An IVC filter and anticoagulation for 3 months is unlikely to show a benefit over anticoagulation alone for high-risk patients with acute pulmonary embolism

2015 ◽  
Vol 20 (5) ◽  
pp. 174-174 ◽  
Author(s):  
Eric K Hoffer
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Acute Pulmonary Embolism ◽  
Ivc Filter ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals MR-proADM and MR-proANP levels in patients with acute pulmonary embolism

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Önsel Öner ◽  
Figen Deveci ◽  
Selda Telo ◽  
Mutlu Kuluöztürk ◽  
Mehmet Balin
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Acute Pulmonary Embolism ◽  
Low Risk ◽  
Control Group ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Relationship

Summary Background The aim of this study was to determine levels of Mid-regional Pro-adrenomedullin (MR-proADM) and Mid-regional Pro-atrial Natriuretic Peptide (MR-proANP) in patients with acute pulmonary embolism (PE), the relationship between these parameters and the risk classification in addition to determining the relationship between 1- and 3-month mortality. Methods 82 PE patients and 50 healthy control subjects were included in the study. Blood samples for MR-proANP and MR-proADM were obtained from the subjects prior to the treatment. Risk stratification was determined according to sPESI (Simplified Pulmonary Embolism Severity Index). Following these initial measurements, cases with PE were assessed in terms of all causative and PE related mortalities. Results The mean serum MR-proANP and MR-proADM levels in acute PE patients were found to be statistically higher compared to the control group (p < 0.001, p < 0.01; respectively) and statistically significantly higher in high-risk patients than low-risk patients (p < 0.01, p < 0.05; respectively). No statistical difference was determined in high-risk patients in case of sPESI compared to low-risk patients while hospital mortality rates were higher. It was determined that the hospital mortality rate in cases with MR-proANP ≥ 123.30 pmol/L and the total 3-month mortality rate in cases with MR-proADM ≥ 152.2 pg/mL showed a statistically significant increase. Conclusions This study showed that MR-proANP and MR-proADM may be an important biochemical marker for determining high-risk cases and predicting the mortality in PE patients and we believe that these results should be supported by further and extensive studies.

Right Atrial Thrombosis and Pulmonary Embolism: A Narrative Review

2020 ◽  
Vol 46 (08) ◽  
pp. 895-907
Author(s):  
Nina D. Anfinogenova ◽  
Oksana Y. Vasiltseva ◽  
Alexander V. Vrublevsky ◽  
Irina N. Vorozhtsova ◽  
Sergey V. Popov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Embolism ◽  
High Risk ◽  
Transesophageal Echocardiography ◽  
Three Dimensional ◽  
Right Atrial ◽  
Treatment Protocols ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Right

AbstractPrompt diagnosis of pulmonary embolism (PE) remains challenging, which often results in a delayed or inappropriate treatment of this life-threatening condition. Mobile thrombus in the right cardiac chambers is a neglected cause of PE. It poses an immediate risk to life and is associated with an unfavorable outcome and high mortality. Thrombus residing in the right atrial appendage (RAA) is an underestimated cause of PE, especially in patients with atrial fibrillation. This article reviews achievements and challenges of detection and management of the right atrial thrombus with emphasis on RAA thrombus. The capabilities of transthoracic and transesophageal echocardiography and advantages of three-dimensional and two-dimensional echocardiography are reviewed. Strengths of cardiac magnetic resonance imaging (CMR), computed tomography, and cardiac ventriculography are summarized. We suggest that a targeted search for RAA thrombus is necessary in high-risk patients with PE and atrial fibrillation using transesophageal echocardiography and/or CMR when available independently on the duration of the disease. High-risk patients may also benefit from transthoracic echocardiography with right parasternal approach. The examination of high-risk patients should involve compression ultrasonography of lower extremity veins along with the above-mentioned technologies. Algorithms for RAA thrombus risk assessment and protocols aimed at identification of patients with RAA thrombosis, who will potentially benefit from treatment, are warranted. The development of treatment protocols specific for the diverse populations of patients with right cardiac thrombosis is important.

scholarly journals Pulmonary embolism: the role of emergency scan and intervening radiology in medium-high-risk patients with pulmonary embolism

2010 ◽  
Vol 6 (1) ◽  
pp. 5
Author(s):  
Eleonora Arboscello ◽  
Irene Ponassi ◽  
Agnese Lomeo ◽  
Maria Nives Parodi ◽  
Paolo Barbera ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Negative D-dimer testing excludes pulmonary embolism in non-high risk patients in the emergency department

2017 ◽  
Vol 24 (3) ◽  
pp. 273-280 ◽  
Author(s):  
John B. Harringa ◽  
Rebecca L. Bracken ◽  
Scott K. Nagle ◽  
Mark L. Schiebler ◽  
Michael S. Pulia ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
High Risk ◽  
High Risk Patients ◽  
Risk Patients ◽  
D Dimer

scholarly journals Acute pulmonary embolism: mortality prediction by the 2014 European Society of Cardiology risk stratification model

2016 ◽  
Vol 48 (3) ◽  
pp. 780-786 ◽  
Author(s):  
Cecilia Becattini ◽  
Giancarlo Agnelli ◽  
Mareike Lankeit ◽  
Luca Masotti ◽  
Piotr Pruszczyk ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Risk Stratification ◽  
Negative Predictive Value ◽  
European Society ◽  
Predictive Value ◽  
Acute Pulmonary Embolism ◽  
Risk Stratification Model ◽  
Risk Patients ◽  
European Society Of Cardiology

The European Society of Cardiology (ESC) has proposed an updated risk stratification model for death in patients with acute pulmonary embolism based on clinical scores (Pulmonary Embolism Severity Index (PESI) or simplified PESI (sPESI)), right ventricle dysfunction (RVD) and elevated serum troponin (2014 ESC model).We assessed the ability of the 2014 ESC model to predict 30-day death after acute pulmonary embolism. Consecutive patients with symptomatic, confirmed pulmonary embolism included in prospective cohorts were merged in a collaborative database. Patients’ risk was classified as high (shock or hypotension), intermediate-high (RVD and elevated troponin), intermediate-low (RVD or increased troponin or none) and low (sPESI 0). Study outcomes were death and pulmonary embolism-related death at 30 days.Among 906 patients (mean±sd age 68±16, 489 females), death and pulmonary embolism-related death occurred in 7.2% and 4.1%, respectively. Death rate was 22% in “high-risk” (95% CI 14.0–29.8), 7.7% in “intermediate-high-risk” (95% CI 4.5–10.9) and 6.0% in “intermediate-low-risk” patients (95% CI 3.4–8.6). One of the 196 “low-risk” patients died (0.5%, 95% CI 0–1.0; negative predictive value 99.5%).By using the 2014 ESC model, RVD or troponin tests would be avoided in about 20% of patients (sPESI 0), preserving a high negative predictive value. Risk stratification in patients at intermediate risk requires further improvement.

Prophylactic placement of an inferior vena cava filter in high-risk patients undergoing spinal reconstruction

2004 ◽  
Vol 17 (4) ◽  
pp. 1-6 ◽  
Author(s):  
Michael K. Rosner ◽  
Timothy R. Kuklo ◽  
Rabih Tawk ◽  
Ross Moquin ◽  
Stephen L. Ondra
Keyword(s):  
Pilot Study ◽  
High Risk ◽  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Matched Cohort ◽  
Filter Placement ◽  
High Risk Patients ◽  
Ivc Filters ◽  
Risk Patients

Object The purpose of this study was to evaluate the safety and efficacy of prophylactic inferior vena cava (IVC) filter placement in high-risk patients who undergo major spine reconstruction. Methods In the pilot study, 22 patients undergoing major spine reconstruction received prophylactic IVC filters. These patients were prospectively followed to evaluate complications related to the filter, the rate of deep venous thrombosis (DVT) formation, and the rate of pulmonary embolism (PE). These data were compared with those obtained in a retrospective review for PE in a matched cohort treated at the same institution. At a second institution the treatment guidelines were implemented in 17 patients undergoing complex spine surgery with the same follow-up criteria. In the pilot study, no patient experienced PE (0%), whereas two had DVT (9%). Bilateral DVT developed postoperatively in one patient (associated morbidity rate 4.5%), who required thrombolytic therapy. One patient died of unrelated surgical complications. The PE rate in the matched cohort at the same institution was 12%. At the second institution, no patient had PE, and no complications were noted. Conclusions In this patient population, prophylactic IVC filter placement appears to decrease the PE rate substantially, from 12 to 0%. The placement of IVC filters appears to be a safe and efficacious intervention for prevention of PE in high-risk patients.

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