scholarly journals Acute Pulmonary Embolism Associated with Low-Dose Olanzapine in a Patient without Risk Factors for Venous Thromboembolism

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Vu Hoang Vu ◽  
Nguyen Duong Khang ◽  
Mai Thanh Thao ◽  
Le Minh Khoi
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Low Dose ◽  
Stable Condition ◽  
Bipolar Disorders ◽  
High Dose ◽  
Arterial Tree ◽  
Olanzapine Therapy ◽  
Long Course

Background. Olanzapine is a second-generation antipsychotic drug commonly prescribed for certain mental/mood conditions such as schizophrenia and bipolar disorders. This agent has been considered a precipitating factor for venous thromboembolism formation. Most of the cases previously reported were associated with high-dose olanzapine therapy or in patients with high-risk factors for the development of thromboembolism. Case Presentation. We report a patient who developed pulmonary embolism after a long course of low-dose olanzapine. A 66-year-old female patient suffering from insomnia had been prescribed olanzapine 2.5 mg and paroxetine 10 mg for two years. The patient suddenly developed a syncopal episode at home and was immediately brought to the hospital. The diagnosis of pulmonary embolism was made by chance during the computerized tomography of coronary arteries. The patient made a full recovery under conventional treatment and was discharged in stable condition. The thoracic computed tomography taken two months after discharge showed a completely normal pulmonary arterial tree. Conclusion. Olanzapine-associated pulmonary embolism is a rare entity and might be missed if the physician in charge is not vigilant and well informed. Even low-dose olanzapine can be associated with pulmonary embolism in patients with low classic risk factors if the treatment is prolonged. Pulmonary embolism should be sought in patients taking olanzapine even though the presenting manifestations are nonspecific.

scholarly journals Forty-One-Year-Old Man with Pulmonary Embolism 5 Months After COVID-19

2021 ◽  
Vol 15 ◽  
pp. 117954842098665
Author(s):  
Muhanad Taha ◽  
Paul Nguyen ◽  
Aditi Sharma ◽  
Mazen Taha ◽  
Lobelia Samavati
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Venous Thrombosis ◽  
Case Summary ◽  
One Year

Background: Hypercoagulation is one of the striking features of COVID-19. Patients hospitalized with COVID-19 are at high risk for venous thromboembolism. However, it is unknown if the risk for venous thromboembolism persists after discharge. Case Summary: We report a case with pulmonary embolism 5 months after COVID-19. No risk factors for venous thrombosis have been identified. Conclusion: In COVID-19 related hospitalization, large studies are needed to identify the risk of venous thromboembolism after discharge.

The Diagnostic Assessment of Suspected Pulmonary Embolism on the Acute Medical Take: An Evidence Based Guide

2007 ◽  
Vol 6 (1) ◽  
pp. 20-26
Author(s):  
Alastair Proudfoot ◽  
◽  
Derek Bell ◽  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Clinical Presentation ◽  
Diagnostic Assessment ◽  
Evidence Based ◽  
Suspected Pulmonary Embolism ◽  
The Subject ◽  
Adjusted Incidence ◽  
Age And Sex

Pulmonary Embolism is a common cardiopulmonary illness with an age and sex adjusted incidence of around 117 cases per 100 000 person years. The clinical presentation is extremely heterogeneous and non specific. Risk factors for venous thromboembolism are well established. When combined with presenting features and investigations. a multimodality algorithm has led to significant changes in the diagnostic approach of suspected PE. While the best combination of tests for any individual patient remains the subject of controversy this article aims to rationalise the acute physician’s approach to diagnosis and use of available investigations.

Venous Thromboembolism

2020 ◽  
Author(s):  
Samuel Z. Goldhaber
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Antithrombotic Agents ◽  
Vein Thrombosis ◽  
Recurrent Venous Thrombosis ◽  
Deep Vein ◽  
D Dimer ◽  
In Pregnancy

Venous thromboembolism, which involves venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients and is being seen with increasing frequency in outpatients. This chapter discusses the risk factors, etiology, classification, pathophysiology, natural history, prognosis, diagnosis (including venous thrombosis, recurrent venous thrombosis, and pulmonary embolism), prophylaxis, and treatment of venous thromboembolism (including the pharmacology of antithrombotic agents), as well as venous thromboembolism in pregnancy and miscellaneous thromboembolic disorders (including thrombosis of unusual sites).  This review contains 8 figures, 16 tables, and 79 references. Keywords: Venous thromboembolism, pulmonary embolism, deep vein thrombosis, embolectomy, thrombolysis, hypercoagulability, duplex ultrasonography, D-dimer, anticoagulation

Incidence and risk factors of preoperative venous thromboembolism and pulmonary embolism in patients with ovarian cancer

2020 ◽  
Vol 190 ◽  
pp. 129-134
Author(s):  
Shanhui Liang ◽  
Wei Tang ◽  
Shuang Ye ◽  
Libing Xiang ◽  
Xiaohua Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ovarian Cancer ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism

Herpesviridae Viral Infections Following Chemotherapy in Patients with Lymphoma : Incidence, Risk Factors, and Prevention.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3704-3704
Author(s):  
Ho Sup Lee ◽  
Ji Young Park ◽  
Seong Hoon Shin ◽  
Sung Bin Kim ◽  
Aeran Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
B Cell ◽  
Cumulative Dose ◽  
Low Dose ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Salvage Chemotherapy ◽  
Neutropenic Fever ◽  
High Dose ◽  
Acyclovir Prophylaxis

Abstract Abstract 3704 Poster Board III-640 Abstract Backgroud Herpesviridae family includes herpes simplex virus, varicella zoster virus, Epstein-Barr virus, and cytomegalovirus, etc. Herpesviridae viral infection(HVI) can lead to serious complications including dissemination, secondary infection, bacterial superinfection in patients with lymphoma undergoing chemotherapy. But there was no consensus on the dose and duration of antiviral agents prophylaxis in lymphoma undergoing chemotherapy. We retrospectively analyzed the incidence, the risk factors and the prevention with low-dose acyclovir for HVI. Method A total of 266 patients who newly diagnosed and received an chemotherapy without prophylaxis of acyclovir at the Kosin University Gospel Hospital, Busan, South Korea between June 1996 and August 2009 were enrolled retrospectively in the current study. HVI was confirmed based on clinical diagnosis, serologic test or pathologic diagnosis. The characteristics of the patients were as follows: the median age was 54years (range 15-83 years) with a female-to-male ratio of 150:116. The enrolled diseases included diffuse large B cell lymphoma (DLBL, n=151, 56.8%), Hodgkin's disease (HD, n=16, 6.0%), T cell lymphoma (TCL, n=43, 16.2%) and other lymphoma (n=56, 21.1%) including mantle cell lymphoma, marzinal zone B cell lymphoma, follicular lymphoma, small lymphocytic lymphoma and burkitt's lymphoma. The results were analyzed using a chi-square test and independent samples T test. For the multivariate analysises, we used logistic regression test. Results Fourty three patients (16.2%) developed HVI at a median of 5.43 months (range 0.43-51.33 months) after initial chemotherapy. In univariate analyses, risk factors for HVI were gender (p=0.002, 10% in male vs 24.1% in female), cumulative dose of prednisone (p < 0.001, 4.0% in less than 4000mg vs 31.6% in more than 4000mg), duration of chemotherapy (p=0.009, 11.8% in less than 6 months vs 24.0% in more than 6 months), presence of relapse (p=0.007, 24.7% in relapse vs 11.9% in non-relapse), receiving salvage chemotherapy (p=0.009, 11.8% in no receiving salvage chemotherapy vs 24.0% in receiving salvage chemotherapy), and presence of neutropenic fever (p=0.019, 26.9% in neutropenic fever vs 13.6% in no neutropenic fever). In multivariate analysis, the results confirmed 2 variables as independent predictive factors for the female (P < 0.001, hazard ratio (HR): 4.915, 95% confidence interval (CI) 2.200-10981) and cumulative dose of prednisone (P < 0.001, HR: 14.269, 95% CI 5.241-38.848). There was no different mortality rate and survival rate between HVI and non-HVI group. Conclusion Female and high dose prednisone was seemed to be high risk for HVI in patients with lymphoma undergoing chemotherapy without acyclovir prophylaxis. Low-dose acyclovir prophylaxis for HVI may be needed in higher risk lymphoma patients undergoing chemotherapy. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Home treatment with intravenous enzyme replacement therapy for Gaucher disease: an international collaborative study of 33 patients

Blood ◽  
1993 ◽  
Vol 82 (4) ◽  
pp. 1107-1109 ◽  
Author(s):  
A Zimran ◽  
CE Hollak ◽  
A Abrahamov ◽  
MH van Oers ◽  
M Kelly ◽  
...  
Keyword(s):  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
High Frequency ◽  
Gaucher Disease ◽  
Low Dose ◽  
Collaborative Study ◽  
Stable Condition ◽  
Home Treatment ◽  
High Dose ◽  
Enzyme Replacement

Intravenous enzyme replacement therapy (Alglucerase; Ceredase; Genzyme Corp, Boston, MA) is an effective and safe treatment for patients with type 1 Gaucher disease. In an attempt to reduce its high cost, a “low- dose high-frequency” protocol (30 U/kg/mo, 3 times a week) was introduced and found to be as effective as the original high-dose protocol (60 U/kg every 2 weeks). Because receiving frequent infusions creates a burden for many patients, we have implemented a program of home treatment for our patients. We now report the safety and feasibility of low-dose/high-frequency home intravenous enzyme- replacement therapy in 33 patients with Gaucher disease. The chronic nature of the treatment, its safety, lack of adverse effects, the stable condition of most patients, and the need to reduce the high cost make enzyme replacement for Gaucher disease a good candidate for intravenous home therapy.

scholarly journals Association between cardiovascular risk-factors and venous thromboembolism in a large longitudinal study of French women

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
C. J. MacDonald ◽  
A. L. Madika ◽  
M. Lajous ◽  
M. Canonico ◽  
A. Fournier ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Pulmonary Embolism ◽  
Cardiovascular Risk ◽  
Venous Thromboembolism ◽  
Cardiovascular Risk Factors ◽  
Arterial Disease ◽  
Population Based ◽  
Cox Models ◽  
Vein Thrombosis

Abstract Background Previous studies have shown conflicting results regarding the influence of cardiovascular risk-factors on venous thromboembolism. This study aimed to determine if these risk-factors, i.e. physical activity, smoking, hypertension, dyslipidaemia, and diabetes, were associated with the risk of venous thromboembolism, and to determine if these associations were confounded by BMI. Methods We used data from the E3N cohort study, a French prospective population-based study initiated in 1990, consisting of 98,995 women born between 1925 and 1950. From the women in the study we included those who did not have prevalent arterial disease or venous thromboembolism at baseline; thus 91,707 women were included in the study. Venous thromboembolism cases were self-reported during follow-up, and verified via specific mailings to medical practitioners or via drug reimbursements for anti-thrombotic medications. Hypertension, diabetes and dyslipidaemia were self-reported validated against drug reimbursements or specific questionnaires. Physical activity, and smoking were based on self-reports. Cox-models, adjusted for BMI and other potential risk-factors were used to determine hazard ratios for incident venous thromboembolism. Results During 1,897,960 person-years (PY), 1, 649 first incident episodes of thrombosis were identified at an incidence rate of 0.9 per 1000 PY. This included 505 cases of pulmonary embolism and 1144 cases of deep vein thrombosis with no evidence of pulmonary embolism. Hypertension, dyslipidaemia, diabetes, smoking and physical activity were not associated with the overall risk of thrombosis after adjustment for BMI. Conclusions Traditional cardiovascular risk factors were not associated with the risk of venous thromboembolism after adjustment for BMI. Hypertension, dyslipidaemia and diabetes may not be risk-factors for venous thromboembolism.

scholarly journals Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: a narrative review

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yasser Sakr ◽  
Manuela Giovini ◽  
Marc Leone ◽  
Giacinto Pizzilli ◽  
Andreas Kortgen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Hospital Discharge ◽  
Current Data ◽  
Bleeding Events ◽  
Therapeutic Implications ◽  
Therapeutic Anticoagulation ◽  
Life Threatening ◽  
Prophylactic Anticoagulation

Abstract Background Preliminary reports have described significant procoagulant events in patients with coronavirus disease-2019 (COVID-19), including life-threatening pulmonary embolism (PE). Main text We review the current data on the epidemiology, the possible underlying pathophysiologic mechanisms, and the therapeutic implications of PE in relation to COVID-19. The incidence of PE is reported to be around 2.6–8.9% of COVID-19 in hospitalized patients and up to one-third of those requiring intensive care unit (ICU) admission, despite standard prophylactic anticoagulation. This may be explained by direct and indirect pathologic consequences of COVID-19, complement activation, cytokine release, endothelial dysfunction, and interactions between different types of blood cells. Conclusion Thromboprophylaxis should be started in all patients with suspected or confirmed COVID-19 admitted to the hospital. The use of an intermediate therapeutic dose of low molecular weight (LMWH) or unfractionated heparin can be considered on an individual basis in patients with multiple risk factors for venous thromboembolism, including critically ill patients admitted to the ICU. Decisions about extending prophylaxis with LMWH after hospital discharge should be made after balancing the reduced risk of venous thromboembolism (VTE) with the risk of increased bleeding events and should be continued for 7–14 days after hospital discharge or in the pre-hospital phase in case of pre-existing or persisting VTE risk factors. Therapeutic anticoagulation is the cornerstone in the management of patients with PE. Selection of an appropriate agent and correct dosing requires consideration of underlying comorbidities.

scholarly journals Risk of venous thromboembolism associated with Janus kinase inhibitors for rheumatoid arthritis: case presentation and literature review

2021 ◽  
Author(s):  
Shunsuke Mori ◽  
Fumihiko Ogata ◽  
Ryusuke Tsunoda
Keyword(s):  
Rheumatoid Arthritis ◽  
Diabetes Mellitus ◽  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Disease Activity ◽  
Janus Kinase ◽  
Advanced Age ◽  
Jak Inhibitors ◽  
Increased Risk

AbstractJanus kinase (JAK) inhibitors have been developed as disease-modifying antirheumatic drugs. Despite the positive therapeutic impacts of JAK inhibitors, concerns have been raised regarding the risk of venous thromboembolism (VTE), such as deep vein thrombosis (DVT) and pulmonary embolism (PE). A recent post hoc safety analysis of placebo-controlled trials of JAK inhibitors in rheumatoid arthritis (RA) reported an imbalance in the incidence of VTE for a 4-mg daily dose of baricitinib versus placebo. In a recent postmarketing surveillance trial for RA, a significantly higher incidence of PE was reported in treatment with tofacitinib (10 mg twice daily) compared with tofacitinib 5 mg or tumor necrosis factor inhibitors. We also experienced a case of massive PE occurring 3 months after starting baricitinib (4 mg once daily) for multiple biologic-resistant RA. Nevertheless, the evidence to support the role of JAK inhibitors in VTE risk remains insufficient. There are a number of predisposing conditions and risk factors for VTE. In addition to the known risk factors that can provoke VTE, advanced age, obesity, diabetes mellitus, hypertension, hyperlipidemia, and smoking can also contribute to its development. Greater VTE risk is noted in patients with chronic inflammatory conditions, particularly RA patients with uncontrolled disease activity and any comorbidity. Prior to the initiation of JAK inhibitors, clinicians should consider both the number and strength of VTE risk factors for each patient. In addition, clinicians should advise patients to seek prompt medical help if they develop clinical signs and symptoms that suggest VTE/PE. Key Points• Patients with rheumatoid arthritis (RA) are at increased risk of venous thromboembolism (VTE), especially those with uncontrolled, high disease activity and those with comorbidities.• In addition to the well-known risk factors that provoke VTE events, advanced age and cardiovascular risk factors, such as obesity, diabetes mellitus, hypertension, hyperlipidemia, and smoking, should be considered risk factors for VTE.• Although a signal of VTE/pulmonary embolism (PE) risk with JAK inhibitors has been noted in RA patients who are already at high risk, the evidence is currently insufficient to support the increased risk of VTE during RA treatment with JAK inhibitors.• If there are no suitable alternatives, clinicians should prescribe JAK inhibitors with caution, considering both the strength of individual risk factors and the cumulative weight of all risk factors for each patient.

scholarly journals Venous Thromboembolism Prophylaxis with Aspirin for Multiple Myeloma Patients Receiving Thalidomide Combination As First-Line Treatment

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5764-5764
Author(s):  
Edvan de Queiroz Crusoe ◽  
Mariana Massarenti ◽  
Manuella Almeida ◽  
Priscilla Cury ◽  
Fabiana Higashi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Venous Thromboembolism ◽  
Low Dose ◽  
Chemotherapeutic Agents ◽  
Line Treatment ◽  
First Line ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
First Line Treatment

Abstract Introduction: Despite the increase in overall survival in patients with multiple myeloma (MM) over the last decade as a result of the use of new chemotherapeutic agents, the immunomodulators (thalidomide and lenalidomide) are associated with a higher rate of venous thromboembolism (VTE), principally when associated with other chemotherapeutic drugs and erythropoietin (EPO). The incidence of VTE with isolated thalidomide is 3 to 4%, similar to the risk of the disease itself. The association of thalidomide with corticoids or anthracycline agents has led to an increase in the incidence of VTE to 12 and 34%, respectively. The introduction of low-dose aspirin, vitamin K inhibitors or low molecular weight heparin prophylaxis, according to the risk factors present upon diagnosis reduced the risk of thrombosis to 3 to 7%. Objectives: The objectives were to evaluate thrombotic events during the use of thalidomide as first-line treatment in symptomatic MM patients and the effectiveness of low-dose aspirin prophylaxis. Casuistic and Methods: This is a descriptive study of thrombotic events by means of a retrospective survey of patient files for MM patients who had been followed up on at the gammopathies outpatient unit at Santa Casa de Misericórdia de São Paulo from January 2009 to April 2014. The following induction therapy schedules with thalidomide for patients eligible or not for bone marrow transplantation were performed: thalidomide + dexamethasone (TD), cyclophosphamide + thalidomide + dexamethasone (CTD) and melphalan + prednisone + thalidomide (MPT). All of the patients received a dose of 100mg/day of the antiplatelet agent (aspirin) as prophylaxis. Results: In the aforementioned period, 219 patients had been diagnosed with symptomatic MM and of these, 149 patients had received thalidomide-based chemotherapy. The thalidomide group had a median age of 61 years (40 to 88). In the DS IIIA-IIIB stage, there were 131 (87.9%), 14 (9.4%) IIA-IIB, 1 (0.7%) IA and 3 (2%) had not been evaluated. According to the ISS Classification, 36 (24.2%) were ISS I, 41 (27.5%) II and 58 (38.9%) III, with 9.4% not evaluated. The most frequent isotope was IgG (56%). In relation to chemotherapy, 34 (22.8%) received TD, 98 (65.8%) CTD, 17 (11.4%) MPT. We identified 10 (6.7%) cases of thrombotic events in patients using thalidomide, thus distributed: 8 deep vein thrombosis (DVT), one case of DVT/ pulmonary embolism and one case of thrombophlebitis. Only one patient with thrombosis did not follow the prophylactic treatment at the service, which was 100mg/day of aspirin. The events occurred on average 72 days after initiating thalidomide use. Five cases were related to mobility reduction, 2 cases to obesity, 2 to smoking, 3 being ex-smokers, 3 to infection concomitant with the thrombotic event, 2 to diabetes and 1 case of previously treated breast cancer. All of the cases presented some associated risk factor. Conclusion and Discussion: The use of aspirin as prophylaxis in the group of MM patients being treated with thalidomide demonstrated efficacy in the control of risk for thrombosis. We observed 6.7% of VTE with the prophylactic use of low-dose aspirin in recently diagnosed MM patients without a history of thrombotic events, as described in the literature. Thalidomide is made available free of charge for MM treatment by the Brazilian public health system. Therefore, it is the main drug used in the MM treatment in Brazil. A better understanding of adequate thrombophylaxis according to the present risk factors is important for the optimization of the treatment of MM patients. Disclosures No relevant conflicts of interest to declare.

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