-case-report
#3
D Allegrini, S Reposi, E Nocerino, A Pece
BACKGROUND: This case illustrates the importance of prompt assessment and treatment of orbital cellulitis. In fact the ocular signs and symptoms may be associated with systemic complications which should be investigated and identified as soon as possible to avoid a poor prognosis. CASE PRESENTATION: A 46-year-old white woman presented to our emergency room with proptosis, ophthalmoplegia, and conjunctival chemosis of her left eye. An ophthalmologist, having diagnosed orbital cellulitis in her left eye, suspected a cavernous sinus thrombosis...
June 20, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28628412/stratification-imaging-and-management-of-acute-massive-and-submassive-pulmonary-embolism
#4
Akhilesh K Sista, William T Kuo, Mark Schiebler, David C Madoff
While pulmonary embolism (PE) causes approximately 100 000-180 000 deaths per year in the United States, mortality is restricted to patients who have massive or submassive PEs. This state of the art review familiarizes the reader with these categories of PE. The review discusses the following topics: pathophysiology, clinical presentation, rationale for stratification, imaging, massive PE management and outcomes, submassive PE management and outcomes, and future directions. It summarizes the most up-to-date literature on imaging, systemic thrombolysis, surgical embolectomy, and catheter-directed therapy for submassive and massive PE and gives representative examples that reflect modern practice...
July 2017: Radiology
https://www.readbyqxmd.com/read/28628189/-a-statement-the-polish-cardiac-society-working-group-on-pulmonary-circulation-on-screening-for-cteph-patients-after-acute-pulmonary-embolism
#5
Michał Ciurzyński, Marcin Kurzyna, Grzegorz Kopeć, Piotr Błaszczak, Łukasz Chrzanowski, Karol Kamiński, Katarzyna Mizia-Stec, Tatiana Mularek-Kubzdela, Ewa Mroczek, Andrzej Biederman, Piotr Pruszczyk, Adam Torbicki
Both pharmacological and invasive treatment of chronic thromboembolic pulmonary hypertension (CTEPH) is now available in Poland and the awareness of the disease among physicians is growing. Thus, the Polish Cardiac Society's Working Group on Pulmonary Circulation in cooperation with independent experts in this field, have launched the statement on algorithm to guide a CTEPH diagnosis in patients with previous acute pulmonary embolism (APE). In Poland, every year this disease affects about 250 patients. CTEPH should be suspected in individuals after APE with dyspnea, despite at least 3 months period of effective anticoagulation, particularly when specified risk factors are present...
2017: Kardiologia Polska
https://www.readbyqxmd.com/read/28623951/progressive-respiratory-distress-in-a-42-year-old-hiv-positive-woman-with-systemic-lupus-erythematosus
#6
Katongo Mutengo, Patrice Mukomena, Nason Lambwe, Owen Ngalamika
BACKGROUND: Identifying and treating the cause of pulmonary symptoms in HIV patients with underlying systemic lupus erythematosus (SLE) can be very challenging. Delays in diagnosing active SLE in HIV patients can lead to significant morbidity and even mortality. We report the case of an HIV-positive woman with SLE who presented with severe respiratory distress. CASE PRESENTATION: A 42-year-old HIV-positive woman presented with a 7-month history of anorexia, progressive dyspnoea, and a productive cough...
June 17, 2017: European Journal of Medical Research
https://www.readbyqxmd.com/read/28618305/phase-i-study-of-temsirolimus-in-combination-with-cetuximab-in-patients-with-advanced-solid-tumours
#7
A Hollebecque, R Bahleda, L Faivre, J Adam, V Poinsignon, A Paci, C Gomez-Roca, J C Thery, M C Le Deley, A Varga, A Gazzah, E Ileana, M Gharib, E Angevin, K Malekzadeh, C Massard, J C Soria, J P Spano
BACKGROUND: Preclinical studies suggest synergistic antitumour effects of mammalian target of rapamycin (mTOR) inhibitor such as temsirolimus combined with anti-EGFR monoclonal antibody such as cetuximab. METHODS: Temsirolimus (T) and cetuximab (C) were combined and escalated in cohorts of patients with advanced or metastatic solid tumours, respectively from 15 to 25 mg and 150-250 mg/m(2), until the maximum tolerated dose (MTD) was determined. Effort was made in the expansion cohort to enrol patients harbouring a molecular aberration in the human epidermal growth factor receptor (EGFR) and/or phosphoinositide 3-kinase (PI3K) pathways...
June 12, 2017: European Journal of Cancer
https://www.readbyqxmd.com/read/28615115/circulatory-collapse-in-a-parturient-undergoing-cesarean-delivery-a-diagnostic-dilemma
#8
M M Tawfik, M E Taman, A I Tarbay, M Sayed, K A Awad
Embolic events including thromboembolism, air embolism, and amniotic fluid embolism can cause cardiovascular collapse during cesarean delivery. Differentiation between the three conditions is challenging because they share many of the initial clinical and echocardiographic findings, but an accurate, definitive diagnosis allows the administration of specific therapy that may help in saving the life of the mother and/or the fetus. We report a case of cardiovascular collapse during cesarean delivery under general anesthesia; massive pulmonary thromboembolism was suspected and unfractionated heparin was administered...
May 10, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28608312/cost-effectiveness-analysis-of-rivaroxaban-for-treatment-of-deep-vein-thrombosis-and-pulmonary-embolism-in-greece
#9
George Gourzoulidis, Georgia Kourlaba, John Kakisis, Mitiadis Matsagkas, George Giannakoulas, Konstantinos I Gourgoulianis, Theodoros Vassilakopoulos, Nikos Maniadakis
BACKGROUND AND OBJECTIVE: Venous thromboembolism (VTE), comprising deep-vein thrombosis (DVT) and pulmonary embolism (PE), is a major healthcare concern that results in substantial morbidity and mortality with great economic burden for healthcare systems. Hence, the need for effective and efficient treatment of patients with VTE is important for both clinical and economic reasons. The objective of this study was to evaluate the cost effectiveness of rivaroxaban compared to standard of care (SoC) with enoxaparin followed by dose-adjusted vitamin-K antagonists for the treatment of DVT and PE in Greece...
June 12, 2017: Clinical Drug Investigation
https://www.readbyqxmd.com/read/28608003/transarterial-chemoembolization-for-management-of-hemoptysis-initial-experience-in-advanced-primary-lung-cancer-patients
#10
Akihiko Seki, Chigusa Shimono
PURPOSE: To evaluate the hemostatic effects of transarterial infusion chemotherapy in addition to embolization (chemoembolization) for advanced primary lung cancer with tumor-related hemoptysis. MATERIALS AND METHODS: Ten consecutive patients with stage IIIB/IV or recurrent primary lung cancer (squamous cell carcinoma in six, adenocarcinoma in four) who underwent chemoembolization for control of hemoptysis were enrolled. At enrollment, five patients were considered refractory and five had contraindications to standard therapies...
June 12, 2017: Japanese Journal of Radiology
https://www.readbyqxmd.com/read/28593681/initial-anticoagulation-in-patients-with-pulmonary-embolism-thrombolysis-unfractionated-heparin-lmwh-fondaparinux-or-doacs
#11
REVIEW
Jenneke Leentjens, Mike Peters, Anne C Esselink, Yvo Smulders, Cornelis Kramers
The initial treatment of hemodynamically stable patients with pulmonary embolism (PE) has dramatically changed since the introduction of low molecular weight heparins (LMWHs). With the recent discovery of the direct oral anticoagulant drugs (DOACs), initial treatment of PE will be simplified even further. In several large clinical trials it has been demonstrated that DOACs are non-inferior to standard therapy for the initial treatment of PE, and because of their practicability they are becoming the agents of first choice...
June 7, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28593335/key-points-to-optimizing-management-and-research-on-cancer-associated-thrombosis
#12
REVIEW
A Carmona-Bayonas, M Sánchez-Cánovas, J M Plasencia, A Custodio, E Martínez de Castro, J A Virizuela, F Ayala de la Peña, P Jiménez-Fonseca
Despite the fact that thromboembolism is relatively common in oncology patients and that the interrelationship between thrombotic risk and specific mechanisms of tumorigenesis has long been known, many cardinal elements of prevention and treatment remain unresolved. Among the existing knowledge gaps, the need to validate the Ay scale and compare it to the Khorana index, develop, and standardize the use of predictive biomarkers for thrombotic risk, conduct clinical trials in thromboprophylaxis adapted to thrombotic risk, evaluate the efficacy and safety of direct anticoagulants, select patients who can benefit from anticoagulants for antitumor treatment, validate the EPIPHANY study decision tree to choose patients with low-risk pulmonary embolism, and accumulate more practical experience in special situations (rethrombosis, prolonged therapy beyond 6 months, etc...
June 7, 2017: Clinical & Translational Oncology
https://www.readbyqxmd.com/read/28592630/management-of-superficial-venous-thrombosis-of-the-leg
#13
(no author information available yet)
Although for many people superficial venous thrombosis of the leg is a benign self-limiting condition, for others it is a potentially serious problem associated with an increased risk of deep vein thrombosis and pulmonary embolism.1-4 Here, we consider some of the challenges associated with managing superficial venous thrombosis and review the evidence for non-surgical treatment options.
June 2017: Drug and Therapeutics Bulletin
https://www.readbyqxmd.com/read/28589462/discharge-or-admit-emergency-department-management-of-incidental-pulmonary-embolism-in-patients-with-cancer-a-retrospective-study
#14
Srinivas R Banala, Sai-Ching Jim Yeung, Terry W Rice, Cielito C Reyes-Gibby, Carol C Wu, Knox H Todd, W Frank Peacock, Kumar Alagappan
BACKGROUND: Hospitalization and early anticoagulation therapy remain standard care for patients who present to the emergency department (ED) with pulmonary embolism (PE). For PEs discovered incidentally, however, optimal therapeutic strategies are less clear-and all the more so when the patient has cancer, which is associated with a hypercoagulable state that exacerbates the threat of PE. METHODS: We conducted a retrospective review of a historical cohort of patients with cancer and incidental PE who were referred for assessment to the ED in an institution whose standard of care is outpatient treatment of selected patients and use of low-molecular-weight heparin for anticoagulation...
December 2017: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28586697/the-diagnostic-management-of-upper-extremity-deep-vein-thrombosis-a-review-of-the-literature
#15
REVIEW
Noémie Kraaijpoel, Nick van Es, Ettore Porreca, Harry R Büller, Marcello Di Nisio
Upper extremity deep vein thrombosis (UEDVT) accounts for 4% to 10% of all cases of deep vein thrombosis. UEDVT may present with localized pain, erythema, and swelling of the arm, but may also be detected incidentally by diagnostic imaging tests performed for other reasons. Prompt and accurate diagnosis is crucial to prevent pulmonary embolism and long-term complications as the post-thrombotic syndrome of the arm. Unlike the diagnostic management of deep vein thrombosis (DVT) of the lower extremities, which is well established, the work-up of patients with clinically suspected UEDVT remains uncertain with limited evidence from studies of small size and poor methodological quality...
June 1, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28580827/therapeutic-management-of-acute-pulmonary-embolism
#16
Cécile Tromeur, Liselotte M Van Der Pol, Francis Couturaud, Frederikus A Klok, Menno V Huisman
Acute pulmonary embolism (PE) is a potentially fatal manifestation of venous thromboembolism. Prompt anticoagulant treatment is crucial for PE patients, which can decrease morbidity and mortality. Risk assessment is the cornerstone of the therapeutic management of PE. It guides physicians to the most appropriate treatment and selects patients for early discharge or home treatment. Areas covered: Here, we review the current treatments of acute PE according to contemporary risk stratification strategies, highlighting each step of PE therapeutic management...
June 8, 2017: Expert Review of Respiratory Medicine
https://www.readbyqxmd.com/read/28579859/clot-in-lung-clot-in-heart-a-case-report-of-tumor-like-thrombus-in-right-atrium
#17
Roshanak Habibi, Alvaro J Altamirano, Shahriar Dadkhah
Tumor-like formation of thrombus in the right atrial cavity is rare. It may be mistaken for a myxoma. The exact pathophysiology of an isolated thrombus in the heart is still unclear. Management to prevent complications such as pulmonary thromboembolism depends on the clinical judgment of a cardiologist. This report describes a 76-year-old woman with right atrial thrombus causing subsequent pulmonary thromboembolism in right lung. She initially presented to us with pulmonary embolism, and later, an incidental finding of a mass in her right atrium revealed an association of thrombus in heart with thrombus in lung...
2017: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/28578933/extracorporeal-membrane-oxygenation-pulmonary-embolectomy-and-right-ventricular-assist-device-for-massive-pulmonary-embolism
#18
Carly L Lodewyks, Joseph M Bednarczyk, Owen T Mooney, Rakesh C Arora, Rohit K Singal
Consensus regarding the management of massive pulmonary embolism (PE) and persistent shock after thrombolysis is lacking. A 30-year-old man collapsed with massive PE 3 days after an exploratory laparotomy for penetrating trauma, and he remained hypoxic and hypotensive despite thrombolytic therapy. Extracorporeal membrane oxygenation (ECMO) was instituted as a bridge to surgical embolectomy, and placement of a right ventricular assist device (RVAD) was used to facilitate separation from cardiopulmonary bypass...
March 31, 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28574672/safety-of-multidetector-computed-tomography-pulmonary-angiography-to-exclude-pulmonary-embolism-in-patients-with-a-likely-pretest-clinical-probability
#19
Helia Robert-Ebadi, Frédéric Glauser, Benjamin Planquette, Thomas Moumneh, Grégoire Le Gal, Marc Righini
BACKGROUND: In patients with suspected pulmonary embolism (PE) classified as having a likely or high pre-test clinical probability, the necessity of performing additional testing after a negative multidetector computed tomography pulmonary angiography (CTPA) remains a matter of debate. OBJECTIVES: The aim of this study was to assess the safety of excluding PE by CTPA without additional imaging in patients with a likely pre-test probability of PE. PATIENTS/METHODS: We retrospectively analysed patients included in two multicentre management outcome studies that assessed diagnostic algorithms for PE diagnosis...
June 2, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28569924/is-a-normal-computed-tomography-pulmonary-angiography-safe-to-rule-out-acute-pulmonary-embolism-in-patients-with-a-likely-clinical-probability-a-patient-level-meta-analysis
#20
Tom van der Hulle, Nick van Es, Paul den Exter, Josien van Es, Inge C M Mos, Renée A Douma, Marieke J H A Kruip, Marcel M C Hovens, Marije Ten Wolde, Mathilde Nijkeuter, Hugo Ten Cate, Pieter W Kamphuisen, Harry R Büller, Menno V Huisman, Erik Klok
A normal computed tomography pulmonary angiography (CTPA) remains a controversial criterion for ruling out acute pulmonary embolism (PE) in patients with a likely clinical probability. We set out to determine the risk of VTE and fatal PE after a normal CTPA in this patient category and compare these risk to those after a normal pulmonary angiogram of 1.7 % (95 %CI 1.0-2.7 %) and 0.3 % (95 %CI 0.02-0.7 %). A patient-level meta-analysis from 4 prospective diagnostic management studies that sequentially applied the Wells rule, D-dimer tests and CTPA to consecutive patients with clinically suspected acute PE...
June 1, 2017: Thrombosis and Haemostasis
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