THE CLOT THICKENS: AN OBSERVATIONAL RETROSPECTIVE ANALYSIS OF STANDARD OF CARE VS CATHETER-DIRECTED THERAPY FOR SADDLE PULMONARY EMBOLISM

Introduction: Venous thromboembolism is a burden on healthcare systems. The aim of this analysis was to project the long-term costs and outcomes for rivaroxaban compared to standard of care (enoxaparin/warfarin) in Portugal for the treatment and secondary prevention of venous thromboembolism. Material and Methods: A Markov model was developed using event rates extracted from the EINSTEIN trials supplemented with literature-based estimates of longer-term outcomes. Core outcomes included per patient costs and quality-adjusted life years reported separately per treatment arm and incrementally, as well as cost per quality-adjusted life years gained. The deep vein thrombosis and pulmonary embolism indications were analysed separately. The analyses were conducted from the Portuguese societal perspective and over a 5-year time horizon. Costs and outcomes were discounted at a 5% annual rate. Several scenario analyses were undertaken to explore the impact on results of varying key modeling assumptions. Results: Rivaroxaban treatment was associated with cost-savings for the treatment of deep vein thrombosis and was both cost-saving and more effective for the treatment of pulmonary embolism, compared with enoxaparin/warfarin. Discussion: The results of the sensitivity and scenario analyses further supported that rivaroxaban is a cost-effective alternative to standard of care treatment. The use of an expert panel to derive some input values and the lack of Portuguese specific utilities were the main limitations. Conclusion: Rivaroxaban represents an efficient alternative to using enoxaparin/warfarin in Portugal, as it’s associated with lower costs (for both indications) and greater quality adjusted life years (for the pulmonary embolism indication). Keywords: Venous Thrombosis; Pulmonary Embolism; Rivaroxaban; Venous Thromboembolism.

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A Retrospective Analysis on the Use of Age-Adjusted D-Dimer Cutoff Values in Ruling out Pulmonary Embolism at Montefiore Hospital

American Journal of Clinical Pathology ◽

10.1093/ajcp/142.suppl1.023 ◽

2014 ◽

Vol 142 (suppl_1) ◽

pp. A023-A023

Author(s):

James Szymanski ◽

Lucy Wolgast ◽

Jacob Rand

Keyword(s):

Pulmonary Embolism ◽

Retrospective Analysis ◽

Cutoff Values ◽

D Dimer

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DIFFICULTIES AND PECULIARITIES OF EARLY DIAGNOSTICS OF PULMONARY EMBOLISM

EMERGENCY MEDICAL CARE ◽

10.24884/2072-6716-2018-19-1- ◽

2018 ◽

Vol 19 (1) ◽

pp. 25-30

Author(s):

O. M. Urysiev ◽

S. V. Aksentiev ◽

A. V. Solovieva ◽

A. V. Cheskidov

Keyword(s):

Pulmonary Embolism ◽

Pulmonary Artery ◽

Retrospective Analysis ◽

Arterial Hypotension ◽

Early Diagnostics ◽

Lethal Outcome ◽

White Syndrome ◽

Revised Geneva Score ◽

Clinical Records

The retrospective analysis of 22 patients’ clinical records with the verified pulmonary artery thromboembolism (PE) with various outcomes of a disease is carried out. Hypodiagnostics of PE at a pre-hospital stage is revealed, the predictive importance of Revised Geneva Score scale is shown, predictors of a lethal outcome at a PE are defined: arterial hypotension, tachycardia, McGinn-White syndrome (SI-QIII phenomenon).

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Management of pulmonary embolism in patients with cancer

ESC CardioMed ◽

10.1093/med/9780198784906.003.0666 ◽

2018 ◽

pp. 2790-2794

Author(s):

Cihan Ay ◽

Florian Posch

Keyword(s):

Pulmonary Embolism ◽

Vitamin K ◽

Meta Analysis ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Standard Of Care ◽

Current Standard ◽

Patients With Cancer ◽

High Index Of Suspicion ◽

Excessive Anticoagulation

Pulmonary embolism (PE) is a frequent complication in patients with cancer. Clinicians have to maintain a high index of suspicion to reduce the large proportion of PEs that remain undiagnosed in the cancer population. Thrombolysis is not a standard treatment for haemodynamically unstable patients with cancer-associated PE because the risk of haemorrhage can be excessive. Anticoagulation with a low-molecular-weight heparin (LMWH) for at least 6 months is the current standard of care for the treatment of cancer-associated PE, while vitamin K antagonists are a reasonable second choice for patients with contraindications against LMWH or a strong preference towards an oral agent. Although an indirect network meta-analysis suggests that non-vitamin K-dependent oral anticoagulants may be comparably efficacious and safe as LMWH for treating PE in cancer patients, these agents cannot be recommended as a standard first-line treatment at this time because a head-to-head comparison to the standard of care has not yet been reported. Anticoagulation beyond 6 months is an emerging concept; however, the patient population that may benefit from this intervention still needs to be defined. Guidance statements facilitate the management of challenging patients with brain metastases, unsuspected PE, thrombocytopenia, and recurrent PE.

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Usefulness of CT Abdomen and Pelvis to Exclude Malignancy in Patients with Pulmonary Embolism (PE) Diagnosed on CTPA: A Retrospective Analysis

10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a6583 ◽

2020 ◽

Author(s):

A.B. Afzal ◽

K. Heyes ◽

S. Baksi ◽

S. Khalid

Keyword(s):

Pulmonary Embolism ◽

Retrospective Analysis

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Comparison of hydroxychloroquine, lopinavir/ritonavir, and standard of care in critically ill patients with SARS-CoV-2 pneumonia: an opportunistic retrospective analysis

Critical Care ◽

10.1186/s13054-020-03117-9 ◽

2020 ◽

Vol 24 (1) ◽

Cited By ~ 15

Author(s):

Marie Lecronier ◽

Alexandra Beurton ◽

Sonia Burrel ◽

Luc Haudebourg ◽

Robin Deleris ◽

...

Keyword(s):

Retrospective Analysis ◽

Critically Ill ◽

Critically Ill Patients ◽

Standard Of Care

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Asymptomatic venous thrombosis in cancer patients – a problem often overlooked. Results of a retrospective and prospective study

VASA ◽

10.1024/0301-1526.38.2.160 ◽

2009 ◽

Vol 38 (2) ◽

pp. 160-166 ◽

Cited By ~ 17

Author(s):

Heidrich ◽

Konau ◽

Hesse

Keyword(s):

Pulmonary Embolism ◽

Prospective Study ◽

Venous Thrombosis ◽

Retrospective Analysis ◽

Causes Of Death ◽

Duplex Sonography ◽

Systematic Screening ◽

Surgical Interventions ◽

Regular Screening ◽

Venous Thromboses

Background: Venous thrombosis with and without pulmonary embolism is a frequent complication of malignancies and second among the causes of death in tumour patients. Its incidence is reported to be 10 to 15%. Since for methodological reasons, this rate can be assumed to be too low and to disregard asymptomatic venous thrombosis, a combined retrospective and prospective study was performed to examine the actual frequency of venous thrombosis in tumour patients. Patients and methods: The histories of 409 patients (175 women, 234 men, mean age 69 years [19 to 96 years]) with different tumours, consecutively enrolled in the order of their altogether 426 inpatient treatments, were checked in retrospect for the frequency of venous thrombosis and pulmonary embolism. Subsequently, 97 tumour inpatients (36 women, 61 men, mean age 70 years [42 to 90 years]) were systematically screened, by means of duplex sonography and/or venography, for venous thromboses in the veins of the pelvis and both legs. Results: In the retrospective analysis, where no systematic screening for thromboses was performed and only symptomatic thrombosis was recorded, venous thrombosis was found in 6.6% of all tumour patients, whereas in the prospective examination with systematic duplex sonography and / or venography of all patients, the percentage was 33%. In the prospective study, 31.3% of venous thromboses were symptomatic and 68.7% asymptomatic. In 39.3% of the cases in the retrospective analysis and 25% in the prospective analysis, venous thrombosis occurred during chemotherapy, surgery or radiation therapy. Venous thrombosis was most often seen in metastasizing tumours and in colorectal carcinoma (40%), haematological system diseases (28.6%), gastric cancer (30%), bronchial, pancreas and ovarian carcinoma (28.6%), and carcinoma of the prostate (16.7%). Conclusion: Regular screening for thrombosis is indicated even in asymptomatic tumour patients because asymptomatic venous thrombosis is frequent, can lead to pulmonary embolism and has to be treated like symptomatic venous thrombosis. This is particularly true for metastasization during chemotherapy, surgical interventions, or radiation.

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