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1.
Br J Nurs ; 29(1): 22-26, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31917939

RESUMO

Pulmonary embolism (PE) is a condition characterised by an obstruction of the pulmonary arterial system by one or more emboli. Advanced clinical practitioners are often faced with ruling out a diagnosis of PE in patients with non-specific symptoms such as dyspnoea and pleuritic chest pain, which can be fairly mild and therefore a diagnosis of PE easily missed. PEs can be a challenge to diagnose, especially in elderly people, since it can be difficult to differentiate their symptoms from other less serious illnesses. Widely used scoring tools are helpful to calculate a patient's probability of having a PE. The Wells score is the most widely used pre-test clinical probability indicator of PE used in the UK, which scores the patient's probability of having a PE based on their risk factors. The D-dimer test is a relatively simple investigation to rule out venous thromboembolism (VTE) but can be raised for various reasons other than PE. Computed tomography pulmonary angiography (CTPA) is regarded as the gold standard imaging modality for investigation of acute PE but ventilation-perfusion (VQ) scans can be used as an alternative imaging technique for diagnosing PE in those where CTPA is contraindicated. Thrombolysis is underused in clinical practice due to the fear of adverse bleeding events. Patients without a massive or sub-massive PE are treated with anticoagulant therapy, usually commencing with subcutaneous low-molecular-weight heparin and switching over to a direct oral anticoagulant (DOAC). There has been a shift away from treatment with warfarin for the prevention and treatment of VTE over the past decade.


Assuntos
Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Humanos , Fatores de Risco
2.
Vasc Endovascular Surg ; 54(2): 135-140, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31769352

RESUMO

PURPOSE: Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis (USAT) appears to provide promising results for the management of acute submassive pulmonary embolisms (ASMPEs) at tertiary care centers. This study assessed outcome measures at a community-based hospital systems and compared results to known studies. MATERIALS AND METHODS: This is a single-center, retrospective study assessing clinical outcomes of the EkoSonic Endovascular System intervention for ASMPEs performed by three surgical 3 subspecialties (interventional radiology, interventional cardiology, and vascular surgery) part of a pulmonary embolism response team (PERT). We reviewed 146 PERT activations from June 2013 to December 2017. Eighty-three patients with ASMPEs underwent USAT. RESULTS: Our study showed greater differences (P = .01) between baseline and follow-up pulmonary artery systolic pressures (20.9 ± 9.8 mm Hg [n = 14]) compared to the ULTIMA study (12.3 ± 10 mm Hg [n = 30]). Our length-of-stay measures were shorter (6.1 ± 5.1 [n = 83]; P = .0001) compared to the SEATTLE II study (8.8 ± 5.0 [n = 150]). Preprocedure transthoracic echocardiograms (TTEs) were performed for 54 (65%) of 83 patients. Postprocedure TTEs at 48 hours was performed for 52 (62%) of 83 patients. Use of TTEs before and after intervention did not change outcomes. Intracranial hemorrhage was not observed in our patient population. There was no difference in outcomes between the three subspecialties in our study. CONCLUSIONS: Use of USAT in a community-based hospital PERT has similar outcomes to tertiary care centers. Furthermore, similar outcomes were observed between the three subspecialties suggesting development of a comprehensive care team for management of ASMPEs.


Assuntos
Cateterismo Periférico , Fibrinolíticos/administração & dosagem , Hospitais Comunitários , Embolia Pulmonar/terapia , Terapia Trombolítica/métodos , Terapia por Ultrassom , Doença Aguda , Adulto , Idoso , Cardiologistas , Cateterismo Periférico/efeitos adversos , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Intra-Arteriais , Masculino , Michigan , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/fisiopatologia , Radiologistas , Estudos Retrospectivos , Especialização , Cirurgiões , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Terapia por Ultrassom/efeitos adversos
3.
Tidsskr Nor Laegeforen ; 139(18)2019 Dec 10.
Artigo em Norueguês | MEDLINE | ID: mdl-31823570

RESUMO

BACKGROUND: Early discharge and home treatment for pulmonary embolism patients results in fewer hospital complications and may reduce treatment costs. We wished to investigate whether it is as safe and effective as hospital treatment, and if so, how best to select patients for home treatment. MATERIAL AND METHOD: We searched the databases Embase, Ovid MEDLINE, In-Process & Other Non-Indexed Citations and the Cochrane Library for clinical trials of acute, objectively verified pulmonary embolism, where outcomes for hospital treatment and home treatment were compared. RESULTS: For a selected group of patients with acute, symptomatic pulmonary embolism, home treatment is as safe and effective as hospital treatment. PESI (Pulmonary Embolism Severity Index) and Hestia criteria have the best documented clinical utility for selection of patients for home treatment. INTERPRETATION: The Hestia criteria represent a pragmatic approach to selection of patients who can be treated at home for pulmonary embolism, and they can be applied without taking other formal criteria into consideration.


Assuntos
Serviços de Assistência Domiciliar , Embolia Pulmonar , Doença Aguda , Assistência Ambulatorial , Humanos , Alta do Paciente , Embolia Pulmonar/terapia
4.
Medicine (Baltimore) ; 98(38): e17219, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567979

RESUMO

RATIONALE: Retained placenta accreta is an increasing obstetric problem in recent years, and pulmonary embolism (PE) during pregnancy and the postpartum period is a vital condition, but lack of standard therapy guidelines. This report describes a case of postpartum PE combined with retained placenta accreta. PATIENT CONCERNS: A 27-year-old woman presenting with fever and dyspnea after delivery was admitted to our hospital with retained placenta accreta. DIAGNOSES: The patient was diagnosed with the infection, postpartum PE, and residual placenta. INTERVENTIONS: The antibiotics and low molecular weight heparin were initially started to cure the infection and control PE. Mifepristone was then used to promote the necrosis of residual placenta while long-term use of warfarin was served as continuous anticoagulant therapy. Hysteroscopic resection of retained placenta was not performed until thrombi had been almost disappeared after more than 2 months of anticoagulation therapy. OUTCOMES: The patient's menstruation returned to normal within several weeks after hysteroscopic resection and she completely recovered from PE after 3 months of anticoagulant therapy. LESSONS: Treatment of retained placenta accreta can be postponed when encountering complicated cases, such as postpartum PE. PE in perinatal stage can be managed referring to nonmaternal PE.


Assuntos
Placenta Acreta/terapia , Placenta Retida/terapia , Período Pós-Parto , Embolia Pulmonar/terapia , Adulto , Feminino , Humanos , Placenta Acreta/diagnóstico , Placenta Retida/diagnóstico , Gravidez , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Tomografia Computadorizada por Raios X
5.
Dtsch Med Wochenschr ; 144(18): 1286-1300, 2019 09.
Artigo em Alemão | MEDLINE | ID: mdl-31514220

RESUMO

Pulmonary embolism (PE) is a life-threatening disease and the third most frequent cardiovascular cause of death after stroke and myocardial infarction. The annual incidence is increasing. The individual risk for PE-related complications and death increases with the number of comorbidities and severity of right ventricular dysfunction. Using clinical, laboratory and imaging parameters, patients with PE can be stratified to four risk classes (high, intermediate-high, intermediate-low and low risk). This risk stratification has concrete therapeutic consequences ranging from out-of-hospital treatment of low-risk patients to reperfusion treatment of (intermediate-) high-risk patients. For haemodynamically unstable patients, a treatment decision should preferable be made in interdisciplinary "Pulmonary Embolism Response Teams" (PERT). Being comparably efficient and due to a preferable safety profile compared to vitamin-K antagonists (VKAs), non-vitamin K-dependent oral anticoagulants (NOACs) are increasingly considered to be the treatment of choice for initial and prolonged anticoagulation of patients with pulmonary embolism. The use of low molecular weight heparins (LMWHs) is recommended for PE patients with cancer; however, recent studies indicate that treatment with factor Xa-inhibitors may be effective and safe (in patients without gastrointestinal cancer). Only prolonged anticoagulation (in reduced dosage) will ensure reduction of VTE recurrence and thus should be considered for all patients with unprovoked events.


Assuntos
Embolia Pulmonar , Administração Oral , Adolescente , Adulto , Idoso , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Criança , Alemanha , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Incidência , Pessoa de Meia-Idade , Neoplasias/complicações , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/terapia , Fatores de Risco , Adulto Jovem
6.
Vnitr Lek ; 65(7-8): 475-482, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31487990

RESUMO

INTRODUCTION: Acute pulmonary embolism, usually caused by thromboembolism is still a serious medical problem in spite of technical progress in diagnostics, as well as the enhancements in prophylactic and therapeutic options. AIM: The evaluation of characteristic, incidence, diagnostic, treatment and mortality rate of patients with pulmonary embolism hospitalized at the 1st Internal Clinic, University Hospital in Martin, within the years 1996-2017. METHODS: The authors offer retrospective analysis of 699 (359 men) patients with pulmonary embolism. Diagnosis was confirmed by angiography, perfusion scan or computed tomography. The data of patients were collected continuously and they are archived at the workplace of the authors. RESULTS: Patients with explicitly confirmed pulmonary embolism created 1.01 % of all hospitalized patients with average age 60.2. The average age of men was lower compared to women (56.6 vs 65.9). As high-risk pulmonary embolism presented 14.88 %, intermediate-risk 40.77 % and low-risk 44.34 % patients with pulmonary embolism. The source of pulmonary embolism was detected in 46.35 % and risk factors were detected in 52.79 % patients with pulmonary embolism. With thrombolytic therapy were treated 23.18 % of all patient with pulmonary embolism and intracranial bleeding occurred in 0.28 % of them. Early mortality rate was 7.58 % of all patients with pulmonary embolism. CONCLUSION: The authors detected increasing occurrence of patients with pulmonary embolism and from 2005 increasing occurrence of non-provoked pulmonary embolism. An average age in the patients with non-provoked pulmonary embolism compared to patients with provoked pulmonary was lower in men (53.5 vs 60.9) as well in women (56 vs 67.7). Patients with non-provoked pulmonary embolism compared to patients with provoked pulmonary were more frequent hospitalized because acute coronary syndrome (5.03 % vs 2.91 %) as well ischemic stroke (7.16 % vs 5.61 %) within one year after pulmonary embolism.


Assuntos
Embolia Pulmonar , Angiografia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Embolia Pulmonar/terapia , Estudos Retrospectivos , Fatores de Risco , Terapia Trombolítica
7.
Int Heart J ; 60(5): 1137-1141, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484878

RESUMO

Current therapeutic methods for chronic thromboembolic pulmonary hypertension (CTEPH) can improve hemodynamic status and are expected to improve prognoses. However, some patients experience dyspnea during effort and continue supplemental oxygenation despite their hemodynamic status being fully improved. Considering the pathogenesis of CTEPH, the dead space and intrapulmonary shunt are assumed to be responsible for hypoxia in CTEPH, but their contributions are unclear. It is also unclear whether they are improved after treatment. The aim of this study was to investigate the implications of the dead space ratio (DSR) and the intrapulmonary shunt ratio (ISR) for hypoxia in CTEPH and treatment for CTEPH.We retrospectively measured the DSR and ISR of 23 consecutive patients with CTEPH. For 11 of these 23 (10 were treated by balloon pulmonary angioplasty, one with riociguat), we also measured these parameters before and after CTEPH treatments. Overall, the DSR and ISR were abnormally elevated (DSR: 0.63 ± 0.06; ISR: 0.20 ± 0.05). After treatment, mean pulmonary artery pressure was improved (from 40.3 ± 8.1 to 25.5 ± 2.7 mmHg). Although atrial oxygen saturation (SaO2), DSR and ISR were improved (SaO2: from 90.2 ± 3.2 to 93.7 ± 1.8%; DSR: from 0.64 ± 0.06 to 0.58 ± 0.05; ISR: from 0.20 ± 0.04 to 0.18 ± 0.02), these improvements were slight compared with that of mean pulmonary artery pressure.The DSR and ISR were abnormally elevated in patients with CTEPH and their improvement by treatment was limited. Only DSR can be a useful marker for normalization of hypoxia in CTEPH.


Assuntos
Angioplastia com Balão/métodos , Hipertensão Pulmonar/terapia , Embolia Pulmonar/terapia , Pirazóis/uso terapêutico , Pirimidinas/uso terapêutico , Espaço Morto Respiratório/efeitos dos fármacos , Adulto , Idoso , Doença Crônica , Feminino , Hemodinâmica/fisiologia , Hospitais Universitários , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/mortalidade , Japão , Masculino , Pessoa de Meia-Idade , Oxigenoterapia/métodos , Prognóstico , Circulação Pulmonar/fisiologia , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/mortalidade , Espaço Morto Respiratório/fisiologia , Testes de Função Respiratória , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Taxa de Sobrevida , Resultado do Tratamento
9.
BMJ Case Rep ; 12(7)2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31340942

RESUMO

Right ventricular thrombus (RVT) can be life-threatening, since it has the potential to embolise and cause saddle pulmonary embolism (PE). We present a patient who initially presented with haemodynamically stable PE with evidence of RVT on echocardiogram. She was placed on heparin drip; however, she later developed cardiac arrest and died due to embolisation of RVT to the pulmonary vasculature. Although management of haemodynamically stable PE in patients with RVT is still a matter of debate, 1 given the outcome we suggest that thrombolysis or emergent embolectomy at the presentation, in this case, may have had a favourable outcome.


Assuntos
Tomada de Decisão Clínica , Parada Cardíaca/mortalidade , Embolia Pulmonar/terapia , Terapia Trombolítica/métodos , Trombose/diagnóstico por imagem , Trombose/terapia , Idoso de 80 Anos ou mais , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Progressão da Doença , Dispneia/diagnóstico , Dispneia/etiologia , Ecocardiografia/métodos , Embolectomia/métodos , Serviço Hospitalar de Emergência , Evolução Fatal , Feminino , Parada Cardíaca/etiologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Hemodinâmica/fisiologia , Heparina/uso terapêutico , Humanos , Embolia Pulmonar/diagnóstico por imagem
11.
Rev Med Chil ; 147(4): 426-436, 2019 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-31344203

RESUMO

BACKGROUND: Balloon pulmonary angioplasty (BPA) is a therapeutic alternative for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). AIM: To report the initial experience with the "refined BPA technique" with the use of intravascular images. PATIENTS AND METHODS: Between June 2015 and June 2016 we selected fourteen patients with CTEPH who were considered candidates for BPA. Lesions targeted for treatment were further analyzed using intravascular imaging with optical frequency domain imaging (OFDI). We report the immediate hemodynamic results and four weeks of follow-up of the first eight patients of this series. RESULTS: We performed 16 BPA in eight patients aged 61 ± 14 years (88% women). Mean pulmonary artery pressure (PAPm) was 48.6 ± 5.8 mmHg. Success was achieved in seven patients (88%). A mean of 2.3 segments per patient were intervened in 11 sessions (1.6 sessions/ patient). Only one patient developed lung reperfusion injury. No mortality was associated with the procedure. After the last BPA session, PAPm decreased to 37.4 ± 8.6 mmHg (p=0.02). Pulmonary vascular resistance (RVP) decreased from 858,6 ± 377,0 at baseline to 516,6 ± 323,3 Dynes/sec/cm-5 (p<0.01) and the cardiac index increased from 2.4±0.6 at baseline to 2.8±0.3 L/min/m2 (p=0.01). At 4 weeks after the last BPA, WHO functional class improved from 3.3±0.5 to 2.5±0.5 (p<0,01) and six minutes walking distance from 331±92 to 451±149 m (p=0.01). CONCLUSIONS: BPA guided by OFDI for the treatment of inoperable CTEPH patients is a safe alternative with excellent immediate hemodynamic and clinical results.


Assuntos
Angioplastia com Balão/métodos , Hipertensão Pulmonar/terapia , Embolia Pulmonar/terapia , Adulto , Idoso , Angiografia/métodos , Doença Crônica , Feminino , Hemodinâmica , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/fisiopatologia , Reprodutibilidade dos Testes , Fatores de Tempo , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento
12.
Medicine (Baltimore) ; 98(30): e16522, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348266

RESUMO

INTRODUCTION: Paradoxical embolism (PDE) refers to direct passage of venous thrombi into the arterial circulation through an arteriovenous shunt. It is well-known that the pulmonary thromboembolism (PTE) can cause opening of the foramen ovale leading to paradoxical arterial embolism. Long term follow up of PDE patient over 10 years was not reported in the literature. PATIENT CONCERNS: A 57-year-old woman presented with initial symptoms of numbness/weakness and hypoxemia. Ultrasonography and pulmonary arteriography indicated pulmonary thromboembolism. DIAGNOSIS: Pulmonary embolism and paradoxical multiple arterial embolism or acute PTE concomitant with paradoxical multiple arterial embolism. INTERVENTIONS: Craniectomy and anticoagulation treatment was administered and the patient received low-dose warfarin therapy for 10 years. OUTCOMES: The patient is currently stable with no abnormalities seen in the deep veins of the bilateral lower limbs. The international normalized ratio (INR) was controlled within the range of 1.20 to 1.51. As this is a 10-year follow-up case report, the patient has responded well to the treatment and has been followed-up. The follow-up has been annual and the patient has been stable CONCLUSION:: Low intensity and persistent anticoagulation therapy can inhibit blood thrombophilia and reduce the risk of bleeding. It is noteworthy that such an approach used effectively in this patient. To best our knowledge, it is first report for long term follow up PDE patient successfully over 10 years.


Assuntos
Embolia Paradoxal/etiologia , Forame Oval/irrigação sanguínea , Extremidade Inferior/irrigação sanguínea , Embolia Pulmonar/etiologia , Trombose Venosa/complicações , Anticoagulantes/uso terapêutico , Craniotomia/métodos , Embolia Paradoxal/terapia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Embolia Pulmonar/terapia , Resultado do Tratamento , Trombose Venosa/terapia
13.
BMJ ; 366: l4416, 2019 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-31358508

RESUMO

OBJECTIVES: To evaluate the association between experience in the management of acute pulmonary embolism, reflected by hospital case volume, and mortality. DESIGN: 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. SETTING: 353 hospitals in 16 countries. PARTICIPANTS: 39 257 consecutive patients with confirmed diagnosis of acute symptomatic pulmonary embolism. MAIN OUTCOME MEASURE: Pulmonary embolism related mortality within 30 days after diagnosis of the condition. RESULTS: Patients with acute symptomatic pulmonary embolism admitted to high volume hospitals (>40 pulmonary embolisms per year) had a higher burden of comorbidities. A significant inverse association was seen between annual hospital volume and pulmonary embolism related mortality. Admission to hospitals in the highest quarter (that is, >40 pulmonary embolisms per year) was associated with a 44% reduction in the adjusted odds of pulmonary embolism related mortality at 30 days compared with admission to hospitals in the lowest quarter (<15 pulmonary embolisms per year; adjusted risk 1.3% v 2.3%; adjusted odds ratio 0.56 (95% confidence interval 0.33 to 0.95); P=0.03). Results were consistent in all sensitivity analyses. All cause mortality at 30 days was not significantly reduced between the two quarters (adjusted odds ratio 0.78 (0.50 to 1.22); P=0.28). Survivors showed little change in the odds of recurrent venous thromboembolism (odds ratio 0.76 (0.49 to 1.19)) or major bleeding (1.07 (0.77 to 1.47)) between the low and high volume hospitals. CONCLUSIONS: In patients with acute symptomatic pulmonary embolism, admission to high volume hospitals was associated with significant reductions in adjusted pulmonary embolism related mortality at 30 days. These findings could have implications for management strategies.


Assuntos
Hemorragia/epidemiologia , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Embolia Pulmonar/mortalidade , Tromboembolia Venosa/epidemiologia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Internacionalidade , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/terapia , Recidiva , Sistema de Registros , Resultado do Tratamento
14.
Med J Aust ; 210(11): 516-524, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31155730

RESUMO

Diagnosis of deep vein thrombosis (DVT) requires a multifaceted approach that includes clinical assessment, evaluation of pre-test probability, and objective diagnostic testing. Common symptoms and signs of DVT are pain, swelling, erythema and dilated veins in the affected limb. The pre-test probability of DVT can be assessed using a clinical decision rule that stratifies DVT into "unlikely" or "likely". If DVT is "unlikely", refer for D-dimer test. If the D-dimer level is normal, DVT can be excluded; if the D-dimer level is increased, refer for compression ultrasound. If DVT is "likely", refer for compression ultrasound. When DVT is confirmed, anticoagulation is indicated to control symptoms, prevent progression and reduce the risk of post-thrombotic syndrome and pulmonary embolism. Anticoagulation may consist of a parenteral anticoagulant overlapped by warfarin or followed by a direct oral anticoagulant (DOAC) (dabigatran or edoxaban), or of a DOAC (apixaban or rivaroxaban) without initial parenteral therapy. DOACs are the preferred treatment for DVT because they are at least as effective, safer and more convenient than warfarin. DOACs may require dose reduction or avoidance in patients with renal dysfunction, and should be avoided in pregnancy. Recent evidence shows that DVT in patients with cancer may be treated with edoxaban (after discontinuation of 5 days of initial heparin or low molecular weight heparin [LMWH]) or rivaroxaban if patients prefer not to have daily injections of LMWH, but the risk of gastrointestinal bleeding is higher with DOACs than with LMWH in patients with gastrointestinal cancer.


Assuntos
Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Trombose Venosa/diagnóstico , Trombose Venosa/terapia , Administração Oral , Anticoagulantes/efeitos adversos , Progressão da Doença , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hemorragia Gastrointestinal/induzido quimicamente , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Neoplasias/complicações , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Trombose Venosa/sangue
16.
Heart Surg Forum ; 22(3): E180-E182, 2019 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-31237539

RESUMO

BACKGROUND: Cor biloculare, two-chambered heart due to the absence of atrial and ventricular septa, is a rare congenital heart anomaly. For Cor biloculare and other cardiac defects with single ventricle physiology, Glenn anastomosis has been developed as a palliative procedure. Thrombosis secondary to Glenn anastomosis in the patient with Cor biloculare could pose a serious threat to the survival, and has never been reported before. CASE REPORT: We report the case of a 27-year-old patient, with past history of Glenn anastomosis that was performed 7 years ago for the palliation of Cor biloculare. She presented with pulmonary embolism and ischemic stroke simultaneously at 7 days after Cesarean section. Due to her critical status, systemic anticoagulation with low-molecular-weight heparin was started immediately, followed by lifelong warfarin therapy. Pulmonary embolism regressed and neurological symptoms were considerably diminished after the anticoagulation treatment. CONCLUSION: This case illuminates the potential risk of thrombotic events in this patient cohort and demonstrates that anticoagulation therapy is an effective, secure, and appropriate for the management of this disease.


Assuntos
Isquemia Encefálica/etiologia , Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/cirurgia , Transtornos Puerperais/etiologia , Embolia Pulmonar/etiologia , Acidente Vascular Cerebral/etiologia , Adulto , Anticoagulantes/uso terapêutico , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/terapia , Cesárea , Feminino , Cardiopatias Congênitas/complicações , Humanos , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/terapia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia
17.
Clin Appl Thromb Hemost ; 25: 1076029619853037, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31185730

RESUMO

Pulmonary embolism (PE) is a life-threatening condition and a leading cause of morbidity and mortality. There have been many advances in the field of PE in the last few years, requiring a careful assessment of their impact on patient care. However, variations in recommendations by different clinical guidelines, as well as lack of robust clinical trials, make clinical decisions challenging. The Pulmonary Embolism Response Team Consortium is an international association created to advance the diagnosis, treatment, and outcomes of patients with PE. In this consensus practice document, we provide a comprehensive review of the diagnosis, treatment, and follow-up of acute PE, including both clinical data and consensus opinion to provide guidance for clinicians caring for these patients.


Assuntos
Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Doença Aguda , Consenso , Seguimentos , Humanos , Embolia Pulmonar/diagnóstico por imagem , Medição de Risco
19.
J Vasc Interv Radiol ; 30(6): 801-806, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31040058

RESUMO

PURPOSE: To evaluate changes in the use of catheter-directed therapy (CDT) for pulmonary embolism (PE) treatment with attention to primary operator specialty in the Medicare population. METHODS: Using a 5% national sample of Medicare claims data from 2004 to 2016, all claims associated with PE were identified. The annual volume of 2 billable CDT services-arterial mechanical thrombectomy and transcatheter arterial infusion for thrombolysis-were determined to evaluate changes in CDT use and primary CDT operator specialty over time. RESULTS: The total number of CDT procedures increased over the course of the study period, representing 0.457 and 5.057 service counts per 100,000 Medicare beneficiaries in 2004 and 2016, respectively. The proportion of PEs treated with CDT increased 10-fold from 2004 to 2016, increasing from 0.1% to 1.0%. Interventional radiologists performed most CDT therapies each year, with the exception of 2010 when vascular surgeons performed more. In 2016, interventional radiologists performed 3.54 CDT services for PE per 100,000 Medicare beneficiaries, which was 70% of total CDT for PE procedures, followed by interventional cardiologists and vascular surgeons performing 0.92 services (18%) and 0.60 services (12%), respectively. CONCLUSIONS: CDT is an increasingly used treatment for PE, with a 10-fold increase from 2004 to 2016. Interventional radiologists are the dominant providers of these services, followed by interventional cardiologists and vascular surgeons.


Assuntos
Cateterismo/tendências , Procedimentos Endovasculares/tendências , Medicare/tendências , Padrões de Prática Médica/tendências , Embolia Pulmonar/terapia , Radiologistas/tendências , Trombectomia/tendências , Terapia Trombolítica/tendências , Demandas Administrativas em Assistência à Saúde , Cardiologistas/tendências , Cateterismo/efeitos adversos , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Humanos , Embolia Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Cirurgiões/tendências , Trombectomia/efeitos adversos , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
20.
Int J Cardiovasc Imaging ; 35(8): 1509-1524, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31049753

RESUMO

Multi-energy computed tomography (MECT) refers to acquisition of CT data at multiple energy levels (typically two levels) using different technologies such as dual-source, dual-layer and rapid tube voltage switching. In addition to conventional/routine diagnostic images, MECT provides additional image sets including iodine maps, virtual non-contrast images, and virtual monoenergetic images. These image sets provide tissue/material characterization beyond what is possible with conventional CT. MECT provides invaluable additional information in the evaluation of pulmonary vasculature, primarily by the assessment of pulmonary perfusion. This functional information provided by the MECT is complementary to the morphological information from a conventional CT angiography. In this article, we review the technique and applications of MECT in the evaluation of pulmonary vasculature.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Hemodinâmica , Hipertensão Pulmonar/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Imagem de Perfusão/métodos , Artéria Pulmonar/diagnóstico por imagem , Circulação Pulmonar , Embolia Pulmonar/diagnóstico por imagem , Humanos , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/terapia , Valor Preditivo dos Testes , Prognóstico , Artéria Pulmonar/fisiopatologia , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/terapia , Interpretação de Imagem Radiográfica Assistida por Computador
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