262 research outputs found
Improving the diagnostic strategy of pulmonary embolism
Pulmonary embolism is a common clinical disorder that is associated with high morbidity
and mortality if untreated. In the only randomized study comparing anticoagulant therapy
with no treatment in patients with pulmonary embolism, 26% of untreated patients had
a fatal embolic event and another 26% developed nonfatal recurrent emboli1. With a course
of anticoagulant treatment, the recurrence rate of thromboembolic events decreases to
approximately 2% to 9% over 3 to 6 months2, 3. However, anticoagulation always carries a risk
for bleeding (annual rate of major bleeding, 7%)4, 5. To avoid unnecessary anticoagulant
therapy, it is therefore important to rapidly confirm or exclude pulmonary embolism in
patients who present with suspicion of the disorder.
Diagnosing or excluding pulmonary embolism on the basis of clinical manifestations alone
is difficult because such manifestations are nonspecific6. Approximately 25% of patients
with suspected pulmonary embolism have the disease confirmed by objective testing7-9.
The goal of the first diagnostic strategies introduced was to confirm rather than exclude the
presence of pulmonary emboli. The more recently evaluated diagnostic approaches have
focused on identifying patients who probably do not have pulmonary embolism and therefore
do not require anticoagulant therapy. Various invasive and noninvasive diagnostic methods
have been advocated for excluding the disease.
We performed a systematic review of the literature to evaluate diagnostic strategies
designed to exclude pulmonary embolism. Our objective was to investigate whether clinical
outcome evaluation properly documented the safety of withholding anticoagulant
treatment in patients in whom pulmonary embolism was excluded according to a given
diagnostic strategy. We assessed the accuracy of the various diagnostic strategies by
examining the number of symptomatic thromboembolic events (deep venous thrombosis or
pulmonary embolism) that occurred without anticoagulant treatment during a follow-up period
of at least 3 months. Studies were grouped according to the number of rounds of diagnostic
testing performed before pulmonary embolism was ruled out
The effect of hospital-based antithrombotic stewardship on adherence to anticoagulant guidelines
Hemophilia B in a female with intellectual disability caused by a deletion of Xq26.3q28 encompassing the F9
Population pharmacokinetics of nadroparin for thromboprophylaxis in COVID-19 intensive care unit patients
Development of a clinical prediction model for an international normalised ratio >= 4.5 in hospitalised patients using vitamin K antagonists
Pharmacokinetic Modelling to Predict FVIII:C Response to Desmopressin and Its Reproducibility in Nonsevere Haemophilia A Patients
Long Term Follow Up, Causes for Re-intervention, and Consequences for Surveillance After Stenting for Proximal Deep Vein Obstruction
Statin use decreases coagulation in users of vitamin K antagonists
Purpose: The purpose of the study is to determine the immediate and long-term effect of statins on coagulation in patients treated with vitamin K antagonists (VKAs). Methods: We selected patients on VKAs of two Dutch anticoagulation clinics who initiated treatment with a statin between 2009 and 2013. Patients who initiated or stopped concomitant drugs that interact with VKAs or were hospitalised during follow-up were excluded. The VKA dosage (mg/day) after statin initiation was compared with the last VKA dosage before the statin was started. Immediate and long-term differences in VKA dosage (at 6 and 12 weeks) were calculated with a paired student t test. Results: Four hund
- …