98 research outputs found
The diagnostic management of suspected pulmonary embolism
Pulmonary embolism is a potentially fatal disease in which early recognition and institution of anticoagulant treatment can prevent mortality. The diagnostic tools available to establish whether a patient has a pulmonary embolism were limited to pulmonary angiography and ventilation-perfusion scintigraphy. Both tests have considerable limitations. Helical CT evolved as a new technique in diagnosing PE and gained widespread interest but has been implemented rapidly, without appropriate assessment in clinical practice. The Christopher-study was performed to investigate whether a dichotomization of the Wells clinical decision rule, classifying patients into __PE unlikely__ and __PE likely__ in combination with a D-dimer test is safe to rule out pulmonary embolism in patients with a clinical suspicion. Furthermore, the study was designed to investigate whether helical CT is safe to rule out PE without performing any additional diagnostic tests. In patients in whom PE was excluded by a clinical decision rule indicating __PE unlikely__ combined with a negative D-dimer, during three months of follow-up venous thrombo-embolism was diagnosed in 5 out of 1028 untreated patients (0.5%, 95%CI: 0.2-1.1). In patients in whom CT had ruled out PE, during three months follow-up 18 of 1446 untreated patients experienced a venous thrombo-embolic event (1.3%, 95%CI: 0.7-2.0). In conclusion, the Christopher-study demonstrates that a simple diagnostic algorithm consisting of a dichotomised clinical decision rule, D-dimer and helical CT can guide treatment decisions with a low risk of subsequent venous thrombo-embolism.Roche Diagnostics, Glaxo Smith Kline, Actelion, Astra ZenecaUBL - phd migration 201
Current practice patterns of outpatient management of acute pulmonary embolism: A post-hoc analysis of the YEARS study
Background: Studies have shown the safety of home treatment of patients with pulmonary embolism (PE) at low risk of adverse events. Management studi
Local Ultrasound-Facilitated Thrombolysis in High-Risk Pulmonary Embolism: First Dutch Experience
Purpose To provide insight into the current use and results
of ultrasound-facilitated catheter-directed thrombolysis
(USAT) in patients with high-risk pulmonary embolism
(PE).
Introduction Systemic thrombolysis is an effective treatment for hemodynamically unstable, high-risk PE, but is
associated with bleeding complications. USAT is thought
to reduce bleeding and is therefore advocated in patients
with high-risk PE and contraindications for systemic
thrombolysis.
Methods We conducted a retrospective cohort study of all
patients who underwent USAT for high-risk PE in the
Netherlands from 2010 to 2017. Characteristics and outcomes were analyzed. Primary outcomes were major
(including intracranial and fatal) bleeding and all-cause
mortality after 1 month. Secondary outcomes were allcause mortality and recurrent venous thromboembolism
within 3 months.
Results 33 patients underwent USAT for high-risk PE.
Major bleeding occurred in 12 patients (36%, 95% CI
22–53), including 1 intracranial and 3 fatal bleeding. Allcause mortality after 1 month was 48% (16/33, 95% CI
31–66). All-cause mortality after 3 months was 50% (16/
32, 95% CI 34–66), recurrent venous thromboembolism
occurred in 1 patient (1/32, 3%, 95% CI 1–16).
Conclusions This study was the first to describe characteristics and outcomes after USAT in a study population of
patients with high-risk PE only, an understudied population. Although USAT is considered a relatively safe
treatment option, our results illustrate that at least caution
is needed in critically ill patients with high-risk PE. Further
research in patients with high-risk PE is warranted to guide
patient selection
Cardiothoracic CT: one-stop-shop procedure? Impact on the management of acute pulmonary embolism
In the treatment of pulmonary embolism (PE) two groups of patients are traditionally identified, namely the hemodynamically stable and instable groups. However, in the large group of normotensive patients with PE, there seems to be a subgroup of patients with an increased risk of an adverse outcome, which might benefit from more aggressive therapy than the current standard therapy with anticoagulants. Risk stratification is a commonly used method to define subgroups of patients with either a high or low risk of an adverse outcome. In this review the clinical parameters and biomarkers of myocardial injury and right ventricular dysfunction (RVD) that have been suggested to play an important role in the risk stratification of PE are described first. Secondly, the use of more direct imaging techniques like echocardiography and CT in the assessment of RVD are discussed, followed by a brief outline of new imaging techniques. Finally, two risk stratification models are proposed, combining the markers of RVD with cardiac biomarkers of ischemia to define whether patients should be admitted to the intensive care unit (ICU) and/or be given thrombolysis, admitted to the medical ward, or be safely treated at home with anticoagulant therapy
New Oral Anticoagulants for the Treatment of Venous Thromboembolism: Understanding Differences and Similarities
The diagnostic management of suspected pulmonary embolism
Pulmonary embolism is a potentially fatal disease in which early recognition and institution of anticoagulant treatment can prevent mortality. The diagnostic tools available to establish whether a patient has a pulmonary embolism were limited to pulmonary angiography and ventilation-perfusion scintigraphy. Both tests have considerable limitations. Helical CT evolved as a new technique in diagnosing PE and gained widespread interest but has been implemented rapidly, without appropriate assessment in clinical practice. The Christopher-study was performed to investigate whether a dichotomization of the Wells clinical decision rule, classifying patients into __PE unlikely__ and __PE likely__ in combination with a D-dimer test is safe to rule out pulmonary embolism in patients with a clinical suspicion. Furthermore, the study was designed to investigate whether helical CT is safe to rule out PE without performing any additional diagnostic tests. In patients in whom PE was excluded by a clinical decision rule indicating __PE unlikely__ combined with a negative D-dimer, during three months of follow-up venous thrombo-embolism was diagnosed in 5 out of 1028 untreated patients (0.5%, 95%CI: 0.2-1.1). In patients in whom CT had ruled out PE, during three months follow-up 18 of 1446 untreated patients experienced a venous thrombo-embolic event (1.3%, 95%CI: 0.7-2.0). In conclusion, the Christopher-study demonstrates that a simple diagnostic algorithm consisting of a dichotomised clinical decision rule, D-dimer and helical CT can guide treatment decisions with a low risk of subsequent venous thrombo-embolism
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