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management of pulmonary embolism

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https://www.readbyqxmd.com/read/28331932/pulmonary-embolism-and-in-situ-pulmonary-artery-thrombosis-in-paediatrics-a-systematic-review
#1
Madhvi Rajpurkar, Tina Biss, Ernest Amankwah, Denise Martinez, Suzan Williams, C Heleen Van Ommen, Neil A Goldenberg
Data on paediatric pulmonary embolism (PE) are scarce. We sought to systematically review the current literature on childhood PE and conducted a search on paediatric PE via PubMed (1946-2013) and Embase (1980-2013). There was significant heterogeneity in reported data. Two patterns were noted: classic thromboembolic PE (TE-PE) and in situ pulmonary artery thrombosis (ISPAT). Mean age of presentation for TE-PE was 14.86 years, and 51 % of cases were males. The commonest method for diagnosis of TE-PE was contrast CT with angiography (74 % of patients)...
March 23, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28316124/anticoagulation-in-patients-with-isolated-distal-deep-vein-thrombosis-a-meta-analysis
#2
Laura Franco, Michela Giustozzi, Giancarlo Agnelli, Cecilia Becattini
BACKGROUND: The optimal management of patients with isolated distal deep vein thrombosis (IDDVT) concerning both the need for anticoagulation and its duration is undefined. OBJECTIVES: We performed a meta-analysis of randomized and cohort studies in patients with IDDVT to assess the clinical benefit of i) anticoagulation versus no anticoagulation and ii) anticoagulant treatment for 6 weeks vs. more than 6 weeks. METHODS: The primary outcome of this analysis was recurrent venous thromboembolism (proximal propagation, recurrence of deep vein thrombosis and pulmonary embolism)...
March 17, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28314981/time-trends-in-incidence-rates-of-venous-thromboembolism-in-a-large-cohort-recruited-from-the-general-population
#3
Nadia Arshad, Trond Isaksen, John-Bjarne Hansen, Sigrid K Brækkan
Changes in the incidence of venous thromboembolism (VTE) during the last two decades have not been extensively studied. Therefore, we studied time trends in the incidence rates (IRs) of deep vein thrombosis (DVT) and pulmonary embolism (PE) in a cohort of 26,855 subjects, aged 25-97 years, enrolled in the Tromsø study in 1994/1995. The subject were followed-up throughout 2012, and all symptomatic, objectively confirmed, incident VTEs were identified using multiple sources (hospital discharge-, radiology procedure- and autopsy registry) and validated by review of medical records...
March 17, 2017: European Journal of Epidemiology
https://www.readbyqxmd.com/read/28314711/validating-the-herdoo2-rule-to-guide-treatment-duration-for-women-with-unprovoked-venous-thrombosis-multinational-prospective-cohort-management-study
#4
Marc A Rodger, Gregoire Le Gal, David R Anderson, Jeannot Schmidt, Gilles Pernod, Susan R Kahn, Marc Righini, Patrick Mismetti, Clive Kearon, Guy Meyer, Antoine Elias, Tim Ramsay, Thomas L Ortel, Menno V Huisman, Michael J Kovacs
Objective To prospectively validate the HERDOO2 rule (Hyperpigmentation, Edema, or Redness in either leg; D-dimer level ≥250 μg/L; Obesity with body mass index ≥30; or Older age, ≥65 years), which states that women with none or one of the criteria can safely discontinue anticoagulants after short term treatment.Design Prospective cohort management study.Setting 44 secondary or tertiary care centres in seven countries.Participants Of 3155 consecutive eligible participants with a first unprovoked venous thromboembolism (VTE, proximal leg deep vein thrombosis or pulmonary embolism) who completed 5-12 months of short term anticoagulant treatment, 370 declined to participate, leaving 2785 enrolled participants...
March 17, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28289933/reinforced-cementoplasty-using-dedicated-spindles-in-the-management-of-unstable-malignant-lesions-of-the-cervicotrochanteric-region
#5
Kévin Premat, Frédéric Clarençon, Raphael Bonaccorsi, Vincent Degos, Évelyne Cormier, Jacques Chiras
OBJECTIVES: In long bones, cementoplasty alone does not provide sufficient stability, which may cause secondary fractures. This study reviewed the safety and efficacy of reinforced cementoplasty (RC) (percutaneous internal fixation using dedicated spindles combined with cementoplasty) for unstable malignant lesions of the cervicotrochanteric region (CTR) of the proximal femur. METHODS: Eighteen consecutive patients (nine women [50%] and nine men [50%]; mean age 55...
March 13, 2017: European Radiology
https://www.readbyqxmd.com/read/28289598/massive-hemoptysis-in-a-patient-with-pulmonary-embolism-a-real-therapeutic-conundrum
#6
Yiolanda Herodotou, Andriana I Papaioannou, Anna Karakatsani, Lazaros Reppas, Effrosyni D Manali, Vasiliki Apollonatou, Ioannis Tomos, Elias Brountzos, Spyros Papiris
Massive Hemoptysis and pulmonary embolism are two very severe and potentially fatal pulmonary emergencies requiring completely different treatments. We present the case of a 45-year old male transmitted to our Hospital for massive hemoptysis who at the same time was found to suffer from pulmonary embolism. Hemoptysis was treated with bronchial artery embolization which resulted in cessation of haemorrhage and allowed the administration of anticoagulant therapy a few days later. This case report gives an answer on how to manage a real therapeutic conundrum which is the coexistence of a massive hemoptysis and a concomitant pulmonary embolism...
2017: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/28282004/five-year-retrospective-review-of-blunt-renal-injuries-at-a-level-i-trauma-center
#7
Jessica Burns, Megan Brown, Zakaria I Assi, Eric J Ferguson
We report the experience of a Level I trauma center in the management of blunt renal injury during a 5-year period, with special attention to those treated using angiography with embolization. The institutional trauma registry was queried for all patients with blunt renal injury between September 1, 2009 and August 30, 2014. Each injury was graded using the American Association for the Surgery of Trauma guidelines. Patients that underwent angiography with embolization were reviewed for case-specific information including imaging findings, treatment, materials used, clinical course, and mortality...
February 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28275618/extracorporeal-life-support-for-refractory-ventricular-tachycardia
#8
REVIEW
Sujatha P Bhandary, Nicholas Joseph, James P Hofmann, Theodosios Saranteas, Thomas J Papadimos
Extracorporeal life support (ECLS) is a very effective bridging therapy in patients with refractory ventricular tachycardia (VT) associated with cardiogenic shock. A moribund patient in extremis, is not amenable to optimization by standard ACC/AHA guidelines. New approaches and novel salvage techniques are necessary to improve outcomes in patients with refractory clinical settings such as malignant ventricular arrhythmias, cardiac arrest, cardiogenic shock and/or pulmonary failure until further management options are explored...
February 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28267480/the-safety-and-efficacy-of-full-versus-reduced-dose-betrixaban-in-the-acute-medically-ill-vte-venous-thromboembolism-prevention-with-extended-duration-betrixaban-apex-trial
#9
C Michael Gibson, Rim Halaby, Serge Korjian, Yazan Daaboul, Douglas F Arbetter, Megan K Yee, Samuel Z Goldhaber, Russel Hull, Adrian F Hernandez, Shiao-Ping Lu, Olga Bandman, Janet M Leeds, Alex Gold, Robert A Harrington, Alexander T Cohen
BACKGROUND: The APEX trial assessed the safety and efficacy of extended-duration thromboprophylaxis using betrixaban versus standard dosing of enoxaparin among hospitalized, acutely ill medical patients. The 80-mg betrixaban dose was halved to 40 mg among subjects with severe renal insufficiency and those receiving a concomitant strong P-glycoprotein inhibitor. METHODS: This analysis assessed the pharmacokinetics, efficacy, and safety of full- (80 mg) and reduced-dose (40 mg) betrixaban relative to enoxaparin in the APEX trial...
March 2017: American Heart Journal
https://www.readbyqxmd.com/read/28265130/interventional-therapy-for-upper-extremity-deep-vein-thrombosis
#10
REVIEW
Timothy A Carlon, Deepak Sudheendra
Approximately 10% of all deep vein thromboses occur in the upper extremity, and that number is increasing due to the use of peripherally inserted central catheters. Sequelae of upper extremity deep vein thrombosis (UEDVT) are similar to those for lower extremity deep vein thrombosis (LEDVT) and include postthrombotic syndrome and pulmonary embolism. In addition to systemic anticoagulation, there are multiple interventional treatment options for UEDVT with the potential to reduce the incidence of these sequelae...
March 2017: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/28262269/fracture-fixation-in-the-operative-management-of-hip-fractures-faith-an-international-multicentre-randomised-controlled-trial
#11
(no author information available yet)
BACKGROUND: Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. METHODS: For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws...
March 3, 2017: Lancet
https://www.readbyqxmd.com/read/28262244/risk-adapted-management-of-pulmonary-embolism
#12
Stefano Barco, Stavros V Konstantinides
The presence and severity of right ventricular (RV) dysfunction is a key determinant of prognosis in the acute phase of pulmonary embolism (PE). Risk-adapted treatment strategies continue to evolve, tailoring initial management to the clinical presentation and the functional status of the RV. Beyond pharmacological and, if necessary, mechanical circulatory support, systemic thrombolysis remains the mainstay of treatment for hemodynamically unstable patients; in contrast, it is not routinely recommended for intermediate-risk PE...
March 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28262243/pitfalls-in-the-diagnostic-management-of-pulmonary-embolism-in-pregnancy
#13
Cécile Tromeur, Liselotte M van der Pol, Frederikus A Klok, Francis Couturaud, Menno V Huisman
Women are at increased risk of venous thromboembolism (VTE) during pregnancy and VTE remains one of the main causes of maternal mortality in developed countries (Konstantinides SV, et al. Eur Heart J 2014; 35(43):3033-69, 69a-69k). Although an accurate diagnosis of acute pulmonary embolism (PE) in pregnant patients is thus of crucial importance, the diagnostic management of suspected PE is challenging for this specific patient category. As D-dimer levels increase physiologically throughout pregnancy, the optimal D-dimer threshold to rule out PE during pregnancy remains unknown...
March 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28262225/uterine-bleeding-during-anticoagulation-in-women-with-venous-thromboembolism
#14
Farès Moustafa, Sonia Fernández, Carmen Fernández-Capitán, José Antonio Nieto, José María Pedrajas, Adriana Visoná, Beatriz Valero, Pablo Javier Marchena, Andrei Braester, Manuel Monreal
BACKGROUND: Women presenting with uterine bleeding during the course of anticoagulant therapy for venous thromboembolism (VTE) present a difficult therapeutic dilemma due to the absence of evidence-based recommendations. METHODS: We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to assess the clinical characteristics of women presenting with uterine bleeding during anticoagulation for VTE, its frequency, time course, management and 30-day outcomes...
March 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28261286/fenestration-closure-with-amplatzer-duct-occluder-ii-in-patients-after-total-cavo-pulmonary-connection
#15
Sebastian Góreczny, Paweł Dryżek, Gareth J Morgan, Anna Mazurek-Kula, Jacek J Moll, Jadwiga A Moll, Shakeel Qureshi, Tomasz Moszura
INTRODUCTION: Creation of a fenestration during completion of a total cavopulmonary connection (TCPC) has been associated with a reduction in early mortality and morbidity. However, the long-term benefits are negated by an associated limitation in exercise tolerance and the potential risks of thrombo-embolic complications. We sought to describe the safety and efficacy of an Amplatzer Duct Occluder II (ADO II) for transcatheter fenestration closure following TCPC. MATERIAL AND METHODS: Between January 2000 and July 2014, 102 patients underwent percutaneous closure of extra-cardiac TCPC fenestrations with a range of devices...
March 1, 2017: Archives of Medical Science: AMS
https://www.readbyqxmd.com/read/28259629/structured-reporting-of-ct-examinations-in-acute-pulmonary-embolism
#16
Bastian O Sabel, Jessica L Plum, Nikolaus Kneidinger, Gabriela Leuschner, Leandra Koletzko, Bijan Raziorrouh, Regina Schinner, Wolfgang G Kunz, Franziska Schoeppe, Kolja M Thierfelder, Wieland H Sommer, Felix G Meinel
OBJECTIVES: To evaluate the effect of structured reporting of CT pulmonary angiography (CTPA) studies on the content, clarity and clinical usefulness of radiology reports in acute pulmonary embolism (PE). METHODS: Conventional and structured reports were generated for 41 patients with a CTPA positive for acute PE. Conventional reports were dictated in a free-text form using speech recognition; structured reports contained a consistent ordering of observations with standardized subheadings...
February 22, 2017: Journal of Cardiovascular Computed Tomography
https://www.readbyqxmd.com/read/28258016/primary-axillary-venous-aneurysm-associated-with-local-neurological-complications
#17
David Malem, Haider Khan Bangash, Bibombe Patrice Mwipatayi
Primary axillary venous aneurysms are rare, and there are only a handful of cases reported previously. The patient can be either asymptomatic or symptomatic, and can present with local axillary swelling, dilated venules in overlying skin associated with local discomfort, peripheral neuropathy, or pulmonary embolisms. A 30-year-old man presented with a four-month history of an uncomfortable lump in his left armpit that was associated with paraesthesia radiating down to his left forearm and hand. He had no history of arm swelling and had a normal motor neurological examination...
February 28, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28254117/correlation-of-benign-prostatic-obstruction-related-complications-with-clinical-outcomes-in-patients-after-transurethral-resection-of-the-prostate
#18
Run-Qi Guo, Wei Yu, Yi-Sen Meng, Kai Zhang, Ben Xu, Yun-Xiang Xiao, Shi-Liang Wu, Bai-Nian Pan
We aim to investigate the correlation of benign prostatic obstruction (BPO)-related complications with clinical outcomes in patients after transurethral resection of the prostate in China. We reviewed the medical history of all patients who underwent surgery from 1992 to 2013. We assessed the preoperative clinical profile, clinical management, and operative complications. Overall, 2271 patients were enrolled in the study. Of these patients, 1193 (52.5%) had no BPO-related complications and 1078 (46.3%) had BPO-related complications...
March 2017: Kaohsiung Journal of Medical Sciences
https://www.readbyqxmd.com/read/28248408/prognostic-importance-of-central-thrombus-in-hemodynamically-stable-patients-with-pulmonary-embolism
#19
Aysegul Senturk, Savas Ozsu, Serap Duru, Ebru Cakır, Sevinc Sarinc Ulaslı, Ezgi Demirdogen, Servet Kayhan, Aygul Guzel, Fatih Yakar, Serdar Berk
BACKGROUND: The association between mortality and localization of central thrombus in hemodynamically stable patients with pulmonary embolism (PE) is unclear. Sufficient data are not available to help clinicians to select between low molecular weight heparin (LMWH), unfractionated heparin (UFH) and thrombolytics for the management of central thrombus. The present study aims to investigate whether central thrombus in the pulmonary artery affects 30-day mortality rate, and to compare the outcomes of different treatment approaches in patients with central thrombus...
March 1, 2017: Cardiology Journal
https://www.readbyqxmd.com/read/28247199/cost-effectiveness-of-genotype-guided-warfarin-dosing-in-patients-with-mechanical-heart-valve-replacement-under-the-fee-for-service-system
#20
Dong-Jin Kim, Ho-Sook Kim, Minkyung Oh, Eun-Young Kim, Jae-Gook Shin
BACKGROUND: Although studies assessing the cost effectiveness of genotype-guided warfarin dosing for the management of atrial fibrillation, deep vein thrombosis, and pulmonary embolism have been reported, no publications have addressed genotype-guided warfarin therapy in mechanical heart valve replacement (MHVR) patients or genotype-guided warfarin therapy under the fee-for-service (FFS) insurance system. OBJECTIVE: The aim of this study was to evaluate the cost effectiveness of genotype-guided warfarin dosing in patients with MHVR under the FFS system from the Korea healthcare sector perspective...
February 28, 2017: Applied Health Economics and Health Policy
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