RISKS OF CATHETER-DIRECTED THERAPY VERSUS CONSERVATIVE THERAPY IN A HIGH RISK, PROPENSITY-SCORE MATCHED PULMONARY EMBOLISM PATIENT POPULATION

Summary: COVID-19 is a recently identified illness that is associated with thromboembolic events. We report a case of pulmonary embolism in a patient with COVID-19, treated by catheter directed thrombectomy. A 57 year old patient presented to the emergency center with severe COVID-19 symptoms and developed massive pulmonary embolism. The patient was treated with catheter directed thrombolysis (CDT) and recovered completely. Coagulopathy associated with COVID-19 is present in all severe cases and is a dynamic process. We describe a case of massive/high risk pulmonary embolism, in a patient with COVID-19 receiving full anticoagulation, who was treated by percutaneous intervention. CDT can be an additional therapeutic option in patients with COVID-19 and pulmonary embolism that present with rapid clinical collapse.

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Aortic stenosis in high-risk patients presenting coronary artery disease: Conventional or transcatheter strategy? A propensity score analysis

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0031-1297398 ◽

2012 ◽

Vol 60 (S 01) ◽

Author(s):

D Wendt ◽

P Kahlert ◽

M Neuhäuser ◽

T Lenze ◽

T Konorza ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

High Risk ◽

Propensity Score ◽

Aortic Stenosis ◽

Propensity Score Analysis ◽

High Risk Patients ◽

Score Analysis ◽

Risk Patients ◽

Artery Disease

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The Role of a Decision Rule in Symptomatic Pulmonary Embolism Patients with a Non-high Probability Ventilation-perfusion Scan

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657630 ◽

1997 ◽

Vol 78 (02) ◽

pp. 794-798 ◽

Cited By ~ 2

Author(s):

Bowine C Michel ◽

Philomeen M M Kuijer ◽

Joseph McDonnell ◽

Edwin J R van Beek ◽

Frans F H Rutten ◽

...

Keyword(s):

Pulmonary Embolism ◽

Decision Rule ◽

Predictive Value ◽

Patient Population ◽

High Probability ◽

Characteristic Curve ◽

Stepwise Logistic Regression ◽

Pulmonary Angiogram ◽

Symptomatic Pulmonary Embolism ◽

Perfusion Scan

Summary Background: In order to improve the use of information contained in the medical history and physical examination in patients with suspected pulmonary embolism and a non-high probability ventilation-perfusion scan, we assessed whether a simple, quantitative decision rule could be derived for the diagnosis or exclusion of pulmonary embolism. Methods: In 140 consecutive symptomatic patients with a non- high probability ventilation-perfusion scan and an interpretable pulmonary angiogram, various clinical and lung scan items were collected prospectively and analyzed by multivariate stepwise logistic regression analysis to identify the most informative combination of items. Results: The prevalence of proven pulmonary embolism in the patient population was 27.1%. A decision rule containing the presence of wheezing, previous deep venous thrombosis, recently developed or worsened cough, body temperature above 37° C and multiple defects on the perfusion scan was constructed. For the rule the area under the Receiver Operating Characteristic curve was larger than that of the prior probability of pulmonary embolism as assessed by the physician at presentation (0.76 versus 0.59; p = 0.0097). At the cut-off point with the maximal positive predictive value 2% of the patients scored positive, at the cut-off point with the maximal negative predictive value pulmonary embolism could be excluded in 16% of the patients. Conclusions: We derived a simple decision rule containing 5 easily interpretable variables for the patient population specified. The optimal use of the rule appears to be in the exclusion of pulmonary embolism. Prospective validation of this rule is indicated to confirm its clinical utility.

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Acute pulmonary embolism in COVID-19 patient: a case report of free-floating right heart thrombus successfully treated with fibrinolysis

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa388 ◽

2020 ◽

Author(s):

Fernando Scudiero ◽

Antonino Pitì ◽

Roberto Keim ◽

Guido Parodi

Keyword(s):

Pulmonary Embolism ◽

High Risk ◽

Retrospective Studies ◽

Right Heart ◽

Clinical Issue ◽

Systemic Thrombolysis ◽

Case Summary ◽

High Prevalence ◽

Life Threatening ◽

Complex Scenario

Abstract Background Despite the fast-growing understanding of the coronavirus disease 2019 (COVID-19), patient management remains largely empirical or based on retrospective studies. In this complex scenario, an important clinical issue appears to be represented by the high prevalence of thromboembolic events, but the data regarding high-risk pulmonary embolism (PE) is still not available. Case summary A patient with COVID-19 developed sudden shortness of breath and hypoxia. Early echocardiographic diagnosis of high-risk PE related to right heart thrombus was performed. Systemic thrombolysis was administered with excellent clinical and haemodynamic response. Discussion Pulmonary thromboembolism is a common occurrence in severe COVID-19 infection. In our experience, systemic thrombolysis proved to be effective and for this reason may be considered for life-threatening PE in COVID-19 patients.

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Renal function improves mortality prediction in acute pulmonary embolism: results of a multicentre cohort study with external validation in the RIETE registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.2239 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Chopard ◽

D Jimenez ◽

G Serzian ◽

F Ecarnot ◽

N Falvo ◽

...

Keyword(s):

Pulmonary Embolism ◽

Renal Function ◽

High Risk ◽

Renal Dysfunction ◽

External Validation ◽

Mortality Prediction ◽

Model Fit ◽

Funding Source ◽

Risk Of Death ◽

Acute Pe

Abstract Background Renal dysfunction may influence outcomes after pulmonary embolism (PE). We determined the incremental value of adding renal function impairment (estimated glomerular filtration rate, eGFR <60 ml/min/1.73m2) on top of the 2019 ESC prognostic model, for the prediction of 30-day all-cause mortality in acute PE patients from a prospective, multicenter cohort. Methods and results We identified which of three eGFR formulae predicted death most accurately. Changes in global model fit, discrimination, calibration and net reclassification index (NRI) were evaluated with addition of eGFR. We prospectively included consecutive adult patients with acute PE diagnosed as per ESC guidelines. Among 1,943 patients, (mean age 67.3±17.1, 50.4% women), 107 (5.5% (95% CI 4.5–6.5%)) died during 30-day follow-up. The eGFRMDRD4 formula was the most accurate for prediction of death. The observed mortality rate was higher for intermediate-low risk (OR 1.8, 95% CI 1.1–3.4) and high-risk PE (OR 10.3, 95% CI 3.6–17.3), and 30-day bleeding was significantly higher (OR 2.1, 95% CI 1.3–3.5) in patients with vs without eGFRMDRD4 <60 ml/min/1.73m2. The addition of eGFRMDRD4 information improved model fit, discriminatory capacity, and calibration of the ESC models. NRI was significantly improved (p<0.001), with 18% reclassification of predicted mortality, specifically in intermediate and high-risk PE. External validation using data from the RIETE registry confirmed our findings (Table). Conclusion Addition of eGFRMDRD4-derived renal dysfunction on top of the ESC prognostic algorithm yields significant reclassification of risk of death in intermediate and high-risk PE. Impact on therapy remains to be determined. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): BMS-Pfizer Alliance, Bayer Healthcare

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