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Latest & greatest articles for pulmonary embolism
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-PTP and a d-dimer level of less than 1000 ng per milliliter or with a moderate C-PTP and a d-dimer level of less than 500 ng per milliliter. All other patients underwent chest imaging (usually computed tomographic pulmonary angiography). If pulmonaryembolism was not diagnosed, patients did not receive anticoagulant therapy. All patients were followed for 3 months to detect venous thromboembolism.A total of 2017 patients were enrolled and evaluated, of whom 7.4% had pulmonaryembolism on initial (...) not receive anticoagulant therapy, 1 patient (0.05%; 95% CI, 0.01 to 0.30) had venous thromboembolism. Our diagnostic strategy resulted in the use of chest imaging in 34.3% of patients, whereas a strategy in which pulmonaryembolism is considered to be ruled out with a low C-PTP and a d-dimer level of less than 500 ng per milliliter would result in the use of chest imaging in 51.9% (difference, -17.6 percentage points; 95% CI, -19.2 to -15.9).A combination of a low C-PTP and a d-dimer level of less than
Left atrial size measured on CT pulmonary angiography: another parameter of pulmonaryembolism severity? A systematic review. We systematically review the potential role of left atrial (LA) size, evaluated at computed tomography angiography (CTA) in patients with acute pulmonaryembolism (PE), as a new parameter of PE severity. A literature search based on PubMed (MEDLINE), Scopus, Cochrane library and Google Scholar databases was performed to locate previous published investigations reporting (...) data on the severity of acute PE based on the evaluation of LA size (either volume, diameter or area). Six studies, corresponding to a total of 990 patients, published between 2012 and 2019 were included into the analysis. The severity of acute PE, in terms of hemodynamic impairment, increases with the reduction of the LA volume and a significant negative correlation was observed between the pulmonary artery obstruction index (PAOI) and the LA area. Similarly, the longest left-to-right as well
Thrombolytics for Patients with Acute or Massive PulmonaryEmbolisms: Clinical Effectiveness and Guidelines Thrombolytics for Patients with Acute or Massive PulmonaryEmbolisms: Clinical Effectiveness and Guidelines | CADTH.ca Find the information you need Thrombolytics for Patients with Acute or Massive PulmonaryEmbolisms: Clinical Effectiveness and Guidelines Thrombolytics for Patients with Acute or Massive PulmonaryEmbolisms: Clinical Effectiveness and Guidelines Last updated: August 27 (...) , 2019 Project Number: RB1385-000 Product Line: Research Type: Drug Report Type: Summary of Abstracts Result type: Report Question What is the clinical effectiveness of thrombolytics for the treatment of adults with acute or emergent massive pulmonaryembolism? What are the evidence-based guidelines regarding thrombolytics in managing adult patients with acute or emergent massive pulmonaryembolism? Key Message Three systematic reviews with meta-analyses, seven meta-analyses, five randomized
Elevated serum cardiac troponin and mortality in acute pulmonaryembolism: Systematic review and meta-analysis. To evaluate whether elevated levels of cardiac troponin increases the risk of mortality in patients with acute PE.We conducted a systematic review and meta-analysis with rigorous statistical evaluation using publications (2000-2018) from Cochrane Library, MEDLINE, PubMed, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), WHO International Clinical Trials Registry
Definitions, adjudication, and reporting of pulmonaryembolism-related death in clinical studies: A systematic review. Pulmonaryembolism (PE)-related death is a component of the primary outcome in many venous thromboembolism (VTE) studies. The absence of a standardized definition for PE-related death hampers study outcome evaluation and between-study comparisons.To summarize definitions for PE-related death used in recent VTE studies and to assess the PE-related death rate.A systematic
Meta-Analysis of Catheter Directed Ultrasound-Assisted Thrombolysis in PulmonaryEmbolism. Ultrasound-assisted catheter directed thrombolysis (USAT) has been shown to improve hemodynamic function and reduce bleeding complications in patients with acute massive or submassive pulmonaryembolism. We performed a meta-analysis to better evaluate the efficacy and safety of USAT. We conducted an extensive literature search in PUBMED, MEDLINE, and EMBASE databases from January 1, 2008 to December 31 (...) , 2018. Efficacy outcomes of interest were pulmonary artery systolic pressure, mean pulmonary pressure, ratio of right ventricular to left ventricular diameter, cardiac index, tricuspid annular plane systolic excursion, Miller Index Score, and Qanadli Score. Safety outcomes were in-hospital mortality, long-term mortality, major and minor bleeding complications, and recurrent pulmonaryembolism. Meta-analysis was performed using Cochrane Collaboration Review Manager (version 5.1). Effect size
Could the YEARS algorithm be used to exclude pulmonaryembolism during pregnancy? Data from the CT-PE-pregnancy study The recently proposed YEARS algorithm was shown to safely exclude pulmonaryembolism (PE) and reduce the use of computed tomography pulmonary angiography (CTPA) among pregnant women with suspected PE. Our aim was to externally validate this finding.We performed a post hoc analysis of a prospective management outcome study for PE diagnosis in pregnant women. PE was diagnosed
Hospital volume and outcomes for acute pulmonaryembolism: multinational population based cohort study. To evaluate the association between experience in the management of acute pulmonaryembolism, reflected by hospital case volume, and mortality.Multinational population based cohort study using data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry between 1 January 2001 and 31 August 2018.353 hospitals in 16 countries.39 257 consecutive patients with confirmed (...) diagnosis of acute symptomatic pulmonary embolism.Pulmonary embolism related mortality within 30 days after diagnosis of the condition.Patients with acute symptomatic pulmonaryembolism admitted to high volume hospitals (>40 pulmonaryembolisms per year) had a higher burden of comorbidities. A significant inverse association was seen between annual hospital volume and pulmonaryembolism related mortality. Admission to hospitals in the highest quarter (that is, >40 pulmonaryembolisms per year
Cytomegalovirus infection with pulmonaryembolism, splenic vein thrombosis and monoclonal gammopathy of undetermined significance: a case and systematic review. A 62-year-old immunocompetent woman was admitted with cytomegalovirus (CMV) infection, pulmonaryembolism, splenic vein thrombosis and monoclonal gammopathy of undetermined significance (MGUS). Anticoagulation therapy was started. Two months later, seroconversion of CMV IgM to IgG was observed, while the monoclonal protein was no longer
Patent Foramen Ovale and Ischemic Stroke in Patients With PulmonaryEmbolism: A Prospective Cohort Study. Pulmonaryembolism (PE) is associated with increased risk for ischemic stroke, but the underlying mechanism remains unclear. The authors hypothesized that paradoxical embolism through patent foramen ovale (PFO) should be the main mechanism.To determine the frequency of recent ischemic stroke in patients with symptomatic PE according to whether PFO was detected.Prospective cohort study (...) was more frequent in the PFO group than in the non-PFO group (9 of 42 patients [21.4%] vs. 15 of 273 patients [5.5%]; difference in proportions, 15.9 percentage points [95% CI, 4.7 to 30.7 percentage points]).Because of inconclusive contrast TTE or MRI, 46 patients were excluded from analysis.Frequency of recent ischemic stroke in patients with symptomatic PE was higher in patients with PFO than in those without PFO. This finding supports the hypothesis that paradoxical embolism is an important
Risk of recurrent venous thromboembolism after acute pulmonaryembolism: role of residual pulmonary obstruction and persistent right ventricular dysfunction. A meta-analysis. Essentials Debated is the role of residual pulmonary obstruction (RPO) in predicting venous thromboembolism. Whether right ventricular dysfunction (RVD) predicts recurrent venous thromboembolism is unknown. 15 studies on RPO and 4 on RVD and venous thromboembolism were included in this meta-analysis. RPO is a predictor (...) of recurrent venous thromboembolism when assessed by perfusion lung scan. RVD after acute pulmonaryembolism is not associated with recurrent venous thromboembolism.There is conflicting evidence regarding the role of residual pulmonary obstruction (RPO) or persistent right ventricular dysfunction (RVD) after pulmonaryembolism (PE) as a predictor of recurrent venous thromboembolism (VTE). The aim of this study was to assess whether RPO or persistent RVD after PE is associated with recurrent VTE.MEDLINE
A novel electrocardiographic parameter for diagnosis of acute pulmonaryembolism: RS time: RS time in acute pulmonaryembolismPulmonaryembolism (PE) is one of the leading causes of cardiovascular mortality worldwide. Electrocardiography (ECG) may provide useful information for patients with acute PE. In this study, we aimed to investigate the diagnostic value of the QRS duration and RS time in inferolateral leads in patients admitted to the emergency department, and pre-diagnosed with acute (...) PE.We retrospectively enrolled 136 consecutive patients, admitted to the emergency department, pre-diagnosed with the clinical suspicion of acute PE, and underwent computerized tomographic pulmonary angiography (CTPA) to confirm the PE diagnosis. The study subjects were divided into two groups according to the presence or absence of PE, and the independent predictors of PE were investigated.Sixty-eight patients (50%) had PE. Patients with PE had a longer RS time. Among the ECG parameters, only RS
Efficacy of rivaroxaban for pulmonaryembolism. Previous clinical trials have addressed that rivaroxaban is effective for the treatment of patients with pulmonaryembolism (PE). This study will systematically assess its efficacy and safety for PE.We will carry out this study by searching the following electronic databases from inception to March 1, 2019 without language restrictions: Cochrane Library, EMBASE, PUBMED, Web of Science, Cumulative Index to Nursing and Allied Health Literature
Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected PulmonaryEmbolism. Pulmonaryembolism is one of the leading causes of maternal death in the Western world. Because of the low specificity and sensitivity of the d-dimer test, all pregnant women with suspected pulmonaryembolism undergo computed tomographic (CT) pulmonary angiography or ventilation-perfusion scanning, both of which involve radiation exposure to the mother and fetus. Whether a pregnancy-adapted algorithm could be used (...) to safely avoid diagnostic imaging in pregnant women with suspected pulmonaryembolism is unknown.In a prospective study involving pregnant women with suspected pulmonaryembolism, we assessed three criteria from the YEARS algorithm (clinical signs of deep-vein thrombosis, hemoptysis, and pulmonaryembolism as the most likely diagnosis) and measured the d-dimer level. Pulmonaryembolism was ruled out if none of the three criteria were met and the d-dimer level was less than 1000 ng per milliliter
Evidence for Cerebral Embolic Prevention in Transcatheter Aortic Valve Implantation and Thoracic Endovascular Aortic Repair. Embolic stroke is a formidable complication of transcatheter aortic valve implantation (TAVI) and thoracic endovascular aortic repair (TEVAR). Mechanical strategies to reduce the risk of ischemic embolic lesions include embolic protection devices (EPDs) and carbon dioxide flushing (CDF). This study aims to assess the efficacy for EPD and CDF uses in TAVI and TEVAR.A (...) showed smaller total volume of cerebral lesions and smaller volume per lesion in patients with EPD in all studies. They also performed better in postoperative neurocognitive assessments but could not demonstrate clinical prevention of embolic stroke in all studies. While for EPD use in TEVAR, capture of embolic debris and absence of early postoperative neurocognitive deficit were demonstrated in all cases of 2 prospective pilot studies. Concerning CDF in TEVAR, significant reduction in gaseous emboli
Outpatient versus inpatient treatment for acute pulmonaryembolism. Pulmonaryembolism (PE) is a common life-threatening cardiovascular condition, with an incidence of 23 to 69 new cases per 100,000 people each year. For selected low-risk patients with acute PE, outpatient treatment might provide several advantages over traditional inpatient treatment, such as reduction of hospitalisations, substantial cost savings, and improvements in health-related quality of life. This is an update
The Prognostic Value of Renal Function in Acute PulmonaryEmbolism-A Multi-Centre Cohort Study Haemodynamic alterations caused by acute pulmonaryembolism (PE) may affect multi-organ function including kidneys. This multi-centre, multinational cohort study aimed to validate the prognostic significance of estimated glomerular filtration rate (eGFR) and its potential additive value to the current PE risk assessment algorithms. The post hoc analysis of pooled prospective cohort studies: 2,845
Case report and systematic review of pulmonaryembolism mimicking ST-elevation myocardial infarction. To study trends in the clinical presentation, electrocardiograms, and diagnostic imaging in patients with pulmonaryembolism presenting as ST segment elevation.We performed a systematic literature search for all reported cases of pulmonaryembolism mimicking ST-elevation myocardial infarction. Pre-specified data such as clinical presentation, electrocardiogram changes, transthoracic (...) of bilateral compared to unilateral pulmonary emboli (72.4% vs. 10%). About 65% patients received anticoagulation and 36.3% were treated with thrombolytics. Forty-six percent of patients required intensive care and 18.7% intubation. Overall mortality was 25.8%.A review of the literature reveals that in patients presenting with pulmonaryembolism, electrocardiogram findings of ST-segment elevations will occur predominantly in the anterior-septal distribution.