scholarly journals ACCURACY OF AVAILABLE SCORING SYSTEMS FOR IN-HOSPITAL MAJOR BLEEDING PREDICTION IN ACUTE PULMONARY EMBOLISM PATIENTS

2021 ◽  
Vol 77 (18) ◽  
pp. 1827
Author(s):  
Romain Chopard ◽  
Camille Mathonier ◽  
Fiona Ecarnot ◽  
Matthieu Besutti ◽  
Nicolas Falvo ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Major Bleeding ◽  
Acute Pulmonary Embolism ◽  
Scoring Systems

Treatment of acute pulmonary embolism as outpatients or following early discharge

2008 ◽  
Vol 100 (05) ◽  
pp. 756-761 ◽  
Author(s):  
Muhammad Janjua ◽  
Aaref Badshah ◽  
Fadi Matta ◽  
Liviu G. Danescu ◽  
Abdo Y. Yaekoub ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Major Bleeding ◽  
Acute Pulmonary Embolism ◽  
Cost Effective ◽  
Early Discharge ◽  
Low Risk ◽  
Exclusion Criteria ◽  
Average Hospital ◽  
Risk Patients ◽  
Acute Pe

SummaryThe purpose of this systematic review is to test the hypothesis that carefully selected low-risk patients with acute pulmonary embolism (PE) can safely be treated entirely as outpatients or after early hospital discharge.Included articles were required to describe inclusion or exclusion criteria and outcome of patients treated for PE.Early hospital discharge was defined as an average hospital stay ≤3 days.Six investigations included patients with PE who were treated entirely as outpatients; two investigations included patients with PE who were treated after early discharge. All investigations included only low-risk patients or patients with small or medium sized PE. Outcome after 3-46 months in patients treated entirely as outpatients showed recurrent PE in 0% to 6.2% of patients, major bleeding in 0% to 2.8% with one death from an intracerebral bleed. Definite death from PE did not occur, but there was one possible death from PE. Outcome in three months in patients treated after early discharge showed no instances of recurrent PE. Major bleeding occurred in 0% to 3.7% of patients.There were no deaths from PE, but there was one death from bleeding. In conclusion, outpatient therapy of acute PE is probably safe in low-risk,carefully selected compliant patients who have access to outpatient care if necessary. Such outpatient treatment would be cost-effective.

Embolismo pulmonar agudo en pacientes con neumonía por SARS-COV2. Serie de Casos. [Acute Pulmonary Embolism in patients with SARS-COV2 pneumonia. Cases report]

2021 ◽  
Vol 40 (03) ◽  
Author(s):  
Olmedo Villarreal ◽  
Lizeth Pinilla ◽  
Sabrina Trejos
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Scoring Systems ◽  
Vascular Wall ◽  
Average Hospital ◽  
Vein Thrombosis ◽  
Thrombotic Complications ◽  
Deep Vein ◽  
Hospital General

<p>El síndrome respiratorio agudo severo coronavirus 2 (SARS-COV-2) descrito en Wuhan, China a finales del 2019, ha causado más de 9 millones de infecciones en el mundo, y más de 480 mil muertes. En Panamá se han reportado más de 28 mil casos, y más de 500 muertes por COVID-19. Se ha observado un alto riesgo de complicaciones trombóticas, probablemente como consecuencia del daño vascular asociado con la infección viral y la inflamación severa, con la contribución patógena de las plaquetas que interactúan con la pared vascular y los leucocitos. Describimos 3 casos de pacientes hospitalizados en un hospital general en la provincia de Panamá, República de Panamá. Dos hombres y una mujer, edad promedio 40.6 años, estadía hospitalaria promedio de 35.3 días; ingresados con diagnóstico de neumonía por SARS-COV-2, niveles elevados de dimero D (&gt; 5 ug/mL), riesgo bajo calculado para embolia pulmonar. Encontrando embolia pulmonar aguda en las ANGIO tomografía y en un caso acompañado de trombosis venosa profunda. Todos recibían dosis profiláctica de heparina de bajo peso molecular. Se necesitan algoritmos para identificar a aquellos susceptibles de desarrollar complicaciones trombóticas y enfermedades graves, determinar el papel de los biomarcadores y sistemas de puntuación para estratificar el riesgo.</p><p><strong>Abstract</strong></p><p>The severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) described in Wuhan, China in late 2019, has caused more than 9 million infections worldwide, and more than 480 thousand deaths. In Panama, more than 28 thousand cases have been reported, and more than 500 deaths from COVID-19. A high risk of thrombotic complications has been observed, probably as a consequence of vascular damage associated with viral infection and severe inflammation, with the pathogenic contribution of platelets that interact with the vascular wall and leukocytes. We describe 3 cases of patients hospitalized in a general hospital in the province of Panama, Republic of Panama. Two men and one woman, average age 40.6 years, average hospital stay of 35.3 days; admitted with a diagnosis of SARS-VOC-2 pneumonia, elevated levels of dimer D (&gt; 5 ug / mL), calculated low risk for pulmonary embolism. Finding acute pulmonary embolism on ANGIO tomography and in one case accompanied by deep vein thrombosis. All received prophylactic doses of low molecular weight heparin. Algorithms are needed to identify those susceptible to developing thrombotic complications and serious diseases, determine the role of biomarkers and scoring systems to stratify risk.</p>

scholarly journals Management appropriateness and outcomes of patients with acute pulmonary embolism

2018 ◽  
Vol 51 (5) ◽  
pp. 1800445 ◽  
Author(s):  
David Jiménez ◽  
Behnood Bikdeli ◽  
Deisy Barrios ◽  
Raquel Morillo ◽  
Rosa Nieto ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Major Bleeding ◽  
Acute Pulmonary Embolism ◽  
External Validation ◽  
Vena Cava ◽  
Vena Cava Filters ◽  
All Cause Mortality ◽  
The Impact ◽  
Related Mortality

The impact of adherence to published guidelines on the outcomes of patients with acute pulmonary embolism (PE) has not been well defined by previous studies.In this prospective cohort study of patients admitted to a respiratory department (n=2096), we evaluated whether patients with PE had better outcomes if they were acutely managed according to international guidelines. Outcomes consisted of all-cause mortality, PE-related mortality, recurrent venous thromboembolism (VTE) and major bleeding events during the first month of follow-up after diagnosis.Overall, 408 patients (19% (95% CI 18–21%)) did not receive guideline-adherent PE management. Patients receiving non-adherent management were significantly more likely to experience all-cause mortality (adjusted odds ratio (OR) 2.39 (95% CI 1.57–3.61) or PE-related mortality (adjusted OR 5.02 (95% CI 2.42–10.42); p<0.001) during follow-up. Non-adherent management was also a significant independent predictor of recurrent VTE (OR 2.19 (95% CI 1.11–4.32); p=0.03) and major bleeding (OR 2.65 (95% CI 1.66–4.24); p<0.001). An external validation cohort of 34 380 patients with PE from the RIETE registry confirmed these findings.PE management that does not adhere to guidelines for indications related to anticoagulation, thrombolytics and inferior vena cava filters is associated with worse patient outcomes.

Derivation and validation of a clinical prediction rule for thrombolysis-associated major bleeding in patients with acute pulmonary embolism: the BACS score

2020 ◽  
Vol 56 (6) ◽  
pp. 2002336
Author(s):  
Luis Jara-Palomares ◽  
David Jiménez ◽  
Behnood Bikdeli ◽  
Alfonso Muriel ◽  
Parth Rali ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Logistic Regression ◽  
Risk Score ◽  
Major Bleeding ◽  
Acute Pulmonary Embolism ◽  
Low Risk ◽  
Bleeding Rate ◽  
Systemic Thrombolysis ◽  
Multivariable Logistic Regression ◽  
Major Bleeding Rate

BackgroundImproved prediction of the risk of major bleeding in patients with acute pulmonary embolism (PE) receiving systemic thrombolysis is crucial to guide the choice of therapy.MethodsThe study included consecutive patients with acute PE who received systemic thrombolysis in the RIETE registry. We used multivariable logistic regression analysis to create a risk score to predict 30-day major bleeding episodes. We externally validated the risk score in patients from the COMMAND VTE registry. In addition, we compared the newly created risk score against the Kuijer and RIETE scores.ResultsMultivariable logistic regression identified four predictors for major bleeding: recent major bleeding (3 points), age >75 years (1 point), active cancer (1 point) and syncope (1 point) (BACS). Among 1172 patients receiving thrombolytic therapy in RIETE, 446 (38%) were classified as having low risk (none of the variables present, 0 points) of major bleeding according to the BACS score, and the overall 30-day major bleeding rate of this group was 2.9% (95% CI 1.6–4.9%), compared with 44% (95% CI 14–79%) in the high-risk group (>3 points). In the validation cohort, 51% (149 out of 290) of patients were classified as having low risk, and the overall 30-day major bleeding rate of this group was 1.3%. In RIETE, the 30-day major bleeding event rates in the Kuijer and RIETE low-risk strata were 5.3% and 4.4%, respectively.ConclusionsThe BACS score is an easily applicable aid for prediction of the risk of major bleeding in the population of PE patients who receive systemic thrombolysis.

scholarly journals Contemporary Clinical Management and Course of ACUTE Pulmonary Embolism: The COPE Study

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3230-3230
Author(s):  
Cecilia Becattini ◽  
Giancarlo Agnelli ◽  
Aldo P Maggioni ◽  
Francesco Dentali ◽  
Andrea Fabbri ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Risk Stratification ◽  
Major Bleeding ◽  
Acute Pulmonary Embolism ◽  
Low Risk ◽  
Intermediate Risk ◽  
Bayer Healthcare ◽  
Risk Patients ◽  
Acute Pe

Abstract Background. New management strategies, risk stratification procedures and treatments have become available over the last years for patients with acute pulmonary embolism (PE), leading to changes in clinical practice and potentially influencing patient's course and outcome. Methods: The COntemporary management of Pulmonary Embolism (COPE) is an academical prospective, non-interventional, multicentre study in patients with confirmed acute symptomatic PE. In-hospital and 30-day mortality were the co-primary study outcomes. At first evaluation, patients were categorized at low-risk (simplified PESI [sPESI]=0), intermediate-risk (further classified based presence/absence of increased levels and right ventricle dysfunction [RVD] at echocardiography) and high-risk (shock or cardiac arrest). Results. Among 5213 study patients, PE was confirmed by computed tomography in 96.3% and at least one test for risk stratification was obtained in more than 80% (81% echocardiography, 83% troponin, 56% brain natriuretic peptide/NT-pro BNP). Among 4885 patients entering the Emergency Department for acute PE, 1.2% were managed as outpatients and 5.8% by short-observation. In-hospital, 289 patients underwent reperfusion (5.5%); at discharge, 6.7% received a vitamin K antagonist and 75.6% a direct oral anticoagulant. Median duration of hospitalization was 7 days (IQR 5-12 days). Overall in-hospital mortality was 3.4% (49% due to PE, 16% cancer and 4.5% major bleeding) and 30-day mortality 4.8% (36% PE, 28% cancer and 4% major bleeding). In-hospital major bleeding was 2.6%. Death at 30 days occurred in 22.6% of 177 high-risk patients, in 6% of the 3281 intermediate-risk and in 0.5% of 1702 low-risk patients. Time to death at 30 days in patients at low, intermediate and high risk for death is reported in the Figure. Conclusions: COPE is the largest ever cohort of patients with acute PE. In this contemporary scenario, the majority of patients received CT for diagnosis, at least one test for risk stratification and direct oral anticoagulants as long-term treatment. Short term death remains not negligible in patients with high and intermediate-risk PE. Figure 1 Figure 1. Disclosures Becattini: Bristol Myers Squibb: Honoraria; Daiichi Sankyo: Honoraria; Bayer HealthCare: Honoraria. Agnelli: Bristol Myers Squibb: Honoraria; Pfizer: Honoraria; Daiichi Sankyo: Honoraria; Bayer HealthCare: Honoraria. Dentali: Daiichi Sankyo: Honoraria; Bayer: Honoraria; Sanofi: Honoraria; Pfizer: Honoraria; Bristol-Myers Squibb: Honoraria; Novartis: Honoraria; Boehringer: Honoraria; Alfa Sigma: Honoraria.

scholarly journals Available Bleeding Scoring Systems Poorly Predict Major Bleeding in the Acute Phase of Pulmonary Embolism

2021 ◽  
Vol 10 (16) ◽  
pp. 3615
Author(s):  
Camille Mathonier ◽  
Nicolas Meneveau ◽  
Matthieu Besutti ◽  
Fiona Ecarnot ◽  
Nicolas Falvo ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Major Bleeding ◽  
Statistical Significance ◽  
Real Life ◽  
Scoring Systems ◽  
International Normalized Ratio ◽  
Risk Scores ◽  
Bleeding Events ◽  
Net Reclassification Improvement ◽  
Acute Pe

We aimed to compare six available bleeding scores, in a real-life cohort, for prediction of major bleeding in the early phase of pulmonary embolism (PE). We recorded in-hospital characteristics of 2754 PE patients in a prospective observational multicenter cohort contributing 18,028 person-days follow-up. The VTE-BLEED (Venous Thrombo-Embolism Bleed), RIETE (Registro informatizado de la enfermedad tromboembólica en España; Computerized Registry of Patients with Venous Thromboembolism), ORBIT (Outcomes Registry for Better Informed Treatment), HEMORR2HAGES (Hepatic or Renal Disease, Ethanol Abuse, Malignancy, Older Age, Reduced Platelet Count or Function, Re-Bleeding, Hypertension, Anemia, Genetic Factors, Excessive Fall Risk and Stroke), ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation), and HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile International Normalized Ratio, Elderly, Drugs/Alcohol) scores were assessed at baseline. International Society on Thrombosis and Haemostasis (ISTH)-defined bleeding events were independently adjudicated. Accuracy of the overall original 3-level and newly defined optimal 2-level outcome of the scores were evaluated and compared. We observed 82 first early major bleedings (3.0% (95% CI, 2.4–3.7)). The predictive power of bleeding scores was poor (Harrel’s C-index from 0.57 to 0.69). The RIETE score had numerically higher model fit and discrimination capacity but without reaching statistical significance versus the ORBIT, HEMORR2HAGES, and ATRIA scores. The VTE-BLEED and HAS-BLED scores had significantly lower C-index, integrated discrimination improvement, and net reclassification improvement compared to the others. The rate of observed early major bleeding in score-defined low-risk patients was high, between 15% and 34%. Current available scoring systems have insufficient accuracy to predict early major bleeding in patients with acute PE. The development of acute-PE-specific risk scores is needed to optimally target bleeding prevention strategies.

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