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Pulmonary embolism management strategy 2014 THORAX

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4 papers 0 to 25 followers
By Jason Mann No BS pulmonary critical care fellow
Guy Meyer, Antoine Vieillard-Baron, Benjamin Planquette
The aim of this narrative review is to summarize for intensivists or any physicians managing "severe" pulmonary embolism (PE) the main recent advances or recommendations in the care of patients including risk stratification, diagnostic algorithm, hemodynamic management in the intensive care unit (ICU), recent data regarding the use of thrombolytic treatment and retrievable vena cava filters and finally results of direct oral anticoagulants. Thanks to the improvements achieved in the risk stratification of patients with PE, a better therapeutic approach is now recommended from diagnosis algorithm and indication to admission in ICU to indication of thrombolysis and general hemodynamic support in patients with shock...
December 2016: Annals of Intensive Care
Ali S Raja, Jeffrey O Greenberg, Amir Qaseem, Thomas D Denberg, Nick Fitterman, Jeremiah D Schuur
DESCRIPTION: Pulmonary embolism (PE) can be a severe disease and is difficult to diagnose, given its nonspecific signs and symptoms. Because of this, testing patients with suspected acute PE has increased dramatically. However, the overuse of some tests, particularly computed tomography (CT) and plasma d-dimer measurement, may not improve care while potentially leading to patient harm and unnecessary expense. METHODS: The literature search encompassed studies indexed by MEDLINE (1966-2014; English-language only) and included all clinical trials and meta-analyses on diagnostic strategies, decision rules, laboratory tests, and imaging studies for the diagnosis of PE...
November 3, 2015: Annals of Internal Medicine
Patrick Mismetti, Silvy Laporte, Olivier Pellerin, Pierre-Vladimir Ennezat, Francis Couturaud, Antoine Elias, Nicolas Falvo, Nicolas Meneveau, Isabelle Quere, Pierre-Marie Roy, Olivier Sanchez, Jeannot Schmidt, Christophe Seinturier, Marie-Antoinette Sevestre, Jean-Paul Beregi, Bernard Tardy, Philippe Lacroix, Emilie Presles, Alain Leizorovicz, Hervé Decousus, Fabrice-Guy Barral, Guy Meyer
IMPORTANCE: Although retrievable inferior vena cava filters are frequently used in addition to anticoagulation in patients with acute venous thromboembolism, their benefit-risk ratio is unclear. OBJECTIVE: To evaluate the efficacy and safety of retrievable vena cava filters plus anticoagulation vs anticoagulation alone for preventing pulmonary embolism recurrence in patients presenting with acute pulmonary embolism and a high risk of recurrence. DESIGN, SETTING, AND PARTICIPANTS: Randomized, open-label, blinded end point trial (PREPIC2) with 6-month follow-up conducted from August 2006 to January 2013...
April 28, 2015: JAMA: the Journal of the American Medical Association
Robin Condliffe, Charlie A Elliot, Rodney J Hughes, Judith Hurdman, Rhona M Maclean, Ian Sabroe, Joost J van Veen, David G Kiely
BACKGROUND: Physicians treating acute pulmonary embolism (PE) are faced with difficult management decisions while specific guidance from recent guidelines may be absent. METHODS: Fourteen clinical dilemmas were identified by physicians and haematologists with specific interests in acute and chronic PE. Current evidence was reviewed and a practical approach suggested. RESULTS: Management dilemmas discussed include: sub-massive PE, PE following recent stroke or surgery, thrombolysis dosing and use in cardiac arrest, surgical or catheter-based therapy, failure to respond to initial thrombolysis, PE in pregnancy, right atrial thrombus, role of caval filter insertion, incidental and sub-segmental PE, differentiating acute from chronic PE, early discharge and novel oral anticoagulants...
February 2014: Thorax
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