scholarly journals Current Endovascular Treatment Options in Acute Pulmonary Embolism

2021 ◽  
Vol 11 ◽  
pp. 5
Author(s):  
Kelli Moore ◽  
Jeff Kunin ◽  
Mohammed Alnijoumi ◽  
Prashant Nagpal ◽  
Ambarish P. Bhat
Keyword(s):  
Pulmonary Embolism ◽  
Endovascular Treatment ◽  
Acute Pulmonary Embolism ◽  
Treatment Options ◽  
Mortality And Morbidity ◽  
Response Team ◽  
Promising Treatment ◽  
Level I ◽  
Acute Pe

Acute pulmonary embolism (PE) is a significant cause of mortality and morbidity across the globe. Over the last few decades, there have been major therapeutic advances in acute PE management, including catheter-based therapy. However, the effectiveness of catheter-based therapy in acute PE is not supported by Level I evidence, making the use of this promising treatment rather controversial and ambiguous. In this paper, we discuss the risk stratification of acute PE and review the medical and endovascular treatment options. We also summarize and review the data supporting the use of endovascular treatment options in acute PE and describe the potential role of the PE response team.

scholarly journals Post pulmonary embolism syndrome: a common, underdiagnosed complication that is not well recognised

2019 ◽  
Vol 12 (2) ◽  
pp. e226674 ◽  
Author(s):  
Alexander Sanders ◽  
Max Matonhodze
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Treatment Options ◽  
Common Complication ◽  
Embolism Syndrome ◽  
Acute Pe

A 56-year-old man developed chronic breathlessness which persisted for years after he suffered acute pulmonary embolism (PE) despite all investigations being subsequently normal. This case illustrates a very common complication which occurs in up to half of all patients after an acute PE which has been labelled ‘post pulmonary embolism syndrome’, yet it is not well recognised and at present there is not much research into the prevention or even possible treatment options for patients who develop these symptoms.

scholarly journals Association of hypocalcemia with in-hospital mortality and complications in patients with acute pulmonary embolism: results from the 2017 Nationwide Inpatient Sample

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mukunthan Murthi ◽  
Hafeez Shaka ◽  
Zain El-amir ◽  
Sujitha Velagapudi ◽  
Abdul Jamil ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Regression Analysis ◽  
Hospital Mortality ◽  
Nationwide Inpatient Sample ◽  
Acute Pulmonary Embolism ◽  
Multivariate Logistic Regression Analysis ◽  
Kidney Injury ◽  
Medical Problem ◽  
Mortality And Morbidity ◽  
Acute Pe

Abstract Background Acute pulmonary embolism (PE) is a common cause for hospitalization associated with significant mortality and morbidity. Disorders of calcium metabolism are a frequently encountered medical problem. The effect of hypocalcemia is not well defined on the outcomes of patients with PE. We aimed to identify the prognostic value of hypocalcemia in hospitalized PE patients utilizing the 2017 Nationwide Inpatient Sample (NIS). Methods In this retrospective study, we selected patients with a primary diagnosis of Acute PE using ICD 10 codes. They were further stratified based on the presence of hypocalcemia. We primarily aimed to compare in-hospital mortality for PE patients with and without hypocalcemia. We performed multivariate logistic regression analysis to adjust for potential confounders. We also used propensity‐matched cohort of patients to compare mortality. Results In the 2017 NIS, 187,989 patients had a principal diagnosis of acute PE. Among the above study group, 1565 (0.8%) had an additional diagnosis of hypocalcemia. 12.4% of PE patients with hypocalcemia died in the hospital in comparison to 2.95% without hypocalcemia. On multivariate regression analysis, PE and hypocalcemia patients had 4 times higher odds (aOR-4.03, 95% CI 2.78–5.84, p < 0.001) of in-hospital mortality compared to those with only PE. We observed a similarly high odds of mortality (aOR = 4.4) on 1:1 propensity-matched analysis. The incidence of acute kidney injury (aOR = 2.62, CI 1.95–3.52, p < 0.001), acute respiratory failure (a0R = 1.84, CI 1.42–2.38, p < 0.001), sepsis (aOR = 4.99, CI 3.08–8.11, p < 0.001) and arrhythmias (aOR = 2.63, CI 1.99–3.48, p < 0.001) were also higher for PE patients with hypocalcemia. Conclusion PE patients with hypocalcemia have higher in-hospital mortality than those without hypocalcemia. The in-hospital complications were also higher, along with longer length of stay.

Intrapulmonary Artery Thrombolysis in Acute Pulmonary Embolism: Case Series from King Chulalongkorn Memorial Hospital Experience

2021 ◽  
Vol 104 (8) ◽  
pp. 1376-1380
Keyword(s):  
Pulmonary Embolism ◽  
Plasminogen Activator ◽  
Acute Pulmonary Embolism ◽  
Case Series ◽  
Systemic Thrombolysis ◽  
Tissue Plasminogen ◽  
Surgical Embolectomy ◽  
Surgical Thrombectomy ◽  
Acute Pe

Acute pulmonary embolism (PE) is a life-threatening condition. In patient who has contraindication for systemic thrombolysis and inappropriate for surgical embolectomy, there is a role of catheter interventions. However, the data are limited. The aim of the present report was to assess a role of intrapulmonary artery thrombolysis bolus in acute PE. A retrospective review of the use of intrapulmonary artery thrombolysis in acute PE. The data were collected from 14 patients with massive or submassive PE who had contraindication or inappropriate for systemic thrombolysis and unsuitable for surgical embolectomy. After intrapulmonary thrombolysis was given, patients were followed clinically and hemodynamically until discharged and after 1 month. Pulmonary pressure was collected at pre and post intervention. Of the 14 patients (age 59±19 years, 78.6% female), 86% were diagnosed as submassive PE. Mean dose of tissue plasminogen activator (rt-PA) was 28±14 mg given as bolus and continuous infusion (19±10 hours). One patient died after completion of intrapulmonary infusion rt-PA at day 90, which did not relate to PE and the treatment. After intervention, mean PA pressure was significantly reduced from 32.3±6.0 to 21.0±4.3 mmHg (p<0.001). Three patients (21%) had minor bleeding (hematoma at access site). The present case series showed that intrapulmonary infusion of rt-PA was effective and safe in patient with massive and submassive PE who had contraindication or inappropriate to systemic thrombolysis or inoperable surgical thrombectomy. Keywords: Acute pulmonary embolism; Intrapulmonary thrombolysis; Tissue plasminogen activator; Surgical thrombectomy

scholarly journals Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium

2019 ◽  
Vol 25 ◽  
pp. 107602961985303 ◽  
Author(s):  
Belinda Rivera-Lebron ◽  
Michael McDaniel ◽  
Kamran Ahrar ◽  
Abdulah Alrifai ◽  
David M. Dudzinski ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
International Association ◽  
Response Team ◽  
Threatening Condition ◽  
Life Threatening ◽  
Acute Pe ◽  
Careful Assessment ◽  
Pulmonary Embolism Response Team

Pulmonary embolism (PE) is a life-threatening condition and a leading cause of morbidity and mortality. There have been many advances in the field of PE in the last few years, requiring a careful assessment of their impact on patient care. However, variations in recommendations by different clinical guidelines, as well as lack of robust clinical trials, make clinical decisions challenging. The Pulmonary Embolism Response Team Consortium is an international association created to advance the diagnosis, treatment, and outcomes of patients with PE. In this consensus practice document, we provide a comprehensive review of the diagnosis, treatment, and follow-up of acute PE, including both clinical data and consensus opinion to provide guidance for clinicians caring for these patients.

scholarly journals The value of ecocardiographic in diagnostication and management of pacients with acute pulmonary embolism

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Tatiana Cuzor ◽  
◽  
Nadejda Diaconu ◽  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Thromboembolism ◽  
Fatal Disease ◽  
Right Ventricle Dysfunction ◽  
Additional Information ◽  
Risk Patients ◽  
Acute Pe

Pulmonary thromboembolism (TP) remains an underdiagnosed fatal disease at the emergency unit that suggests the need for alternative noninvasive approaches to rapid diagnosis. The role of echocardiography in acute pulmonary embolism (EP) remains incompletely defined. Echocardiography cannot reliably diagnose acute EP and does not improve the prognosis of patients with low-risk acute PE, who lack other clinical characteristics of right ventricle dysfunction (VD). However, echocardiography and dopplerography of the venous system may produce additional information in high-risk patients and may help differentiate chronic VD dysfunction. Specific echocardiographic predictors of VD dysfunction have the potential to increase prognosis in patients at high risk of TP.

scholarly journals Negative Baseline Imaging Does not Exclude Acute Pulmonary Embolism in Patients with Recurrent Syncopal Episodes and Cardiac Biomarker Elevation

2020 ◽  
Author(s):  
Umut Kocabaş ◽  
Hakan Altay ◽  
Flora Özkalaycı ◽  
Seçkin Pehlivanoğlu
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Cardiac Biomarker ◽  
Mortality And Morbidity ◽  
Vein Thrombosis ◽  
Doppler Ultrasound Imaging ◽  
Uncommon Presentation ◽  
Echocardiographic Examination ◽  
Deep Vein ◽  
Acute Pe

Acute pulmonary embolism (PE) is an important vascular disease with high mortality and morbidity and syncope is an uncommon presentation sign of acute PE. This report presents two cases illustrating acute PE as a cause of recurrent syncopal episodes with elevated cardiac troponin and N-terminal pro-brain natriuretic peptide levels despite normal initial trans-thoracic echocardiographic examination and negative Doppler ultrasound imaging for detection of deep vein thrombosis.

scholarly journals Diagnostic Role of Mean-Platelet Volume in Acute Pulmonary Embolism: A Meta-analysis and Systematic Review

2020 ◽  
Vol 14 ◽  
pp. 117954842095636
Author(s):  
Cláudia Febra ◽  
Ana Macedo
Keyword(s):  
Pulmonary Embolism ◽  
Mean Platelet Volume ◽  
Acute Pulmonary Embolism ◽  
Meta Analysis ◽  
Control Group ◽  
Significant Heterogeneity ◽  
Platelet Volume ◽  
Diagnostic Role ◽  
Acute Pe

Background: Acute pulmonary embolism (PE) is the third most fatal cardiovascular disease. PE is frequently misdiagnosed due to its clinical presentation’s heterogeneity and the inexistence of biomarkers for its immediate diagnosis. Mean platelet volume (MPV) has shown a potential role as a biomarker in acute PE. In this analysis, we aimed to systematically compare the MPV in patients with and without definite diagnosis of PE, in emergency departments. Methods: Embase, PubMed and Medline were searched for relevant publications, in English. The main inclusion criteria were studies which compared MPV in patients with acute PEA versus a control group. Results: Thirteen studies consisting of a total number of 2428 participants were included. Of the participants included, 1316 were patients with confirmed acute PE, and 1112 were assigned to the control group. MPV was significantly higher in patients with acute PE than in controls (RR: 0.84, 95% CI: 0.76 – 0.92; P < .00001). There was a significant heterogeneity in the data. Conclusions: This analysis showed higher MPV to be associated with acute PE immediate diagnosis. These data show promise for the use of MPV as a readily available biomarker for the diagnosis of acute PE at the emergency department.

Role of echocardiography in managing acute pulmonary embolism

Heart ◽  
2019 ◽  
Vol 105 (23) ◽  
pp. 1785-1792 ◽  
Author(s):  
Noura M Dabbouseh ◽  
Jayshil J Patel ◽  
Paul Anthony Bergl
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Prospective Studies ◽  
Acute Pulmonary Embolism ◽  
Economic Value ◽  
Prognostic Information ◽  
Risk Models ◽  
Risk Patients ◽  
Acute Pe

The role of echocardiography in acute pulmonary embolism (PE) remains incompletely defined. Echocardiography cannot reliably diagnose acute PE, and it does not improve prognostication of patients with low-risk acute PE who lack other clinical features of right ventricular (RV) dysfunction. Echocardiography, however, may yield additional prognostic information in higher risk patients and can aid in distinguishing acute from chronic RV dysfunction. Specific echocardiographic markers of RV dysfunction have the potential to enhance prognostication beyond existing risk models. Until these markers are subjected to rigorous prospective studies, the therapeutic utility and economic value of echocardiography in acute PE are uncertain.

Impact of Pulmonary Embolism Response Team on Anticoagulation Prescribing Patterns in Patients With Acute Pulmonary Embolism

2020 ◽  
pp. 089719002094012
Author(s):  
Shannon Kuhrau ◽  
Dalila Masic ◽  
Erin Mancl ◽  
Yevgeniy Brailovsky ◽  
Katerina Porcaro ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Treatment Options ◽  
Prescribing Patterns ◽  
Multiple Treatment ◽  
Response Team ◽  
Treatment Plans ◽  
Multidisciplinary Group ◽  
Pulmonary Embolism Response Team ◽  
Selection Of

Introduction: Anticoagulation remains the mainstay pharmacotherapy for acute pulmonary embolism (PE), but multiple treatment options exist. The Pulmonary Embolism Response Team (PERT) is a multidisciplinary group that evaluates patients, formulates evidence-based treatment plans, and mobilizes resources. The objective of this study was to characterize the anticoagulation prescribing patterns made by PERT and to determine the clinical impact of anticoagulant selection. Materials and Methods: This was a retrospective analysis of patients evaluated by PERT from 2016 to 2018. Multivariable linear regression was conducted to determine predictors of length of stay (LOS). Results: A total of 209 patients were evaluated by PERT and received anticoagulation on discharge. Of those, 47% received a non-vitamin K oral anticoagulant (NOAC), 29% received warfarin, and 23% received low-molecular-weight heparin. Patient preferences and comorbidities were the most common reasons for NOAC omission. Patients who received NOACs had a shorter median LOS than warfarin (6.1 [4.6-7.6] days vs 10.9 [8.4-13.4] days; P < .05). Selection of NOAC upon discharge was the only factor independently associated with reduced LOS (β coefficient: −0.6; 95% CI: −1.01 to −0.18; P < .01). Conclusion: The most common recommendation made by PERT was to initiate a NOAC upon discharge, resulting in shorter hospital LOS compared to patients who received warfarin.

scholarly journals Lifting the fog in intermediate-risk (submassive) PE: full dose, low dose, or no thrombolysis?

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 330
Author(s):  
Amyn Bhamani ◽  
Joanna Pepke-Zaba ◽  
Karen Sheares
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Practice ◽  
Patient Group ◽  
Acute Pulmonary Embolism ◽  
Low Dose ◽  
Intermediate Risk ◽  
Risk Patients ◽  
Surgical Embolectomy ◽  
Acute Pe

Acute pulmonary embolism (PE) is a disease frequently encountered in clinical practice. While the management of haemodynamically stable, low risk patients with acute PE is well established, managing intermediate disease often presents a therapeutic dilemma. In this review, we discuss the various therapeutic options available in this patient group. This includes thrombolysis, surgical embolectomy and catheter directed techniques. We have also explored the role of specialist PE response teams in the management of such patients. ​

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