scholarly journals Treatment of Pulmonary Embolism: a Decade of Experience

2019 ◽  
pp. 46-49
Author(s):  
A. Nikonenko ◽  
A. Nikonenko ◽  
S. Matvieiev ◽  
V. Osaulenko ◽  
S. Nakonechniy
Keyword(s):  
Pulmonary Embolism ◽  
Outpatient Treatment ◽  
Acute Pulmonary Embolism ◽  
High Efficiency ◽  
Oral Anticoagulants ◽  
Fibrinolytic Therapy ◽  
Major Life ◽  
Life Threatening Illness ◽  
The World ◽  
Life Threatening

Pulmonary embolism (PE) is a major life-threatening illness which remains one of the main causes of sudden death throughout the world. The analysis of diagnosis and treatment of 472 patients with acute pulmonary embolism for a period of 10 years was performed. High efficiency of diagnosis using multispiral computer angiopulmonography (MSCT APG) has been established, thus this method completely supersedes the traditional selective angiopulmonography. Seventeen (3.6 %) patients died due to PE recurrence, another 8 (1.7 %) patients died due to the bleeding after using fibrinolytics and anticoagulants, and 14 (2.9 %) died due to progression of organs failure. This emphasizes the need to improve measures aimed to prevent PE recurrence and identify sources of possible bleeding and refrain from aggressive fibrinolytic therapy. The use of differentiated approach to the treatment with thrombolytic therapy and anticoagulants enabled to achieve recovery in 433 (91.7 %) patients who were discharged for outpatient treatment. New oral anticoagulants were prescribed to 94 (21.7 %) patients after discharge.

scholarly journals Early, real-world experience with direct oral anticoagulants in the treatment of intermediate-high risk acute pulmonary embolism

2017 ◽  
Vol 36 (11) ◽  
pp. 801-806
Author(s):  
Sónia Martins Santos ◽  
Susana Cunha ◽  
Rui Baptista ◽  
Sílvia Monteiro ◽  
Pedro Monteiro ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Real World ◽  
Acute Pulmonary Embolism ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants

scholarly journals CURRENT VIEW ON ANTICOAGULANT AND THROMBOLYTIC TREATMENT OF ACUTE PULMONARY EMBOLISM

2019 ◽  
Vol 9 (5) ◽  
pp. 348-366
Author(s):  
G. G. Taradin ◽  
G. A. Ignatenko ◽  
N. T. Vatutin ◽  
I. V. Kanisheva
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Acute Pulmonary Embolism ◽  
Oral Anticoagulants ◽  
Medical Intervention ◽  
Bleeding Complications ◽  
Current View ◽  
Anticoagulant Treatment ◽  
Thrombolytic Treatment ◽  
Systemic Thrombolysis

The presented review concerns contemporary views on specific aspects of anticoagulant and thrombolytic treatment of venous thromboembolism and mostly of acute pulmonary embolism. Modern classifications of patients with acute pulmonary embolism, based on early mortality risk and severity of thromboembolic event, are reproduced. The importance of multidisciplinary approach to the management of patients with pulmonary embolism with the assistance of cardiologist, intensive care specialist, pulmonologist, thoracic and cardiovascular surgeon, aimed at the management of pulmonary embolism at all stages: from clinical suspicion to the selection and performing of any medical intervention, is emphasized. Anticoagulant treatment with the demonstration of results of major trials, devoted to efficacy and safety evaluation of anticoagulants, is highlighted in details. Moreover, characteristics, basic dosage and dosage scheme of direct (new) oral anticoagulants, including apixaban, rivaroxaban, dabigatran, edoxaban and betrixaban are described in the article. In particular, the management of patients with bleeding complications of anticoagulant treatment and its application in cancer patients, who often have venous thromboembolism, is described. Additionally, modern approaches to systemic thrombolysis with intravenous streptokinase, urokinase and tissue plasminogen activators are presented in this review. The indications, contraindications, results of clinical trials devoted to various regimens of thrombolytic therapy, including treatment of pulmonary embolism by lower doses of fibrinolytic agents, are described.

scholarly journals Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study

2011 ◽  
Vol 9 (8) ◽  
pp. 1500-1507 ◽  
Author(s):  
W. ZONDAG ◽  
I. C. M. MOS ◽  
D. CREEMERS-SCHILD ◽  
A. D. M. HOOGERBRUGGE ◽  
O. M. DEKKERS ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Outpatient Treatment ◽  
Acute Pulmonary Embolism

The Fragility and Tenacity of Hope

Save My Kid ◽  
2020 ◽  
pp. 156-172
Author(s):  
Amanda M. Gengler
Keyword(s):  
Brain Tumor ◽  
Daily Life ◽  
Management Strategies ◽  
Illness Management ◽  
Stepping Stone ◽  
Life Threatening Illness ◽  
The World ◽  
Life Threatening ◽  
Emotional Dynamics

Chapter 7 introduces the author’s sudden personal immersion into the world of negotiating life-threatening illness. When Amanda Gengler’s father was diagnosed with a terminal brain tumor, the significant advantages of care-captaining and the potential consequences of care-entrusting were brought into even sharper relief. By living an experience somewhat parallel to that of the families she was studying, she found the emotional dynamics at the root of these illness management strategies crystalizing in her own daily life. She also learned intimately that hope can ultimately serve as both a stepping stone and a stumbling block as illness unfolds.

Abstract 17285: Trends and Outcomes of Fibrinolytic Therapy in Patients With Pulmonary Embolism and Metastatic Cancer

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Gbolahan O Ogunbayo ◽  
Robert Pecha ◽  
Naoki Misumida ◽  
Karam Ayoub ◽  
Dustin Hillerson ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Metastatic Cancer ◽  
Temporal Trends ◽  
Multivariable Analysis ◽  
Fibrinolytic Therapy ◽  
Primary Diagnosis ◽  
Predictors Of Mortality ◽  
History Of ◽  
Baseline Characteristics

Introduction: Pulmonary embolism in the setting of cancer portends a poor prognosis. There is limited data on the use and outcomes of fibrinolytic therapy (FT) in this subgroup of patients. This study describes temporal trends and outcomes of the use of FT among these patients. Hypothesis: The use of FT in patients with metastatic cancer and acute pulmonary embolism is associated with higher mortality Methods: Using the NIS database, we extracted patients with metastatic cancer admitted with a primary diagnosis of acute pulmonary embolism from January 2010 to December 2014. Using weighted data we analyzed the trends of FT in these patients. For analysis of outcomes, we performed a propensity score matching (match tolerance.01) of patients with PE and FT. After matching, we compared baseline characteristics and inpatient outcomes of patients with PE who underwent FT with those that did not. Or primary outcome was mortality. We performed a multivariable regression analysis with mortality as our outcome. We also described predictors of mortality in patients that underwent FT. Results: Of the 65,882 patients with metastatic cancer admitted with a primary diagnosis of PE, 946 (1.4%) underwent fibrinolytic therapy. There was a significant trends of increase in the use of FT in this cohort of patients, increasing from 0.9% in 2010 to 2.1% in 2014. After exclusions 666 were included in the propensity match and all were matched. Both groups were well matched with regards to baseline characteristics. Patients with FT were less likely to be Caucasian or have anemia. The use of FT was more common in teaching hospitals. Patients in the FT arm were more likely to have cardiac arrest, respiratory failure and acute renal failure. There was no difference in rates of bleeding or blood transfusion. Mortality was significantly higher in the FT arm (24% vs. 1.6%, p<.01). In multivariable analysis, FT was independently associated with mortality (OR 8.35, 95% CI 2.2-32.94; p<.01). Among patients with metastatic cancer and acute PE that underwent FT, independent predictors of mortality were Obesity (OR 4.51, 95% CI 1.35-15.03; p=.02), history of coagulopathy (OR 6.71, 95% CI 1.35-33.46; p=.02), current tobacco abuse (OR 3.26, 95% CI 1.04-10.21; p=.04) and a history of anticoagulant use (OR 2.21, 95% CI 1.02-4.82; p=.046). Conclusions: Fibrinolytic therapy in patients with metastatic cancer and acute pulmonary embolism is associated with increase mortality. The clinical benefits expected from the use fibrinolytic therapy in these patients should be weighed against the risks.

Outcomes of fibrinolytic therapy for patients with metastatic cancer and acute pulmonary embolism

2019 ◽  
Vol 56 ◽  
pp. 104-107
Author(s):  
Gbolahan O. Ogunbayo ◽  
Robert Pecha ◽  
Naoki Misumida ◽  
Elliott Goodwin ◽  
Karam Ayoub ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Metastatic Cancer ◽  
Fibrinolytic Therapy

scholarly journals Outpatient Treatment in Low-Risk Pulmonary Embolism Patients Receiving Direct Acting Oral Anticoagulants Is Associated With Cost Savings

2020 ◽  
Vol 26 ◽  
pp. 107602962093735
Author(s):  
Raein Ghazvinian ◽  
Johan Elf ◽  
Sofia Löfvendahl ◽  
Jan Holst ◽  
Anders Gottsäter
Keyword(s):  
Pulmonary Embolism ◽  
Outpatient Treatment ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Cost Savings ◽  
Severity Index ◽  
Low Risk ◽  
Potential Cost ◽  
Total Cost ◽  
Outpatient Group

Direct oral anticoagulants (DOAC) are first line treatment for pulmonary embolism (PE). Treatment of acute PE is traditionally hospital based and associated with high costs. The aims of this study were to evaluate potential cost savings with outpatient DOAC treatment compared to inpatient DOAC treatment in patients with low risk PE. A retrospective study in patients with DOAC treated low risk PE (simplified pulmonary severity index [sPESI] ≤ 1) admitted to 8 hospitals during 2013-2015. Health care costs were compared in 223(44%) patients treated as outpatients and 287(56%) treated in hospital. Total cost per patient was 8293 EUR in the inpatient group, and 2176 EUR in the outpatient group (p < 0.001). Total costs for inpatients were higher (p < 0.001) compared to outpatients in both subgroups with sPESI 0 and 1. In multivariate analysis, type of treatment (in- or outpatient, p = < 0.001) and sPESI group (0 or 1, p = < 0.001) were associated with total cost below or above median, whereas age (p = 0.565) and gender (p = 0.177) was not. Adherence to guidelines recommending outpatient treatment with DOAC in patients with low risk PE enables significant savings.

scholarly journals Early, real-world experience with direct oral anticoagulants in the treatment of intermediate-high risk acute pulmonary embolism

2017 ◽  
Vol 36 (11) ◽  
pp. 801-806 ◽  
Author(s):  
Sónia Martins Santos ◽  
Susana Cunha ◽  
Rui Baptista ◽  
Sílvia Monteiro ◽  
Pedro Monteiro ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Real World ◽  
Acute Pulmonary Embolism ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants

Outpatient Treatment In Patients with Acute Pulmonary Embolism: The Hestia Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. LBA-1-LBA-1
Author(s):  
Wendy Zondag ◽  
Inge Mos ◽  
Dina Creemers ◽  
Lidia Hoogerbrugge ◽  
Olaf Dekkers ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Confidence Interval ◽  
Outpatient Treatment ◽  
Research Funding ◽  
Acute Pulmonary Embolism ◽  
Bleeding Event ◽  
Total Mortality ◽  
Recurrent Vte ◽  
Acute Pe

Abstract Abstract LBA-1 Introduction: Patients with pulmonary embolism (PE) are initially treated in the hospital with low molecular weight heparin (LMWH). The most recent guideline of the American College of Chest Physicians on Antithrombotic therapy 2008 reports some small studies on outpatient treatment in patients with pulmonary embolism, which suggest outpatient treatment in selected patients with PE is potentially effective and safe but firm recommendations for clinical practice are lacking. Clinicians urgently need reliable, easy-to-use selection criteria for selection of patients with pulmonary embolism eligible for outpatient treatment. Objective: To evaluate the efficacy and safety of outpatient treatment according to predefined criteria (Hestia criteria) in patients with acute PE. Patients and Methods: Open-label, single-arm, multicenter clinical trial of patients with objectively proven acute pulmonary embolism, conducted in twelve hospitals in the Netherlands from 2008 to 2010. Follow-up was completed in September 2010. Patients with acute PE were triaged with the predefined Hestia criteria for eligibility for outpatient treatment starting with therapeutic weight adjusted doses of LMWH (Nadroparin), followed by vitamin K antagonists. All patients eligible for outpatient treatment according to the Hestia criteria, were sent home either immediately or within 24 hours after PE was objectively diagnosed. Outcome: Outpatient treatment was evaluated with respect to recurrent venous thromboembolism (VTE), including PE or deep venous thrombosis (DVT), major haemorrhage and total mortality during initial LMWH treatment and 3 months follow up. We considered outpatient treatment to be effective if the upper limit of the 95% confidence interval of the incidence of recurrent VTE would not exceed 7%. Results: Of 297 included patients, who all completed follow-up, 6 patients (2.0%; 95% confidence interval [CI], 0.8–4.3) had recurrent VTE (5 PE (1.7%), 1 DVT (0.3 %)). Three patients (1.0%, 95% CI 0.2–2.9) died during three months follow-up, but none as a result of fatal PE. One patient died of fatal intracerebral haemorrhage, the other two patients died of progressive malignancy. In addition to the patient with intracranial bleeding, one other patient had a major bleeding event (0.7 %, 95% CI 0.08%-2.4%). Conclusion: Outpatient anticoagulant treatment is effective and safe for patients with pulmonary embolism who have been selected with the Hestia criteria. (Dutch Trial Register NTR1319). Disclosures: Huisman: GSK: Research Funding; Actelion: Research Funding; Bayer: Speakers Bureau; Boehringer Ingelheim: Speakers Bureau; Pfizer: Speakers Bureau.

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