Does Anticoagulant Treatment Reduce the Mortality of Acute Pulmonary Embolism?

2001 ◽  
Vol 161 (17) ◽  
pp. 2148-2148 ◽  
Author(s):  
D. K. Cundiff
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Anticoagulant Treatment

scholarly journals CURRENT VIEW ON ANTICOAGULANT AND THROMBOLYTIC TREATMENT OF ACUTE PULMONARY EMBOLISM

2019 ◽  
Vol 9 (5) ◽  
pp. 348-366
Author(s):  
G. G. Taradin ◽  
G. A. Ignatenko ◽  
N. T. Vatutin ◽  
I. V. Kanisheva
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Acute Pulmonary Embolism ◽  
Oral Anticoagulants ◽  
Medical Intervention ◽  
Bleeding Complications ◽  
Current View ◽  
Anticoagulant Treatment ◽  
Thrombolytic Treatment ◽  
Systemic Thrombolysis

The presented review concerns contemporary views on specific aspects of anticoagulant and thrombolytic treatment of venous thromboembolism and mostly of acute pulmonary embolism. Modern classifications of patients with acute pulmonary embolism, based on early mortality risk and severity of thromboembolic event, are reproduced. The importance of multidisciplinary approach to the management of patients with pulmonary embolism with the assistance of cardiologist, intensive care specialist, pulmonologist, thoracic and cardiovascular surgeon, aimed at the management of pulmonary embolism at all stages: from clinical suspicion to the selection and performing of any medical intervention, is emphasized. Anticoagulant treatment with the demonstration of results of major trials, devoted to efficacy and safety evaluation of anticoagulants, is highlighted in details. Moreover, characteristics, basic dosage and dosage scheme of direct (new) oral anticoagulants, including apixaban, rivaroxaban, dabigatran, edoxaban and betrixaban are described in the article. In particular, the management of patients with bleeding complications of anticoagulant treatment and its application in cancer patients, who often have venous thromboembolism, is described. Additionally, modern approaches to systemic thrombolysis with intravenous streptokinase, urokinase and tissue plasminogen activators are presented in this review. The indications, contraindications, results of clinical trials devoted to various regimens of thrombolytic therapy, including treatment of pulmonary embolism by lower doses of fibrinolytic agents, are described.

scholarly journals Quality of initial anticoagulant treatment and risk of CTEPH after acute pulmonary embolism

PLoS ONE ◽  
2020 ◽  
Vol 15 (4) ◽  
pp. e0232354 ◽  
Author(s):  
Gudula J. A. M. Boon ◽  
Nienke van Rein ◽  
Harm Jan Bogaard ◽  
Yvonne M. Ende-Verhaar ◽  
Menno V. Huisman ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Anticoagulant Treatment

Evolution of CT findings after anticoagulant treatment for acute pulmonary embolism in patients with and without an ultimate diagnosis of CTEPH

2021 ◽  
pp. 2100699
Author(s):  
Natalia J. Braams ◽  
Gudula J. A. M. Boon ◽  
Frances S. de Man ◽  
Josien van Es ◽  
Paul L. den Exter ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Arteries ◽  
Vascular Lesions ◽  
Anticoagulant Treatment ◽  
Thrombotic Occlusion ◽  
Pulmonary Arterial ◽  
Acute Pe ◽  
Over Time

IntroductionThe pulmonary arterial morphology of patients with pulmonary embolism (PE) is diverse and it is unclear how the different vascular lesions evolve after initiation of anticoagulant treatment. A better understanding of the evolution of CTPA findings after the start of anticoagulant treatment may help to better identify those PE patients prone to develop CTEPH. We aimed to assess the evolution of various thromboembolic lesions on CTPA over time after the initiation of adequate anticoagulant treatment in individual acute PE patients with and without an ultimate diagnosis of CTEPH.MethodsWe analysed the CTPA at diagnosis of acute PE (baseline) and at follow-up in 41 patients with CTEPH and 124 patients without an ultimate diagnosis of CTEPH, all receiving anticoagulant treatment. Central and segmental pulmonary arteries were scored by expert chest radiologists as normal or affected. Lesions were further sub-classified as: 1. central thrombus, 2. total thrombotic occlusion, 3. mural thrombus, 4. web or 5. tapered pulmonary artery.ResultsCentral thrombi resolved after anticoagulant treatment, while mural thrombi and total thrombotic occlusions either resolved or evolved into webs or tapered pulmonary arteries. Only patients with an ultimate diagnosis of CTEPH exhibited webs and tapered pulmonary arteries on the baseline scan. Moreover, such lesions always persisted after follow-up.ConclusionWebs and tapered pulmonary arteries at the time of PE diagnosis strongly indicate a state of chronic PE and should raise awareness for possible CTEPH, particularly in patients with persistent dyspnea after anticoagulant treatment for acute PE.

scholarly journals Acute pulmonary embolism following endoscopic sclerotherapy for gastroesophageal variceal hemorrhage: A case report and literature review

2019 ◽  
Vol 7 ◽  
pp. 2050313X1983894 ◽  
Author(s):  
Nuanrat Tangcheewinsirikul ◽  
Chusana Suankratay
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Acute Pulmonary Embolism ◽  
Alcoholic Cirrhosis ◽  
Final Diagnosis ◽  
Endoscopic Sclerotherapy ◽  
Variceal Hemorrhage ◽  
Anticoagulant Treatment ◽  
Progressive Dyspnea ◽  
The Right

Gastroesophageal variceal hemorrhage is a substantial cause of death in patients with portal hypertension. Cyanoacrylate injection is a widely used endoscopic treatment for variceal hemorrhage. We report herein the case of a 49-year-old male with decompensated alcoholic cirrhosis, who received endoscopic sclerotherapy to stop gastroesophageal variceal hemorrhage during hospitalization. The following day, he developed acute progressive dyspnea, and computed tomogram of pulmonary artery revealed acute pulmonary embolism at the right lower pulmonary artery. A final diagnosis of sclerotherapy-associated pulmonary embolism was made, and he gradually improved conservatively without anticoagulant treatment 2 weeks after hospitalization.

scholarly journals Acute treatment of venous thromboembolism

Blood ◽  
2020 ◽  
Vol 135 (5) ◽  
pp. 305-316 ◽  
Author(s):  
Cecilia Becattini ◽  
Giancarlo Agnelli
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Vitamin K ◽  
Acute Pulmonary Embolism ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Anticoagulant Treatment ◽  
Specific Patient ◽  
Long Term Outcome ◽  
Patient Disposition

Abstract All patients with venous thromboembolism (VTE) should receive anticoagulant treatment in the absence of absolute contraindications. Initial anticoagulant treatment is crucial for reducing mortality, preventing early recurrences, and improving long-term outcome. Treatment and patient disposition should be tailored to the severity of clinical presentation, to comorbidities, and to the potential to receive appropriate care in the outpatient setting. Direct oral anticoagulants (DOACs) used in fixed doses without laboratory monitoring are the agents of choice for the treatment of acute VTE in the majority of patients. In comparison with conventional anticoagulation (parenteral anticoagulants followed by vitamin K antagonists), these agents showed improved safety (relative risk [RR] of major bleeding, 0.61; 95% confidence interval [CI], 0.45-0.83) with a similar risk of recurrence (RR, 0.90; 95% CI, 0.77-1.06). Vitamin K antagonists or low molecular weight heparins are still alternatives to DOACs for the treatment of VTE in specific patient categories such as those with severe renal failure or antiphospholipid syndrome, or cancer, respectively. In addition to therapeutic anticoagulation, probably less than 10% of patients require reperfusion by thrombolysis or interventional treatments; those patients are hemodynamically unstable with acute pulmonary embolism, and a minority of them have proximal limb-threatening deep vein thrombosis (DVT). The choice of treatment should be driven by the combination of evidence from clinical trials and by local expertise. The majority of patients with acute DVT and a proportion of selected hemodynamically stable patients with acute pulmonary embolism can be safely managed as outpatients.

scholarly journals Correction: Quality of initial anticoagulant treatment and risk of CTEPH after acute pulmonary embolism

PLoS ONE ◽  
2020 ◽  
Vol 15 (6) ◽  
pp. e0234298
Author(s):  
Gudula J. A. M. Boon ◽  
Nienke van Rein ◽  
Harm Jan Bogaard ◽  
Yvonne M. Ende-Verhaar ◽  
Menno V. Huisman ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Anticoagulant Treatment

Differential effect of anticoagulant treatment on vascular morphology in patients with acute pulmonary embolism

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N.J Braams ◽  
G.J.A.M Boon ◽  
P.L Den Exter ◽  
L.J.M Kroft ◽  
L.F.M Beenen ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Arteries ◽  
Funding Source ◽  
Anticoagulant Treatment ◽  
Private Company ◽  
Total Occlusion ◽  
Almost All

Abstract Introduction Chronic thromboembolic pulmonary hypertension (CTEPH) is described as one of the most severe consequence of acute pulmonary embolism (APE). When signs of chronic PE are present on the CT pulmonary angiogram (CTPA) used to diagnose APE, the question arises whether there is underlying CTEPH. The relevance of chronic lesions, as well as the effect of anticoagulant treatment on their development is currently unknown. Purpose To investigate the effect of anticoagulant treatment on CTPA derived vascular morphological abnormalities in patients with APE. Methods We performed a case-cohort study. As cases, we selected CTEPH patients who had a prior history of a first APE episode. As cohort, we selected patients who had a follow-up CTPA performed 6 months after first episode APE in the context of a clinical trial (den Exter 2015). A baseline (i.e. at moment of APE diagnosis) CTPA and a follow-up CTPA was available for all patients. Experienced chest radiologists morphologically assessed 20 segmental pulmonary arteries per patient as “normal” or “affected” (as defined by a total occlusion by thrombus, central thrombus, mural thrombus, web or tapered pulmonary artery). Pulmonary segmental vessels of the entire cohort were merged for the analysis. All patients were treated adequately with anticoagulant treatment (vitamin K antagonists, direct oral anticoagulation or low molecular weight heparin) in the period between baseline and follow-up CTPA according to current guidelines. Results A total of 30 cases and 116 controls were included. Mean time between baseline and follow-up CTPA was 193 (62) days. At baseline CTPA, 1647 (56%) of the 2920 pulmonary segmental vessels were scored as affected. Almost all central thrombi resolved after oral anticoagulant treatment (1103/1191=93%). Webs (n=85) and tapered pulmonary arteries (n=57) did not change in morphology at follow-up (Figure 1). Most vessels containing a total occlusion by a thrombus at baseline resolved completely (156/280=56%), changed to a tapered pulmonary artery (26%) or became a web (7%). Mural thrombi either remained unchanged (16/34=47%), resolved completely (29%) or became a web (24%). Conclusion After anticoagulant treatment for APE almost all central thrombi completely resolved, whereas mural thrombi or total occlusions by thrombi either resolved or transformed to a web or tapered pulmonary artery. Interestingly, none of the webs and tapered pulmonary arteries resolved after anticoagulant treatment. Therefore, webs and tapered pulmonary arteries at the moment of APE diagnosis indicate a chronic PE state. Figure 1. Web at baseline and follow-up Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Research grant from Actelion Pharmaceuticals

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