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1.
Ann Vasc Surg ; 70: 282-285, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32891745

RESUMO

There is mounting evidence that COVID-19 patients may possess a hypercoagulable profile that increases their risk for thromboembolic complications, including pulmonary embolism (PE). PE has been associated with an increase in morbidity, mortality, prolonged ventilation, and extended ICU admissions. Intervention is warranted in some patients who develop acute massive and submassive PEs. However, the development of PE in COVID-19 patients is often complicated by such factors as delay of diagnosis, confounding medical conditions, and strict isolation precautions. In addition, depleted cardiopulmonary reserve and prone positioning can make management of PE in these patients especially challenging for the physician. In this article, we review current understanding of PE in COVID-19 patients, summarize consensus data regarding the treatment of PE, and propose an algorithm to guide the management of COVID-19 patients with PE.


Assuntos
Algoritmos , Coagulação Sanguínea , Procedimentos Clínicos , Técnicas de Apoio para a Decisão , Embolia Pulmonar/terapia , /patogenicidade , /diagnóstico , /virologia , Tomada de Decisão Clínica , Consenso , Interações Hospedeiro-Patógeno , Humanos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/virologia
2.
Medicina (Kaunas) ; 56(12)2020 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-33287199

RESUMO

Pulmonary embolism (PE) is a commonly encountered clinical entity in patients with coronavirus disease 2019 (COVID-19). Up to 1/3 of patients have been found to have PE in the setting of COVID-19. Given the novelty of the virus causing this pandemic, it has not been easy to address diagnostic and management issues in PE. Ongoing research and publications of the scientific literature have helped in dealing with COVID-19 lately and this applies to PE as well. In this article, we attempt to succinctly yet comprehensively discuss PE in patients with COVID-19 with a review of the prevailing literature.


Assuntos
/sangue , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Trombofilia/sangue , Anticoagulantes/uso terapêutico , Angiografia por Tomografia Computadorizada , Gerenciamento Clínico , Coagulação Intravascular Disseminada/sangue , Ecocardiografia , Oxigenação por Membrana Extracorpórea , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Fibrinogênio/metabolismo , Humanos , Extremidade Inferior/diagnóstico por imagem , Tempo de Tromboplastina Parcial , Contagem de Plaquetas , Sistemas Automatizados de Assistência Junto ao Leito , Tempo de Protrombina , Embolia Pulmonar/sangue , Embolia Pulmonar/etiologia , Terapia Trombolítica , Trombofilia/complicações , Ultrassonografia Doppler Dupla , Trombose Venosa/diagnóstico por imagem , Cintilografia de Ventilação/Perfusão
3.
Vnitr Lek ; 66(6): 386-390, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33380145

RESUMO

The new guidelines on the diagnosis and management of pulmonary embolism developed in collaboration with the European Respiratory Society were presented on the congress od European society of cardiology in 2019. Are internists concerned, when these guidelines were presented at the congress of cardiologic society? Management of acute pulmonary embolism is less „cathlab dependent“than management of acute coronary syndromes - and pulmonary embolism patients are often treated by internists. Moreover, differential diagnosis of dyspnoea is a everyday problem solved by internists. What is new in the updated guidelines? Refinements in interpretation of Ddimer testing will help us to avoid unnecessary pulmonary angiograms. Nonvitamin K antagonist oral anticoagulants (NOACs) are now the preferred agents for treating the majority of patients with PE, both in the acute phase and over the long term, including selected patients with malignancy. Further important updates include recurrence scores and guidance on extended anticoagulation after PE. A new comprehensive algorithm is proposed for patient followup after acute PE to prevent, detect and treat late sequelae of venous thromboembolism.


Assuntos
Embolia Pulmonar , Tromboembolia Venosa , Administração Oral , Anticoagulantes/uso terapêutico , Coagulação Sanguínea , Humanos , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/terapia , Tromboembolia Venosa/tratamento farmacológico
4.
Rev Med Suisse ; 16(718): 2362-2366, 2020 Dec 09.
Artigo em Francês | MEDLINE | ID: mdl-33300694

RESUMO

The latest recommendations from the European Society of Cardiology (ESC) on the diagnostic and therapeutic management of pulmonary embolism (PE) published this year provide an important update compared to the 2014 version. In terms of diagnosis, the use of the age-adjusted D-dimer cutoff is currently suggested, and a diagnostic algorithm for suspected PE during pregnancy is proposed. Detailed recommendations are provided for the initial orientation of patients with acute PE based on prognostic stratification criteria, as well as for clinical follow-up after PE. Finally, direct oral anticoagulants are included as therapeutic options for the treatment of cancer-associated thrombosis.


Assuntos
Cardiologia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Doença Aguda , Administração Oral , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Humanos , Guias de Prática Clínica como Assunto , Prognóstico
5.
BMJ Case Rep ; 13(11)2020 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-33257399

RESUMO

We report an unusual complication of COVID-19 infection in a 53-year-old Caucasian man. He presented with shortness of breath, fever and pleuritic chest pain. A CT pulmonary angiogram (CTPA) demonstrated acute bilateral pulmonary embolism and bilateral multifocal parenchymal ground glass change consistent with COVID-19 (SARS-CoV-2) infection. Right adrenal haemorrhage was suspected on the CTPA which was confirmed on triple-phase abdominal CT imaging. A short Synacthen test revealed normal adrenal function. He was treated initially with an intravenous heparin infusion, which was changed to apixaban with a planned outpatient review in 3 months' time. He made an uncomplicated recovery and was discharged. Follow-up imaging nearly 5 months later showed near complete resolution of the right adrenal haemorrhage with no CT evidence of an underlying adrenal lesion.


Assuntos
Doenças das Glândulas Suprarrenais , Glândulas Suprarrenais/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Hemorragia , Heparina/administração & dosagem , Embolia Pulmonar , Pirazóis/administração & dosagem , Piridonas/administração & dosagem , Testes de Função do Córtex Suprarrenal/métodos , Doenças das Glândulas Suprarrenais/diagnóstico , Doenças das Glândulas Suprarrenais/etiologia , Neoplasias das Glândulas Suprarrenais/diagnóstico , Antitrombinas/administração & dosagem , /diagnóstico , /terapia , Deterioração Clínica , Diagnóstico Diferencial , Hemorragia/diagnóstico , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/terapia , /patogenicidade , Resultado do Tratamento
6.
Tuberk Toraks ; 68(3): 342-345, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33295734

RESUMO

The whole world has been facing the pandemic of SARS-CoV-2 infection and every day we still find out new knowledge regarding the disease. COVID-19 which is the name given to the clinical syndrome related to this infection has been shown to own a wide diversity of clinical presentations which challenges the healthcare workers and makes difficult the diagnosis and management of patients. Pulmonary embolism is also an entity that accompanies this type of infection and sometimes it is difficult to differentiate between the two. Here we present a patient who was admitted inward with typical lesions on chest tomography for COVID-19, but that turned out to be a submassive pulmonary embolism case without any infection. This case is remarkable because it shows that patients suspected for COVID-19 should be carefully examined and that pulmonary embolism can per se mimick the parenchymal lesions caused by viral infections.


Assuntos
Embolia Pulmonar/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Embolia Pulmonar/terapia
7.
Chest ; 158(6): e269-e271, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33280767

RESUMO

There is growing evidence that coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state. To date, all patients reported with venous thromboembolic disease and COVID-19 have shown evidence of viral pneumonia. Here, we report the case of a 31-year-old patient with unexplained extensive DVT and bilateral pulmonary embolism in the absence of COVID-19 pneumonia, leading to the diagnosis of otherwise asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In the context of the COVID-19 pandemic, given the high rates of otherwise asymptomatic patients, testing for SARS-CoV-2 should be performed in all patients with unexplained VTE occurring in COVID-19-endemic areas, even in the absence of other disease manifestations suggestive of SARS-CoV-2 infection.


Assuntos
/complicações , Embolia Pulmonar/virologia , Trombose Venosa/virologia , Adulto , Humanos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Trombose Venosa/diagnóstico , Trombose Venosa/terapia
8.
J Vasc Interv Radiol ; 31(12): 2052-2059, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33183975

RESUMO

PURPOSE: To compare effectiveness and safety of large-bore aspiration thrombectomy (LBAT) with catheter-directed thrombolysis (CDT) for treatment of acute massive and submassive pulmonary embolism (PE). MATERIALS AND METHODS: This retrospective review included patients with acute PE treated with LBAT or CDT using tissue plasminogen activator (tPA) between December 2009 and May 2020. A propensity score based on Pulmonary Embolism Severity Index class and PE severity (massive vs submassive) was calculated, and 26 LBAT cases (age 60.2 y ± 17.1, 14/26 women) were matched with 26 CDT cases (age 59.7 y ± 14.2, 14/26 women). RESULTS: The CDT group had 22.1 mg ± 8.1 tPA infused over 21.2 h ± 6.6. Both groups demonstrated similar initial and final systolic pulmonary artery pressure (PAP) (LBAT: 54.5 mm Hg ± 12.9 vs CDT: 54.5 mm Hg ± 16.3, P = .8, and LBAT: 42.5 mm Hg ± 14.1 vs CDT: 42.6 mm Hg ± 12.1, P = .8, respectively) and similar reductions in heart rate (LBAT: -5.4 beats/min ± 19.2 vs CDT: -9.6 beats/min ± 15.8, P = .4). CDT demonstrated a higher reduction in Miller score (-10.1 ± 3.9 vs -7.5 ± 3.8, P = .02). LBAT resulted in 1 minor hemorrhagic complication and 2 procedure-related mortalities, and CDT resulted in 1 minor and 1 major hemorrhagic complication. CONCLUSIONS: LBAT and CDT resulted in similar reductions of PAP and heart rate when used to treat acute PE. CDT reduced thrombus burden to a greater degree. Although hemorrhagic complications rates were not significantly different, the LBAT group demonstrated a higher rate of procedure-related mortality. Larger studies are needed to compare the safety of these techniques.


Assuntos
Fibrinolíticos/administração & dosagem , Embolia Pulmonar/terapia , Trombectomia , Terapia Trombolítica , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Pesquisa Comparativa da Efetividade , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/mortalidade , Embolia Pulmonar/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sucção , Trombectomia/efeitos adversos , Trombectomia/mortalidade , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/mortalidade , Fatores de Tempo , Resultado do Tratamento
9.
Vasc Health Risk Manag ; 16: 463-466, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33244235

RESUMO

SARS-CoV-2 infection is predominantly a respiratory disease with a diverse clinical spectrum. Pulmonary thromboembolic complications during COVID-19 pneumonia may be associated with a high mortality rate and post-mortem findings confirm the presence of platelet-fibrin thrombi in arterial vessels of patients together with lung tissue alterations. We present a patient transferred to the emergency department due to a syncope with no other associated symptoms, who was diagnosed with an acute pulmonary embolism (PE) concomitant with SARS-CoV-2 infection without lung infiltrates. Presenting with a PE as the only manifestation of this infection, reinforces our conception of COVID-19 as a heterogeneous disease of which we still know very little. We believe that while the virus is still circulating in our environment, we need to consider ruling out COVID-19 in all thrombotic events, even if the patients have no other risk factors.


Assuntos
/complicações , Distrofia Miotônica/complicações , Embolia Pulmonar/etiologia , /diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Distrofia Miotônica/diagnóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Síncope/etiologia , Resultado do Tratamento
10.
J Med Case Rep ; 14(1): 188, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33054805

RESUMO

BACKGROUND: Currently, there is minimal data available highlighting the prevalence of venous thromboembolism in patients infected with coronavirus disease 2019 (COVID-19). This case report with a literature review emphasizes a unique presentation of COVID-19 that is highly important for health care providers to consider when treating their patients. CASE REPORT: A 65-year-old Caucasian male patient presented to the emergency department with a 2-day history of dyspnea on exertion after his wife's recent diagnosis of COVID-19. He additionally had experienced a couple of episodes of self-resolving diarrhea a few days before presentation. Based on the patient's clinical presentation and the laboratory workup identifying an elevated D-dimer, a computed tomography angiogram of the chest was obtained, which was significant for moderately large, bilateral pulmonary emboli with a saddle embolus, and an associated small, left lower lobe, pulmonary infarct. Ultrasound of the lower extremity showed non-occlusive deep vein thrombosis at the distal left femoral vein to the left popliteal vein. The patient was additionally diagnosed with COVID-19 when the results of the COVID-19 polymerase chain reaction test returned as positive. The patient was admitted to the COVID unit, and he was started on an intravenously administered, unfractionated heparin drip for management of his bilateral pulmonary emboli and deep vein thrombosis. The patient's clinical condition improved significantly with anticoagulation, and he was observed in the hospital for 3 days, after which he was discharged home on the enoxaparin bridge with warfarin. Post-discharge telephone calls at day 10 and week 4 revealed that the patient was appropriately responding to anticoagulation treatment and had no recurrence of his symptoms related to venous thromboembolism and COVID-19. CONCLUSION: As COVID-19 continues to lead to significant mortality, more data is emerging that is exposing its perplexing pathogenicity. Meanwhile, the presentation of venous thromboembolism in patients with COVID-19 remains an unusual finding. It is imperative for health care providers to be mindful of this unique association to make necessary diagnostic evaluations and provide appropriate treatment for the patients.


Assuntos
Infecções por Coronavirus , Enoxaparina/administração & dosagem , Veia Femoral/diagnóstico por imagem , Heparina/administração & dosagem , Pandemias , Pneumonia Viral , Embolia Pulmonar , Tromboembolia Venosa , Varfarina/administração & dosagem , Idoso , Anticoagulantes/administração & dosagem , Betacoronavirus/isolamento & purificação , Angiografia por Tomografia Computadorizada/métodos , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hospitalização , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Embolia Pulmonar/terapia , Resultado do Tratamento , Ultrassonografia/métodos , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/terapia
13.
Anesth Analg ; 131(5): 1324-1333, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079850

RESUMO

Patients with coronavirus disease 2019 (COVID-19) frequently experience a coagulopathy associated with a high incidence of thrombotic events leading to poor outcomes. Here, biomarkers of coagulation (such as D-dimer, fibrinogen, platelet count), inflammation (such as interleukin-6), and immunity (such as lymphocyte count) as well as clinical scoring systems (such as sequential organ failure assessment [SOFA], International Society on Thrombosis and Hemostasis disseminated intravascular coagulation [ISTH DIC], and sepsis-induced coagulopathy [SIC] score) can be helpful in predicting clinical course, need for hospital resources (such as intensive care unit [ICU] beds, intubation and ventilator therapy, and extracorporeal membrane oxygenation [ECMO]) and patient's outcome in patients with COVID-19. However, therapeutic options are actually limited to unspecific supportive therapy. Whether viscoelastic testing can provide additional value in predicting clinical course, need for hospital resources and patient's outcome or in guiding anticoagulation in COVID-19-associated coagulopathy is still incompletely understood and currently under investigation (eg, in the rotational thromboelastometry analysis and standard coagulation tests in hospitalized patients with COVID-19 [ROHOCO] study). This article summarizes what we know already about COVID-19-associated coagulopathy and-perhaps even more importantly-characterizes important knowledge gaps.


Assuntos
Anti-Inflamatórios/uso terapêutico , Anticoagulantes/uso terapêutico , Betacoronavirus/patogenicidade , Coagulação Sanguínea/efeitos dos fármacos , Infecções por Coronavirus/terapia , Inflamação/terapia , Pneumonia Viral/terapia , Embolia Pulmonar/terapia , Tromboembolia Venosa/terapia , Trombose Venosa/terapia , Anti-Inflamatórios/efeitos adversos , Anticoagulantes/efeitos adversos , Biomarcadores/sangue , Infecções por Coronavirus/sangue , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Medicina Baseada em Evidências , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Mortalidade Hospitalar , Interações Hospedeiro-Patógeno , Humanos , Inflamação/sangue , Inflamação/mortalidade , Inflamação/virologia , Mediadores da Inflamação/sangue , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Prognóstico , Embolia Pulmonar/sangue , Embolia Pulmonar/mortalidade , Embolia Pulmonar/virologia , Fatores de Risco , Tromboembolia Venosa/sangue , Tromboembolia Venosa/mortalidade , Tromboembolia Venosa/virologia , Trombose Venosa/sangue , Trombose Venosa/mortalidade , Trombose Venosa/virologia
15.
J Cardiothorac Surg ; 15(1): 295, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008478

RESUMO

BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly being utilized in patients with massive pulmonary embolism (PE). However, the efficacy and the safety remain uncertain. This study aimed to investigate clinical courses and outcomes in ECMO-treated patients with acute PE. METHODS: Twenty-one patients with acute PE rescued by ECMO from January 2012 to December 2019 were retrospectively analysed. Clinical features, laboratory biomarkers, and imaging findings of these patients were reviewed, and the relationship with immediate outcome and clinical course was investigated. RESULTS: Sixteen patients (76.2%) experienced refractory circulatory collapse requiring cardiopulmonary resuscitation (CPR) or ECMO support within 2 h after the onset of cardiogenic shock, and none could receive definitive reperfusion therapy before ECMO initiation. Before or during ECMO support, more than 90% of patients had imaging signs of right ventricular (RV) dysfunction. In normotension patients, the computed tomography (CT) value was a valuable predictor of rapid disease progression compared with cardiac troponin I level. Ultimately, in-hospital death occurred in ten patients (47.6%) and 90% of them died of prolonged CPR-related brain death. Cardiac arrest was a significant predictor of poor prognosis (p = 0.001). CONCLUSIONS: ECMO appears to be a safe and effective circulatory support in patients with massive PE. Close monitoring in intensive care unit is recommended in patients with RV dysfunction and aggressive use of ECMO may reduce the risk of sudden cardiac arrest and improve clinical outcome.


Assuntos
Oxigenação por Membrana Extracorpórea , Embolia Pulmonar/terapia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Morte Encefálica , Reanimação Cardiopulmonar , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Reperfusão , Estudos Retrospectivos , Choque Cardiogênico/terapia , Tomografia Computadorizada por Raios X , Disfunção Ventricular Direita/etiologia
17.
J Vasc Interv Radiol ; 31(11): 1817-1824, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33008719

RESUMO

PURPOSE: To prospectively evaluate the initial human experience with an absorbable vena cava filter designed for transient protection from pulmonary embolism (PE). MATERIALS AND METHODS: This was a prospective, single-arm, first-in-human study of 8 patients with elevated risk of venous thromboembolism (VTE). Seven absorbable IVC filters (made of polydioxanone that breaks down into H2O and CO2 in 6 mo) were placed prophylactically before orthopedic (n = 5) and gynecologic (n = 2) surgeries, and 1 was placed in a case of deep vein thrombosis. Subjects underwent CT cavography and abdominal radiography before and 5, 11, and 36 weeks after filter placement to assess filter migration, embolization, perforation, and caval thrombosis and/or stenosis. Potential PE was assessed immediately before and 5 weeks after filter placement by pulmonary CT angiography. RESULTS: No symptomatic PE was reported throughout the study or detected at the planned 5-week follow-up. No filter migration was detected based on the fixed location of the radiopaque markers (attached to the stent section of the filter) relative to the vertebral bodies. No filter embolization or caval perforation was detected, and no caval stenosis was observed. Throughout the study, no filter-related adverse events were reported. CONCLUSIONS: Implantation of an absorbable vena cava filter in a limited number of human subjects resulted in 100% clinical success. One planned deployment was aborted as a result of stenotic pelvic veins, resulting in 89% technical success. No PE or filter-related adverse events were observed.


Assuntos
Implantes Absorvíveis , Polidioxanona/química , Implantação de Prótese/instrumentação , Embolia Pulmonar/terapia , Filtros de Veia Cava , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
19.
Arterioscler Thromb Vasc Biol ; 40(11): 2586-2597, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32960072

RESUMO

The severe acute respiratory syndrome coronavirus-2 emerged as a serious human pathogen in late 2019, causing the disease coronavirus disease 2019 (COVID-19). The most common clinical presentation of severe COVID-19 is acute respiratory failure consistent with the acute respiratory distress syndrome. Airway, lung parenchymal, pulmonary vascular, and respiratory neuromuscular disorders all feature in COVID-19. This article reviews what is known about the effects of severe acute respiratory syndrome coronavirus-2 infection on different parts of the respiratory system, clues to understanding the underlying biology of respiratory disease, and highlights current and future translation and clinical research questions.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/virologia , Pulmão/virologia , Pneumonia Viral/virologia , Respiração , Insuficiência Respiratória/virologia , Pesquisa Médica Translacional , Animais , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Interações Hospedeiro-Patógeno , Humanos , Pulmão/fisiopatologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Prognóstico , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/terapia , Embolia Pulmonar/virologia , Respiração Artificial , /fisiopatologia , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapia , Fatores de Risco , Tromboembolia Venosa/fisiopatologia , Tromboembolia Venosa/terapia , Tromboembolia Venosa/virologia
20.
Rev Med Suisse ; 16(705): 1626-1633, 2020 Sep 09.
Artigo em Francês | MEDLINE | ID: mdl-32914594

RESUMO

Intermediate-risk pulmonary embolism (PE) is usually defined as PE associated with right ventricular dysfunction (echocardiographic, radiological and/or biological) without hemodynamic instability. It is associated with significant mortality, and its management is challenging for the clinician due to its variable clinical presentation. In its recent recommendations, the European Society of Cardiology proposes to differentiate high intermediate risk from low intermediate risk, based on clinical, biological and radiological criteria. The management strategy differs for these two categories, particularly about the need for monitored surveillance. Beyond therapeutic anticoagulation, which remains the first-line treatment in intermediate-risk PE, other therapeutic modalities can be considered, and will be discussed.


Assuntos
Embolia Pulmonar/terapia , Cardiologia , Ecocardiografia , Humanos , Embolia Pulmonar/complicações , Medição de Risco , Disfunção Ventricular Direita/complicações , Disfunção Ventricular Direita/terapia
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