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By Faye Kehler Family Physician and GP Anesthetist since 1987 interested in all aspects of Medicine
Allison E Burnett, Charles E Mahan, Sara R Vazquez, Lynn B Oertel, David A Garcia, Jack Ansell
Venous thromboembolism (VTE) is a serious medical condition associated with significant morbidity and mortality, and an incidence that is expected to double in the next forty years. The advent of direct oral anticoagulants (DOACs) has catalyzed significant changes in the therapeutic landscape of VTE treatment. As such, it is imperative that clinicians become familiar with and appropriately implement new treatment paradigms. This manuscript, initiated by the Anticoagulation Forum, provides clinical guidance for VTE treatment with the DOACs...
January 2016: Journal of Thrombosis and Thrombolysis
Swaroopa Pulivarthi, Murali Krishna Gurram
Venous thromboembolism (VTE) is the leading cause of morbidity and mortality among hospitalized patients. We searched the PubMed database and reviewed the articles published until June 2011. Articles related to the D-dimer and VTE were considered to write this paper. Many factors play a key role in changing the sensitivity and specificity of D-dimer testing, including the extent of thrombosis and fibrinolytic activity, duration of symptoms, anticoagulant therapy, comorbidity due to surgical or medical illnesses, inflammatory diseases, cancer, elderly age, pregnancy and the postpartum period, and previous VTE...
October 2014: North American Journal of Medical Sciences
Babak Tamizifar, Padideh Oghab, Morteza Abdar Esfahani
BACKGROUND: After discontinuing oral anticoagulant therapy (OAT), the recurrence of venous thromboembolism (VTE) is greatest in the 1(st) year and gradually diminishes. D-dimer assay was proposed to be effective in selecting patients with idiopathic DVT. The aim of this study was to determine the rate of VTE recurrence after discontinuing OAT according to the results of D-dimer. MATERIALS AND METHODS: This prospective study was conducted in patients with a first episode of symptomatic proximal deep vein thrombosis (DVT) who had received OAT for at least 3 months...
July 2014: Journal of Research in Medical Sciences: the Official Journal of Isfahan University of Medical Sciences
Henrike J Schouten, Geert-Jan Geersing, Ruud Oudega, Johannes J M van Delden, Karel G M Moons, Huiberdina L Koek
OBJECTIVES: To determine whether the Wells clinical prediction rule for pulmonary embolism (PE), which produces a point score based on clinical features and the likelihood of diagnoses other than PE, combined with normal D-dimer testing can be used to exclude PE in older unhospitalized adults. DESIGN: Prospective cohort study. SETTING: Primary care and nursing homes. PARTICIPANTS: Older adults (≥60) clinically suspected of having a PE (N = 294, mean age 76, 44% residing in a nursing home)...
November 2014: Journal of the American Geriatrics Society
Robert A Fowler, Nicole Mittmann, William Geerts, Diane Heels-Ansdell, Michael K Gould, Gordon Guyatt, Murray Krahn, Simon Finfer, Ruxandra Pinto, Brian Chan, Orges Ormanidhi, Yaseen Arabi, Ismael Qushmaq, Marcelo G Rocha, Peter Dodek, Lauralyn McIntyre, Richard Hall, Niall D Ferguson, Sangeeta Mehta, John C Marshall, Christopher James Doig, John Muscedere, Michael J Jacka, James R Klinger, Nicholas Vlahakis, Neil Orford, Ian Seppelt, Yoanna K Skrobik, Sachin Sud, John F Cade, Jamie Cooper, Deborah Cook
IMPORTANCE: Venous thromboembolism (VTE) is a common complication of acute illness, and its prevention is a ubiquitous aspect of inpatient care. A multicenter blinded, randomized trial compared the effectiveness of the most common pharmocoprevention strategies, unfractionated heparin (UFH) and the low-molecular-weight heparin (LMWH) dalteparin, finding no difference in the primary end point of leg deep-vein thrombosis but a reduced rate of pulmonary embolus and heparin-induced thrombocytopenia among critically ill medical-surgical patients who received dalteparin...
November 26, 2014: JAMA: the Journal of the American Medical Association
G E Raskob, P Angchaisuksiri, A N Blanco, H Buller, A Gallus, B J Hunt, E M Hylek, A Kakkar, S V Konstantinides, M McCumber, Y Ozaki, A Wendelboe, J I Weitz
BACKGROUND: Thrombosis is the common pathology underlying ischemic heart disease, ischemic stroke, and venous thromboembolism (VTE). The Global Burden of Disease Study 2010 (GBD 2010) documented that ischemic heart disease and stroke collectively caused 1 in 4 deaths worldwide. GBD 2010 did not report data for VTE as a cause of death and disability. OBJECTIVE: To review the literature on the global burden of disease caused by VTE. APPROACH AND RESULTS: We performed a systematic review of the literature on the global disease burden because of VTE in low-, middle-, and high-income countries...
November 2014: Arteriosclerosis, Thrombosis, and Vascular Biology
Dolores Taboada, Joanna Pepke-Zaba, David P Jenkins, Marius Berman, Carmen M Treacy, John E Cannon, Mark Toshner, John J Dunning, Choo Ng, Steven S Tsui, Karen K Sheares
Chronic thromboembolic disease is characterised by persistent pulmonary thromboembolic occlusions without pulmonary hypertension. Early surgical treatment with pulmonary endarterectomy may improve symptoms and prevent disease progression. We sought to assess the outcome of pulmonary endarterectomy in symptomatic patients with chronic thromboembolic disease. Patients with symptomatic chronic thromboembolic disease and a mean pulmonary artery pressure <25 mmHg at baseline with right heart catheterisation and treated with pulmonary endarterectomy between January 2000 and July 2013 were identified...
December 2014: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Lana A Castellucci, Chris Cameron, Grégoire Le Gal, Marc A Rodger, Doug Coyle, Philip S Wells, Tammy Clifford, Esteban Gandara, George Wells, Marc Carrier
IMPORTANCE: Many anticoagulant strategies are available for the treatment of acute venous thromboembolism, yet little guidance exists regarding which drug is most effective and safe. OBJECTIVE: To summarize and compare the efficacy and safety outcomes associated with 8 anticoagulation options (unfractionated heparin [UFH], low-molecular-weight heparin [LMWH], or fondaparinux in combination with vitamin K antagonists); LMWH with dabigatran or edoxaban; rivaroxaban; apixaban; and LMWH alone) for treatment of venous thromboembolism...
September 17, 2014: JAMA: the Journal of the American Medical Association
A A Khorana, H-M Otten, J I Zwicker, G C Connolly, D F Bancel, I Pabinger
No abstract text is available yet for this article.
November 2014: Journal of Thrombosis and Haemostasis: JTH
Vasilis Bagalas, Asimina Paspala, Evdokia Sourla, Sofia Akritidou, Katerina Tsolakidou, Afroditi Boutou, Antonis A Pitsis, Katerina Manika, Ioannis P Kioumis, Ioannis Stanopoulos, Georgia Pitsiou
BACKGROUND: Chronic thromboembolic pulmonary hypertension most often results from obstruction of the pulmonary vascular bed by nonresolving thromboemboli. Misdiagnosis of the disease is common because patients often present with subtle or nonspecific symptoms. Furthermore, some features in chest imaging may mimic parenchymal lung disease. The most clinically important mimic in high-resolution chest tomography is air trapping, which can be seen in a variety of small airway diseases. CASE REPORT: We present the case of a 45-year-old woman with a long history of dyspnea and exercise intolerance, misdiagnosed with allergic alveolitis...
2014: American Journal of Case Reports
O Zusman, M Paul, L Farbman, V Daitch, Y Akayzen, G Witberg, T Avni, A Gafter-Gvili, L Leibovici
BACKGROUND: Venous thromboembolism (VTE) is a feared complication during hospitalization. The practice of administering pharmacological prophylaxis is highly endorsed despite failure of studies to show reduction in mortality. AIM: : To determine the benefit of VTE prophylaxis in acutely ill medical patients with sepsis. METHODS: A prospective cohort, with enrollment between January 2010 and April 2011. Patients were detected in four medicine departments at a university-affiliated hospital and followed for 90 days for pre-specified outcomes...
March 2015: QJM: Monthly Journal of the Association of Physicians
Ilana Kopolovic, Agnes Y Y Lee, Cynthia Wu
Venous thromboembolism (VTE) and thrombocytopenia are both more common in cancer patients than in general populations. Both the outcomes and optimal management of cancer-associated VTE in thrombocytopenic patients are unknown. The objective of the current  study is to describe a cohort of patients presenting with acute cancer-associated VTE with concomitant thrombocytopenia, including management patterns and outcomes. We conducted a retrospective cohort study of all cancer patients admitted to a regional cancer centre and the main university hospital's hematology service in Edmonton, Alberta, from 2005-2011, who had thrombocytopenia at the time of acute VTE...
February 2015: Annals of Hematology
Marcello Di Nisio, Ettore Porreca, Hans-Martin Otten, Anne W S Rutjes
BACKGROUND: Venous thromboembolism (VTE) often complicates the clinical course of cancer. The risk is further increased by chemotherapy, but the safety and efficacy of primary thromboprophylaxis in cancer patients treated with chemotherapy is uncertain. This is an update of a review first published in February 2012. OBJECTIVES: To assess the efficacy and safety of primary thromboprophylaxis for VTE in ambulatory cancer patients receiving chemotherapy compared with placebo or no thromboprophylaxis...
2014: Cochrane Database of Systematic Reviews
F A Klok, T van der Hulle, P L den Exter, M Lankeit, M V Huisman, S Konstantinides
Long-term follow-up studies have consistently demonstrated that after an episode of acute pulmonary embolism (PE), half of patients report functional limitations and/or decreased quality of life up to many years after the acute event. Incomplete thrombus resolution occurs in one-fourth to one-third of patients. Further, pulmonary artery pressure and right ventricular function remain abnormal despite adequate anticoagulant treatment in 10-30% of patients, and 0.5-4% is diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) which represents the most severe long term complication of acute PE...
November 2014: Blood Reviews
Ingrid Torjesen
No abstract text is available yet for this article.
2014: BMJ: British Medical Journal
Erik J Olson, Ashley L Zander, Jan-Michael Van Gent, Steven R Shackford, Jayraan Badiee, C Beth Sise, Michael J Sise
BACKGROUND: The prevention of venous thromboembolic disease following trauma is a priority. In contrast to above-knee deep vein thrombosis (AKDVT), the management of below-knee deep vein thrombosis (BKDVT) is controversial because the risk of pulmonary embolism (PE) has not been firmly established. We hypothesized that BKDVT and AKDVT have an equivalent risk for PE in trauma patients. METHODS: We identified patients from July 2006 to December 2011 with BKDVT and/or AKDVT diagnosed by lower extremity duplex ultrasound (LEDU) and patients with PE diagnosed by computed tomography angiogram...
September 2014: Journal of Trauma and Acute Care Surgery
Thomas W Wakefield, Andrea T Obi, Peter K Henke
No abstract text is available yet for this article.
September 23, 2014: Circulation
John Simes, Cecilia Becattini, Giancarlo Agnelli, John W Eikelboom, Adrienne C Kirby, Rebecca Mister, Paolo Prandoni, Timothy A Brighton
BACKGROUND: In patients with a first unprovoked venous thromboembolism (VTE) the risk of recurrent VTE remains high after anticoagulant treatment is discontinued. The Aspirin for the Prevention of Recurrent Venous Thromboembolism (the Warfarin and Aspirin [WARFASA]) and the Aspirin to Prevent Recurrent Venous Thromboembolism (ASPIRE) trials showed that aspirin reduces this risk, but they were not individually powered to detect treatment effects for particular outcomes or subgroups. METHODS AND RESULTS: An individual patient data analysis of these trials was planned, before their results were known, to assess the effect of aspirin versus placebo on recurrent VTE, major vascular events (recurrent VTE, myocardial infarction, stroke, and cardiovascular disease death) and bleeding, overall and within predefined subgroups...
September 23, 2014: Circulation
Jean-Philippe Galanaud, Susan R Kahn
PURPOSE OF REVIEW: Postthrombotic syndrome (PTS) is the most frequent complication of deep vein thrombosis. Its pathophysiology is incompletely understood and therapeutic options are limited. This review aims to present and discuss recently published studies that have improved our knowledge related to PTS. RECENT FINDINGS: From a prognostic point of view, some polymorphisms of plasminogen activator inhibitor-1 and platelet endothelial cell adhesion molecule 1 influence the degree of thrombus resolution after deep vein thrombosis and the subsequent rate of PTS, and could help in predicting the risk of PTS...
November 2014: Current Opinion in Cardiology
Scott A Flanders, M Todd Greene, Paul Grant, Scott Kaatz, David Paje, Bobby Lee, James Barron, Vineet Chopra, David Share, Steven J Bernstein
IMPORTANCE: Hospitalization for acute medical illness is associated with increased risk of venous thromboembolism (VTE). Although efforts designed to increase use of pharmacologic VTE prophylaxis are intended to reduce hospital-associated VTE, whether higher rates of prophylaxis reduce VTE in medical patients is unknown. OBJECTIVE: To examine the association between pharmacologic VTE prophylaxis rates and hospital-associated VTE. DESIGN, SETTING, AND PARTICIPANTS: Retrospective, multicenter cohort study conducted at 35 Michigan hospitals participating in a statewide quality collaborative from January 1, 2011, through September 13, 2012...
October 2014: JAMA Internal Medicine
2014-10-04 18:21:57
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