1951
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Kow CS, Sunter W, Bain A, Zaidi STR, Hasan SS. Management of Outpatient Warfarin Therapy amid COVID-19 Pandemic: A Practical Guide. Am J Cardiovasc Drugs 2020; 20:301-309. [PMID: 32458370 PMCID: PMC7247959 DOI: 10.1007/s40256-020-00415-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Many healthcare resources have been and continue to be allocated to the management of patients with COVID-19. Therefore, the ongoing care of patients receiving oral anticoagulation with warfarin is likely to be compromised amid this unprecedented crisis. This article discusses a stepwise algorithm for the management of outpatient warfarin therapy. Alternative management strategies are presented and discussed, including alternative pharmacological therapy options and self-monitoring. Our algorithm aims to help clinicians safely optimize the treatment of patients requiring anticoagulation therapy in the context of the global response to the current pandemic.
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1952
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Trombo en tránsito. Arch Bronconeumol 2020; 56:537-539. [DOI: 10.1016/j.arbres.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/22/2020] [Accepted: 04/13/2020] [Indexed: 11/20/2022]
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1953
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Vannini L, Llanos Gómez JM, Quijada-Fumero A, Fernández Pérez AB, Hernández Afonso JS. Embolia pulmonar aguda durante la cuarentena por COVID-19. Rev Esp Cardiol (Engl Ed) 2020; 73:680-682. [PMID: 32834363 PMCID: PMC7296300 DOI: 10.1016/j.recesp.2020.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Luca Vannini
- Departamento de Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, España
- Autor para correspondencia:
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1954
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Horowitz JM, Yuriditsky E, Henderson IJ, Stachel MW, Kwok B, Saric M. Clot in Transit on Transesophageal Echocardiography in a Prone Patient with COVID-19 Acute Respiratory Distress Syndrome. CASE (PHILADELPHIA, PA.) 2020; 4:200-203. [PMID: 32426575 PMCID: PMC7229961 DOI: 10.1016/j.case.2020.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
•The risk for thromboembolic events in COVID-19 is substantial. •PE should be considered in cases of clinical deterioration. •Management of CIT is controversial.
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Affiliation(s)
- James M Horowitz
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Eugene Yuriditsky
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Ian J Henderson
- Department of Medicine, New York University Langone Health, New York, New York
| | - Maxine Wallis Stachel
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Benjamin Kwok
- Department of Medicine, New York University Langone Health, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
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1955
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Alzghoul BN, Reddy R, Chizinga M, Innabi A, Zou B, Papierniak ES, Faruqi I. Pulmonary Embolism in Acute Asthma Exacerbation: Clinical Characteristics, Prediction Model and Hospital Outcomes. Lung 2020; 198:661-669. [PMID: 32424799 PMCID: PMC7711330 DOI: 10.1007/s00408-020-00363-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/11/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Little is known about the characteristics and impact of acute pulmonary embolism (PE) during episodes of asthma exacerbation. We aimed to characterize patients diagnosed with acute PE in the setting of asthma exacerbation, develop a prediction model to help identify future patients and assess the impact of acute PE on hospital outcomes. METHODS We included 758 patients who were treated for asthma exacerbation and underwent a computed tomographic pulmonary angiography (CTA) during the same encounter at a university-based hospital between June 2011 and October 2018. We compared clinical characteristics of patients with and without acute PE and developed a machine learning prediction model to classify the PE status based on the clinical variables. We used multivariable regression analysis to evaluate the impact of acute PE on hospital outcomes. RESULTS Twenty percent of the asthma exacerbation patients who underwent CTA had an acute PE. Factors associated with acute PE included previous history of PE, high CHA2DS2-VASc score, hyperlipidemia, history of deep vein thrombosis, malignancy, chronic systemic corticosteroids use, high body mass index and atrial fibrillation. Using these factors, we developed a random forest machine learning prediction model which had an 88% accuracy in classifying the acute PE status of the patients (area under the receiver operating characteristic curve = 0.899; 95% confidence interval: 0.885-0.913). Acute PE in asthma exacerbation was associated with longer hospital stay and intensive care unit stay. CONCLUSION It is important to consider acute PE, a potentially life-threatening event, in the setting of asthma exacerbation especially when other risk factors are present.
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Affiliation(s)
- Bashar N Alzghoul
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Road, Box 100277, Gainesville, FL, 32608, USA.
- Department of Medicine, University of Florida, Gainesville, FL, USA.
| | - Raju Reddy
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Road, Box 100277, Gainesville, FL, 32608, USA
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Mwelwa Chizinga
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Road, Box 100277, Gainesville, FL, 32608, USA
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Ayoub Innabi
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Road, Box 100277, Gainesville, FL, 32608, USA
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Baiming Zou
- Department of Biostatistics and School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - Eric S Papierniak
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Road, Box 100277, Gainesville, FL, 32608, USA
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Ibrahim Faruqi
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Road, Box 100277, Gainesville, FL, 32608, USA
- Department of Medicine, University of Florida, Gainesville, FL, USA
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1956
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Medina MA, Guerrero AF, Sandoval NF, Umana JP. Successful surgical treatment of clot in transit with impending paradoxical embolism: A case report. JTCVS Tech 2020; 4:140-142. [PMID: 34317989 PMCID: PMC8302995 DOI: 10.1016/j.xjtc.2020.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Maria A Medina
- Department of Cardiovascular Surgery, Fundación Cardioinfantil - Instituto de Cardiologia, Bogotá, Colombia.,Universidad del Rosario, Bogotá, Colombia
| | - Albert F Guerrero
- Department of Cardiovascular Surgery, Fundación Cardioinfantil - Instituto de Cardiologia, Bogotá, Colombia
| | - Nestor F Sandoval
- Department of Cardiovascular Surgery, Fundación Cardioinfantil - Instituto de Cardiologia, Bogotá, Colombia.,Universidad del Rosario, Bogotá, Colombia
| | - Juan P Umana
- Department of Cardiovascular Surgery, Fundación Cardioinfantil - Instituto de Cardiologia, Bogotá, Colombia.,Universidad del Rosario, Bogotá, Colombia
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1957
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Clinical characteristics and outcomes of patients with venous thromboembolism according to diagnosis on weekends versus on weekdays. J Thromb Thrombolysis 2020; 51:779-788. [PMID: 32728908 DOI: 10.1007/s11239-020-02234-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
There are uncertainties on the influence of the days of diagnosis in a week (weekends versus weekdays) on clinical outcomes in patients with acute venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT). The COMMAND VTE registry is a multicenter cohort study enrolling 3027 consecutive patients with acute symptomatic VTE. The current study population consisted of 337 patients diagnosed on weekends and 2690 patients diagnosed on weekdays. We compared the clinical characteristics, management strategies and 30-day outcomes between the 2 groups. The patients diagnosed on weekends more often presented with PE (72% vs. 55%, P < 0.001), and with more severe hemodynamic condition for PE patients. The patients diagnosed on weekends more often received initial parenteral anticoagulation therapy and thrombolysis than those diagnosed on weekdays. The cumulative 30-day incidence of all-cause death was not significantly different between the two groups among PE patients (diagnosis on weekends: 6.2% vs. diagnosis on weekdays: 6.5%, P = 0.87), as well as among DVT patients (0.0% vs. 1.5%, P = 0.24). The most frequent cause of deaths was fatal PE in both groups among PE patients. The risks for recurrent VTE and major bleeding at 30-day were not significantly different between the 2 groups among PE patients, nor among DVT only patients. In conclusion, the VTE patients diagnosed on weekends presented more often with PE, and with more severe condition for PE patients. Nevertheless, the risk for 30-day mortality was not significantly different between patients diagnosed on weekends and on weekdays.
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1958
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Hobohm L, Keller K, Münzel T, Gori T, Konstantinides SV. EkoSonic® endovascular system and other catheter-directed treatment reperfusion strategies for acute pulmonary embolism: overview of efficacy and safety outcomes. Expert Rev Med Devices 2020; 17:739-749. [DOI: 10.1080/17434440.2020.1796632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Lukas Hobohm
- Center for Thrombosis and Hemostasis (CTH, University Medical Center Mainz, Mainz, Germany
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Karsten Keller
- Center for Thrombosis and Hemostasis (CTH, University Medical Center Mainz, Mainz, Germany
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
- Department of Sports Medicine, Internal Medicine VII, Medical Clinic, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Tommaso Gori
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Stavros V. Konstantinides
- Center for Thrombosis and Hemostasis (CTH, University Medical Center Mainz, Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
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1959
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Elgendy IY, Fogerty A, Blanco-Molina Á, Rosa V, Schellong S, Skride A, Portillo J, Lopez-Miguel P, Monreal M, Weinberg I. Clinical Characteristics and Outcomes of Women Presenting with Venous Thromboembolism during Pregnancy and Postpartum Period: Findings from the RIETE Registry. Thromb Haemost 2020; 120:1454-1462. [PMID: 32717760 DOI: 10.1055/s-0040-1714211] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Although venous thromboembolism (VTE) is a leading cause of maternal mortality, there is a paucity of real-world clinical data on clinical presentation and management of VTE during pregnancy and postpartum period. Using data from the international RIETE (Registro Informatizado Enfermedad Trombo Embólica) registry, pregnant and postpartum women with VTE were identified. Baseline characteristics, risk factors, therapies, and outcomes were compared. From March 2001 to July 2019, 596 pregnant and 523 postpartum women had symptomatic, objectively confirmed VTE. Pregnant or postpartum women were less likely to have another risk factor for VTE (i.e., immobility, cancer, recent travel) than nonpregnant women aged < 50 years. The prevalence of thrombophilia was higher among pregnant and postpartum women compared with nonpregnant women (53.2% vs. 46%). Pulmonary embolism (PE) was less commonly diagnosed in pregnant versus postpartum women (27% vs. 42%). Pregnant women with PE were commonly treated with low molecular weight heparin (73% vs. 29%), and received more inferior vena cava filters (6.0% vs. 4.2%) compared with postpartum women. By 90 days, one pregnant and one postpartum woman died after PE, and one died after a deep venous thrombosis. The incidence of recurrent VTE was low. In this largest cohort of pregnant and postpartum women with confirmed VTE, we found that pregnant and postpartum women with VTE were unlikely to present with other risk factors for VTE. Adverse outcomes in our study were uncommon.
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Affiliation(s)
- Islam Y Elgendy
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Annemarie Fogerty
- Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | | | - Vladimir Rosa
- Department of Internal Medicine, Hospital Universitario Virgen de Arrixaca, Murcia, Spain
| | - Sebastian Schellong
- Department of Medical Clinic, Municipal Hospital of Dresden Friedrichstadt, Dresden, Germany
| | - Andris Skride
- Department of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - José Portillo
- Department of Internal Medicine, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Patricia Lopez-Miguel
- Department of Pneumonology, Hospital General Universitario de Albacete, Albacete, Spain
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ido Weinberg
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, United States
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1960
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Jara-Palomares L, Jiménez D, Bikdeli B, Muriel A, Rali P, Yamashita Y, Morimoto T, Kimura T, Le Mao R, Riera-Mestre A, Maestre A, Moustafa F, Monreal M. Derivation and validation of a clinical prediction rule for thrombolysis-associated major bleeding in patients with acute pulmonary embolism: the BACS score. Eur Respir J 2020; 56:2002336. [PMID: 32703772 DOI: 10.1183/13993003.02336-2020] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/27/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Improved 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. METHODS The 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. We also compared the newly created risk score against the Kuijer and RIETE scores. RESULTS Multivariable 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% (149/290) 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 stratum were 5.3% and 4.4%, respectively. CONCLUSIONS The 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.
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Affiliation(s)
- Luis Jara-Palomares
- Respiratory Department, Virgen del Rocío Hospital and Instituto de Biomedicina, Sevilla, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - David Jiménez
- Respiratory Department, Virgen del Rocío Hospital and Instituto de Biomedicina, Sevilla, Spain
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS)
- Medicine Department, Universidad de Alcalá, (IRYCIS) Madrid, Spain
| | - Behnood Bikdeli
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York-Presbyterian Hospital. New York, USA
- Center for Outcomes Research and Evaluation (CORE), Yale University School of Medicine, New Haven, USA
- Cardiovascular Research Foundation, New York, USA
| | - Alfonso Muriel
- Biostatistics Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBERESP, Madrid, Spain
| | - Parth Rali
- Division of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, USA
| | - Yugo Yamashita
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Raphael Le Mao
- EA3878, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université Européenne de Bretagne, Brest, France
| | - Antoni Riera-Mestre
- Department of Internal Medicine, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Ana Maestre
- Department of Internal Medicine, Hospital del Vinalopó, Elche, Spain
| | - Fares Moustafa
- Department of Emergency, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Manuel Monreal
- Respiratory Department, Virgen del Rocío Hospital and Instituto de Biomedicina, Sevilla, Spain
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- Universidad Católica de Murcia, Murcia, Spain
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1961
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Jolobe OMP. Dilemnas raised by implementation of an unqualified STEMI algorithm. Am J Emerg Med 2020; 44:472-473. [PMID: 32690225 DOI: 10.1016/j.ajem.2020.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Oscar M P Jolobe
- Medical Division, Manchester Medical Society, Simon Building, Brunswick Street, Manchester M13 9PL, UK.
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1962
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Predictive Value of Red Blood Cell Distribution Width in Chronic Obstructive Pulmonary Disease Patients with Pulmonary Embolism. Anal Cell Pathol (Amst) 2020; 2020:1935742. [PMID: 32775176 PMCID: PMC7391120 DOI: 10.1155/2020/1935742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/07/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose This study is aimed at investigating the relationship between red cell distribution width (RDW) and chronic obstructive pulmonary disease (COPD) patients with pulmonary embolism (PE). Methods We conducted a retrospective study enrolling a total of 125 patients from January 2013 to December 2019. The study group consisted of 40 COPD patients with PE, and the control group had 85 COPD patients without PE. Clinical data including demographic characteristics, comorbidities, and results of imaging examinations and laboratory tests were recorded. Blood biomarkers, including red blood cell distribution width standard deviation (RDW-SD), red blood cell distribution width coefficient of variation (RDW-CV), and D-Dimer, were included. Results RDW-SD and RDW-CV were higher in the COPD patients with the PE group (p < 0.001). A higher RDW-SD led to a significantly increased risk of PE than a lower RDW-SD (adjusted odds ratio (OR): 1.188; 95% confidence interval (CI): 1.048-1.348). The area under the curve (AUC) of RDW-SD used for predicting PE was 0.737. Using 44.55 as the cutoff value of RDW-SD, the sensitivity was 80% and the specificity was 64.7%. The prediction accuracy of RDW-SD combined with D-Dimer (AUC = 0.897) was higher than that of RDW-SD or D-Dimer alone. The optimal cutoff value of RDW-SD+D-Dimer for predicting PE was 0.266, which generated a sensitivity of 87.5% and specificity of 83.5%. Conclusion RDW is significantly increased in COPD patients with PE and may thus be useful in predicting the occurrence of PE in patients with COPD.
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1963
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Fu Z, Zhuang X, He Y, Huang H, Guo W. The diagnostic value of D-dimer with simplified Geneva score (SGS) pre-test in the diagnosis of pulmonary embolism (PE). J Cardiothorac Surg 2020; 15:176. [PMID: 32690039 PMCID: PMC7372827 DOI: 10.1186/s13019-020-01222-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/13/2020] [Indexed: 11/16/2022] Open
Abstract
Background Pulmonary embolism (PE) is the third most common cardiovascular syndrome with an average annual incidence rate of 77 per 100,000 population in the worldwide. The diagnose algorithms for suspected PE are generally include clinical scoring assessment and plasma D-dimer evaluation, patients with high risk of PE require computed tomographic pulmonary angiogram (CTPA) detection for confirmation. Methods In this retrospective analysis, 1035 patients with suspected PE were recruited. All the patients were clinically received simplified Geneva score (SGS) pre-test, determination of plasma D-dimer level, and CTPA detection. All enrolled patients were grouped according to the CTPA results: PE patients and non-PE patients. Then, receiver operating characteristic (ROC) curve were constructed to determine the optimal D-dimer cutoff point value which is based on Yonden’s index (YI). Results 294 (28.4%) patients were confirmed with PE and 741(71.6%) individuals were regarded as non-PE cases by CTPA detection. Using the SGS pre-test, 829 (80.1%) patients were classified PE-unlikely (SGS ≤ 2) and 206 (19.9%) patients were PE-likely (SGS ≥ 3). Patients with D-dimer levels above 1.96 mg/L had a significant risk to suffer from PE (area under curve (AUC), 0.707; 95% CI, 0.678–0.735; p < 0.05). Meanwhile, in patients with SGS ≥ 3, the D-dimer cutoff point value moved to 2.2 mg/L (AUC, 0.644; 95% CI, 0.574–0.709; p < 0.05). Conclusion D-dimer test in combination with SGS pre-test could improve the accuracy of PE diagnosis. Patients with D-dimer levels over 1.96 mg/L (4 times of the normal level) have a significant risk for PE. In patients with SGS ≥ 3, the D-dimer cutoff point concentration for PE risk moves to the levels of 2.2 mg/L.
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Affiliation(s)
- Zhihui Fu
- Department of Respiratory, Quanzhou First Hospital Affiliated to Fujian Medical University, No. 248-252 Dongjie Street, Quanzhou, 362000, Fujian Province, China.
| | - Xibin Zhuang
- Department of Respiratory, Quanzhou First Hospital Affiliated to Fujian Medical University, No. 248-252 Dongjie Street, Quanzhou, 362000, Fujian Province, China
| | - Yueming He
- Department of Respiratory, Quanzhou First Hospital Affiliated to Fujian Medical University, No. 248-252 Dongjie Street, Quanzhou, 362000, Fujian Province, China
| | - Hong Huang
- Department of Respiratory, Quanzhou First Hospital Affiliated to Fujian Medical University, No. 248-252 Dongjie Street, Quanzhou, 362000, Fujian Province, China
| | - Weifeng Guo
- Department of Respiratory, Quanzhou First Hospital Affiliated to Fujian Medical University, No. 248-252 Dongjie Street, Quanzhou, 362000, Fujian Province, China
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1964
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Havranek S, Fingrova Z, Ambroz D, Jansa P, Kuchar J, Dusik M, Lindner J, Kunstyr J, Aschermann M, Linhart A. Atrial fibrillation and atrial tachycardia in patients with chronic thromboembolic pulmonary hypertension treated with pulmonary endarterectomy. Eur Heart J Suppl 2020; 22:F30-F37. [PMID: 32694951 PMCID: PMC7361671 DOI: 10.1093/eurheartj/suaa096] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Atrial fibrillation (AF) and atrial tachycardia (AT) are frequently observed in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who were treated with pulmonary endarterectomy (PEA). Their prevalence and impact on prognosis of patients are not known. We analysed the prevalence of AF/AT and the clinical outcome in 197 patients with CTEPH treated with PEA (median age 62; interquartile range 53–68 years; 62% males). The prevalence of AF/AT was 29% (57 patients). Compared to patients without arrhythmia, the subjects with AF/AT were older [60 (50–67) vs. 62 (57–70) years], manifested an increased size of the left atrium [39 (35–44) vs. 45 (40–50) mm], had a reduced 6-min walking distance [411 (321–506) vs. 340 (254–460) m], and higher pulmonary artery systolic pressure after PEA [38 (30–47) vs. 45 (38–71) mmHg], all results with P-value <0.05. During the follow-up with a median 4.2 (1.6–6.3) years, 45 (23%) patients died. In a multivariate Cox regression model only the male gender [hazard ratio (HR) 2.27, 95% confidence interval (CI) 1.15–4.50], a reduced 6-min walking distance (HR 3.67, 95% CI 1.74–7.73), and an increased New York Heart Association class (HR 8.56, 95% CI 4.17–17.60) were associated with mortality (P < 0.05). The prevalence of AF/AT in patients with CTEPH treated with PEA is high. Arrhythmias are associated with reduced functional capacity but not with mortality.
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Affiliation(s)
- Stepan Havranek
- 2nd Department of Medicine - Department of Cardiovascular Medicine, General University Hospital in Prague, 1st Faculty of Medicine, Charles University, U Nemocnice 2, Prague 128 08, Czech Republic
| | - Zdenka Fingrova
- 2nd Department of Medicine - Department of Cardiovascular Medicine, General University Hospital in Prague, 1st Faculty of Medicine, Charles University, U Nemocnice 2, Prague 128 08, Czech Republic
| | - David Ambroz
- 2nd Department of Medicine - Department of Cardiovascular Medicine, General University Hospital in Prague, 1st Faculty of Medicine, Charles University, U Nemocnice 2, Prague 128 08, Czech Republic
| | - Pavel Jansa
- 2nd Department of Medicine - Department of Cardiovascular Medicine, General University Hospital in Prague, 1st Faculty of Medicine, Charles University, U Nemocnice 2, Prague 128 08, Czech Republic
| | - Jan Kuchar
- Regional Hospital in Tabor, Kpt. Jarose 2000, Tabor 390 03, Czech Republic
| | - Milan Dusik
- 2nd Department of Medicine - Department of Cardiovascular Medicine, General University Hospital in Prague, 1st Faculty of Medicine, Charles University, U Nemocnice 2, Prague 128 08, Czech Republic
| | - Jaroslav Lindner
- 2nd Department of Surgery - Department of Cardiovascular Surgery, General Univesity Hospital in Prague, 1st Faculty of Medicine, Charles University, U Nemocnice 2, Prague 128 08, Czech Republic
| | - Jan Kunstyr
- Department of Anesthesiology, Resuscitation and Intensive Medicine, General Univesity Hospital in Prague, 1st Faculty of Medicine, Charles University, U Nemocnice 2, Prague 128 08, Czech Republic
| | - Michael Aschermann
- 2nd Department of Medicine - Department of Cardiovascular Medicine, General University Hospital in Prague, 1st Faculty of Medicine, Charles University, U Nemocnice 2, Prague 128 08, Czech Republic
| | - Ales Linhart
- 2nd Department of Medicine - Department of Cardiovascular Medicine, General University Hospital in Prague, 1st Faculty of Medicine, Charles University, U Nemocnice 2, Prague 128 08, Czech Republic
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1965
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Intravascular Leiomyomatosis as a Rare Cause of Nonthrombotic Pulmonary Embolism. Case Rep Vasc Med 2020; 2020:6084061. [PMID: 32733736 PMCID: PMC7378625 DOI: 10.1155/2020/6084061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/30/2020] [Indexed: 11/24/2022] Open
Abstract
Intravascular leiomyomatosis (IVL) is a very rare condition. It is characterized by the proliferation of benign smooth muscle cells within vascular structures without invasion of these tissues. Symptoms depend on the site of origin and the extent of invasion. Rarely, this neoplasm is located in the inferior vena cava or in the pulmonary vasculature potentially causing symptoms of dyspnea, chest pain, or syncope. We report the case of a 53-year-old woman who was referred to our hospital with extensive pulmonary embolism comprising of a subtotal occlusion of the right pulmonary artery with extension into the left pulmonary artery. Due to persistent dyspnea (New York Heart Association class II) despite anticoagulation, after a six-week period, imaging was repeated and showed stable findings. As she was not responding to adequate anticoagulant therapy, intima sarcoma of the pulmonary artery was suspected, and a pulmonary endarterectomy (PEA) was performed. A smooth, white, intravascular mass was easily and completely removed. Analysis demonstrated a lesion consisting of cells without atypia, showing expression of alpha-smooth muscle actin (alpha SMA) and desmin with partial expression of estrogen receptor (ER) and progesterone receptor (PR), leading to the diagnosis of intravascular leiomyomatosis. The patient fully recovered. Complete surgical removal of the intravascular tumor is recommended to relieve symptoms and prevent possible complications. Clinicians have to be aware that in unresolved pulmonary embolism, nonthrombotic and rare causes, like an intima sarcoma or intravascular leiomyomatosis, should be considered.
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1966
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Manual zur Indikation und Durchführung der Echokardiographie – Update 2020 der Deutschen Gesellschaft für Kardiologie. KARDIOLOGE 2020. [DOI: 10.1007/s12181-020-00402-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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1967
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Sun N, Fan Y, Chang J, Chen Y, Gao X, Sun H, Wang Z, Gu X, Tian J, Zhao Y, Yu B, Tian J, Wu B. Plasma irisin level associated with hemodynamic parameters and predict clinical outcome in patients with acute pulmonary embolism. Respir Med 2020; 171:106072. [PMID: 32658835 DOI: 10.1016/j.rmed.2020.106072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of the present study is to investigate the correlation of plasma irisin level and hemodynamic parameters in patients with acute pulmonary embolism (APE) and to estimate clinical outcome prediction value of plasma irisin level. METHODS We prospectively recruited 86 adult patients with APE in the present study. All recruited patients conduct measurement of plasma irisin levels using ELISA kits. Baseline clinical characteristics, hemodynamic parameters and prognostic conditions were evaluated according to different plasma irisin levels. RESULTS According to median values of irisin levels, APE patients were divided into high irisin group (irisin≥6.9 μg/ml) and low irisin group (irisin<6.9 μg/ml). Plasma NT-proBNP (P = 0.044), mean pulmonary artery pressure (mPAP, P = 0.013), systolic pulmonary artery pressure (sPAP, P = 0.001), mean right ventricular pressure (mRVP, P = 0.021) and systolic right ventricular pressure (sPVP, P = 0.003) were higher in low irisin group compared with high irisin group. Hemodynamic parameters of mPAP, sPAP, mRVP and sRVP were negatively correlated with plasma irisin levels. Kaplan- Meier survival analysis showed that APE patients with lower plasma irisin levels had significantly higher clinical worsening event rate (P = 0.026) and could be the independent predictor of prognosis in multivariate analysis (P = 0.035). CONCLUSION Plasma irisin level was negatively correlated with hemodynamic parameters in patients with APE. Low irisin group patients had significantly higher clinical worsening event rate and could be the independent predictor of clinical outcome in multivariate analysis.
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Affiliation(s)
- Na Sun
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Youli Fan
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiaxue Chang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yiqiang Chen
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xuan Gao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongru Sun
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Department of Epidemiology, Public Health College, Harbin Medical University, Harbin, China
| | - Zhuozhong Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Xia Gu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China; Department of Cardiology, Heilongjiang Provincial Hospital, Harbin, China
| | - Jiangtian Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Yingzi Zhao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Jinwei Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China.
| | - Bingxiang Wu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China.
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1968
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Cameli M, Pastore MC, Soliman Aboumarie H, Mandoli GE, D'Ascenzi F, Cameli P, Bigio E, Franchi F, Mondillo S, Valente S. Usefulness of echocardiography to detect cardiac involvement in COVID-19 patients. Echocardiography 2020; 37:1278-1286. [PMID: 32654210 PMCID: PMC7404652 DOI: 10.1111/echo.14779] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/27/2020] [Accepted: 06/07/2020] [Indexed: 12/19/2022] Open
Abstract
Coronavirus disease 2019 (COVID‐19) outbreak is a current global healthcare burden, leading to the life‐threatening severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). However, evidence showed that, even if the prevalence of COVID‐19 damage consists in pulmonary lesions and symptoms, it could also affect other organs, such as heart, liver, and spleen. Particularly, some infected patients refer to the emergency department for cardiovascular symptoms, and around 10% of COVID‐19 victims had finally developed heart injury. Therefore, the use of echocardiography, according to the safety local protocols and ensuring the use of personal protective equipment, could be useful firstly to discriminate between primary cardiac disease or COVID‐19–related myocardial damage, and then for assessing and monitoring COVID‐19 cardiovascular complications: acute myocarditis and arrhythmias, acute heart failure, sepsis‐induced myocardial impairment, and right ventricular failure derived from treatment with high‐pressure mechanical ventilation. The present review aims to enlighten the applications of transthoracic echocardiography for the diagnostic and therapeutic management of myocardial damage in COVID‐19 patients.
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Affiliation(s)
- Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | | | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Paolo Cameli
- Department of Clinical Medical and Neurosciences, Respiratory Disease and Lung Transplantation Section, Le Scotte Hospital, University of Siena, Siena, Italy
| | - Elisa Bigio
- Anesthesiology Unit, Alta Val D'Elsa Hospital, Siena, Italy
| | - Federico Franchi
- Department of Medical Biotechnologies, Anesthesia and Intensive Care, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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1969
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Yuriditsky E, Mitchell OJL, Sista AK, Xia Y, Sibley RA, Zhong J, Moore WH, Amoroso NE, Goldenberg RM, Smith DE, Brosnahan SB, Jamin C, Maldonado TS, Horowitz JM. Right ventricular stroke distance predicts death and clinical deterioration in patients with pulmonary embolism. Thromb Res 2020; 195:29-34. [PMID: 32652350 DOI: 10.1016/j.thromres.2020.06.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/16/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The right ventricular outflow tract (RVOT) velocity time integral (VTI), an echocardiographic measure of stroke distance, correlates with cardiac index. We sought to determine the prognostic significance of low RVOT VTI on clinical outcomes among patients with acute pulmonary embolism (PE). MATERIALS AND METHODS We conducted a retrospective review of echocardiograms on Pulmonary Embolism Response Team (PERT) activations at our institution. The main outcome was a composite of death, cardiac arrest, or hemodynamic deterioration. RESULTS Of 188 patients, 30 met the combined outcome (16%) and had significantly lower RVOT VTI measurements (9.0 cm v 13.4 cm, p < 0.0001). The AUC for RVOT VTI at a cutoff of 10 cm was 0.78 (95% CI 0.67-0.90) with a sensitivity, specificity, negative predictive value, and positive predictive value of 0.72, 0.81, 0.94, and 0.42, respectively. Fifty-two patients of the cohort were classified as intermediate-high-risk PE and 21% of those met the combined outcome. RVOT VTI was lower among outcome positive patients (7.3 cm v 10.7 cm, p = 0.02). CONCLUSIONS Low RVOT VTI is associated with poor clinical outcomes among patients with acute PE.
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Affiliation(s)
- Eugene Yuriditsky
- Division of Cardiology, Department of Medicine, New York University School of Medicine, 530 First Ave. Skirball 9R, New York, NY 10016, United States of America.
| | - Oscar J L Mitchell
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, United States of America
| | - Akhilesh K Sista
- Department of Radiology, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America
| | - Yuhe Xia
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, 180 Madison Ave, New York, NY 10016, United States of America
| | - Rachel A Sibley
- Department of Medicine, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America
| | - Judy Zhong
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, 180 Madison Ave, New York, NY 10016, United States of America
| | - William H Moore
- Department of Radiology, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America
| | - Nancy E Amoroso
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America
| | - Ronald M Goldenberg
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America
| | - Deane E Smith
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America
| | - Shari B Brosnahan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America
| | - Catherine Jamin
- Department of Emergency Medicine, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America
| | - Thomas S Maldonado
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America
| | - James M Horowitz
- Division of Cardiology, Department of Medicine, New York University School of Medicine, 530 First Ave. Skirball 9R, New York, NY 10016, United States of America
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1970
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Tkacheva ON, Kotovskaya YV, Aleksanyan LA, Milto AS, Naumov AV, Strazhesko ID, Vorobyeva NM, Dudinskaya EN, Malaya IP, Krylov KY, Tyukhmenev EA, Rozanov AV, Ostapenko VS, Manevich TM, Shchedrina AY, Semenov FA, Mkhitaryan EA, Khovasova NO, Yeruslanova KA, Kotovskaya NV, Sharashkina NV. Novel coronavirus infection SARS-CoV-2 in elderly and senile patients: prevention, diagnosis and treatment. Expert Position Paper of the Russian Association of Gerontology and Geriatrics. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2601] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A novel coronavirus infection SARS-CoV-2 (COVID19) is especially dangerous for elderly and senile patients. Preventive measures for elderly people should cover three areas: 1) direct prevention of the viral infection, 2) preservation of the functional status and prevention of geriatric syndromes, including the use of social support measures, 3) control of comorbidities. The clinical pattern of COVID-19 in older patients may be atypical, while the mildness of symptoms (no fever, cough, shortness of breath) may not correspond to the severity of the prognosis. Delirium may be the first manifestation of COVID-19, which requires special care in its screening. Management of elderly and senile patients with COVID19 should include measures for delirium prevention, the detection and improvement of nutrition. The risk of malnutrition with sarcopenia increases with hospitalization of a patient, especially when using artificial ventilation, is associated with an unfavorable prognosis during hospitalization, accelerates the progression of senile asthenia and reduces the quality of life. Geriatric assessment is the cornerstone of determining the management of an elderly patient.
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1971
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Coleman CI, Dobesh PP, Danese S, Ulloa J, Lovelace B. Real-world management of oral factor Xa inhibitor-related bleeds with reversal or replacement agents including andexanet alfa and four-factor prothrombin complex concentrate: a multicenter study. Future Cardiol 2020; 17:127-135. [PMID: 32618210 DOI: 10.2217/fca-2020-0073] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: We describe the real-world utilization and outcomes associated with managing oral factor Xa inhibitor (FXai)-related major bleeds. Materials & methods: Electronic records from 45 US hospitals were queried (ICD-10-CM billing codes D68.32, T45.515x or T45.525x) to identify major bleed hospitalizations related to FXai use. Patient demographics, bleed type (intracranial hemorrhage, gastrointestinal, critical compartment, traumatic, other), FXai taken, reversal or replacement agents administered (including andexanet alfa, four-factor prothrombin complex concentrate, fresh frozen plasma, others), in-hospital mortality and length of stay were recorded. Results: Of 3030 FXai-related hospitalizations for major bleeds, patients averaged 68 years old and 47% were women. In-hospital mortality was highest for intracranial hemorrhage (23%, n = 507) and lowest for gastrointestinal bleeds (4%, n = 1453). In-hospital mortality was lowest (4%) for bleeds managed with andexanet alfa (n = 342), compared with 10% for four-factor prothrombin complex concentrate (n = 733), 11% for fresh frozen plasma (n = 925) and 8% for both other agents (n = 794) and no agents (n = 438). Median length of stay was 5 days across all agents, while ICU length of stay was shorter andexanet alfa (2 days) compared with other agents (3 days). Conclusion: In-hospital mortality differed by bleed type and agents administered. Andexanet alfa was associated with the lowest rate of in-hospital mortality across all bleed types.
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Affiliation(s)
- Craig I Coleman
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, 69 North Eagleville Road, Unit 3092, Storrs, CT 06269-3092, USA
| | - Paul P Dobesh
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Nebraska Medical Center, 986145 Nebraska Medical Center, Omaha, NE 68198-6145, USA
| | - Sherry Danese
- Outcomes Insights, 2801 Townsgate Road, Suite 330, Westlake Village, CA 91361, USA
| | - Julie Ulloa
- Outcomes Insights, 2801 Townsgate Road, Suite 330, Westlake Village, CA 91361, USA
| | - Belinda Lovelace
- Portola Pharmaceuticals Inc. 270 E. Grand Avenue South San Francisco, CA 94080, USA
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1972
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Campean IA, Lang IM. Treating pulmonary hypertension in the elderly. Expert Opin Pharmacother 2020; 21:1193-1200. [DOI: 10.1080/14656566.2020.1739270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Ioana A Campean
- Department of Cardiology, Pulmonary Hypertension Unit, Medical University of Vienna, Vienna, Austria
| | - Irene M Lang
- Department of Cardiology, Pulmonary Hypertension Unit, Medical University of Vienna, Vienna, Austria
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1973
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Nair S, Garza N, George M, Kaatz S. Treatment of Acute Venous Thromboembolism. Med Clin North Am 2020; 104:631-646. [PMID: 32505257 DOI: 10.1016/j.mcna.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
"Acute venous thromboembolism is a common disease seen by nearly all hospitalists. The advent of low molecular weight heparin (LMWH) several decades ago ushered in the era of early hospital discharge and home treatment. More recently, the direct oral anticoagulants (DOACs) have further simplified outpatient treatment and some offer treatment without parenteral therapy. Use of DOACs for cancer-associated venous thromboembolism is emerging and is a welcome evolution of care to spare oncologic patients the burden of daily LMWH injections."
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Affiliation(s)
- Sashi Nair
- Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Nina Garza
- Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Matt George
- Division of Hospital Medicine, Henry Ford West Bloomfield Hospital, 6777 West Maple Road, West Bloomfield, MI 48322, USA
| | - Scott Kaatz
- Division of Hospital Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
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1974
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Longchamp A, Longchamp J, Manzocchi‐Besson S, Whiting L, Haller C, Jeanneret S, Godio M, Garcia Martinez JJ, Bonjour T, Caillat M, Maitre G, Thaler JM, Pantet R, Donner V, Dumoulin A, Emonet S, Greub G, Friolet R, Robert‐Ebadi H, Righini M, Sanchez B, Delaloye J. Venous thromboembolism in critically Ill patients with COVID-19: Results of a screening study for deep vein thrombosis. Res Pract Thromb Haemost 2020; 4:842-847. [PMID: 32685893 PMCID: PMC7272794 DOI: 10.1002/rth2.12376] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The rapid spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and coronavirus disease 2019 (COVID-19), has caused more than 3.9 million cases worldwide. Currently, there is great interest to assess venous thrombosis prevalence, diagnosis, prevention, and management in patients with COVID-19. OBJECTIVES To determine the prevalence of venous thromboembolism (VTE) in critically ill patients with COVID-19, using lower limbs venous ultrasonography screening. METHODS Beginning March 8, we enrolled 25 patients who were admitted to the intensive care unit (ICU) with confirmed SARS-CoV-2 infections. The presence of lower extremity deep vein thrombosis (DVT) was systematically assessed by ultrasonography between day 5 and 10 after admission. The data reported here are those available up to May 9, 2020. RESULTS The mean (± standard deviation) age of the patients was 68 ± 11 years, and 64% were men. No patients had a history of VTE. During the ICU stay, 8 patients (32%) had a VTE; 6 (24%) a proximal DVT, and 5 (20%) a pulmonary embolism. The rate of symptomatic VTE was 24%, while 8% of patients had screen-detected DVT. Only those patients with a documented VTE received a therapeutic anticoagulant regimen. As of May 9, 2020, 5 patients had died (20%), 2 remained in the ICU (8%), and 18 were discharged (72%). CONCLUSIONS In critically ill patients with SARS-CoV-2 infections, DVT screening at days 5-10 of admission yielded a 32% prevalence of VTE. Seventy-five percent of events occurred before screening. Earlier screening might be effective in optimizing care in ICU patients with COVID-19.
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Affiliation(s)
- Alban Longchamp
- Department of Intensive Care MedicineCentre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion)SionSwitzerland
- Department of Vascular SurgeryCentre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion)SionSwitzerland
- Department of Vascular SurgeryCentre Hospitalier Universitaire Vaudois and University of LausanneLausanneSwitzerland
| | - Justine Longchamp
- Department of Intensive Care MedicineCentre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion)SionSwitzerland
- Department of Vascular SurgeryCentre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion)SionSwitzerland
| | - Sara Manzocchi‐Besson
- Department of Vascular SurgeryCentre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion)SionSwitzerland
- Division of Angiology and HaemostasisFaculty of MedicineGeneva University HospitalsGenevaSwitzerland
| | - Livia Whiting
- Department of Intensive Care MedicineCentre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion)SionSwitzerland
| | - Claude Haller
- Department of Vascular SurgeryCentre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion)SionSwitzerland
| | - Séverin Jeanneret
- Department of Intensive Care MedicineCentre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion)SionSwitzerland
| | - Manoelle Godio
- Department of Intensive Care MedicineCentre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion)SionSwitzerland
| | - Juan Jose Garcia Martinez
- Department of Intensive Care MedicineCentre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion)SionSwitzerland
| | - Thierry Bonjour
- Department of Intensive Care MedicineCentre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion)SionSwitzerland
| | - Mary Caillat
- Department of Intensive Care MedicineCentre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion)SionSwitzerland
| | - Guillaume Maitre
- Department of Intensive Care MedicineCentre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion)SionSwitzerland
| | - Julian Matthias Thaler
- Department of Intensive Care MedicineCentre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion)SionSwitzerland
| | - Rémy Pantet
- Department of Intensive Care MedicineCentre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion)SionSwitzerland
| | - Viviane Donner
- Department of Intensive Care MedicineCentre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion)SionSwitzerland
| | - Alexis Dumoulin
- Department of Infectious DiseasesInstitut Central des HôpitauxHôpital du ValaisSionSwitzerland
| | - Stéphane Emonet
- Department of Infectious DiseasesInstitut Central des HôpitauxHôpital du ValaisSionSwitzerland
| | - Gilbert Greub
- Department of Infectious DiseasesInstitute of MicrobiologyCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
| | - Raymond Friolet
- Department of Intensive Care MedicineCentre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion)SionSwitzerland
| | - Helia Robert‐Ebadi
- Division of Angiology and HaemostasisFaculty of MedicineGeneva University HospitalsGenevaSwitzerland
| | - Marc Righini
- Division of Angiology and HaemostasisFaculty of MedicineGeneva University HospitalsGenevaSwitzerland
| | - Bienvenido Sanchez
- Department of Intensive Care MedicineCentre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion)SionSwitzerland
| | - Julie Delaloye
- Department of Intensive Care MedicineCentre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion)SionSwitzerland
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1975
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Nopp S, Janata‐Schwatczek K, Prosch H, Shulym I, Königsbrügge O, Pabinger I, Ay C. Pulmonary embolism during the COVID-19 pandemic: Decline in diagnostic procedures and incidence at a university hospital. Res Pract Thromb Haemost 2020; 4:835-841. [PMID: 32685892 PMCID: PMC7276790 DOI: 10.1002/rth2.12391] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/15/2020] [Accepted: 05/17/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has focused medical attention on treating affected patients and protecting others from infection. However, concerns have been raised regarding the pandemic´s impact and associated containment measures (eg curfew, lockdown) on non-coronavirus disease 2019 (COVID-19)-related acute medical diseases. OBJECTIVES To investigate changes in the incidence of pulmonary embolism (PE) during the COVID-19 pandemic compared to the period before the pandemic and reference periods in previous years. METHODS In this single-center study, we explored all diagnostic imaging tests performed for suspected PE between weeks 1 and 17 of the years 2018, 2019, and 2020. Incidence of PE (ie, primary outcome) was analyzed. Secondary outcomes included number of imaging tests for suspected PE. RESULTS Compared to weeks 1 to 11, 2020, an abrupt decline in PE diagnosis (mean weekly rate, 5.2; 95% confidence interval [CI], 3.8-6.6 vs 1.8; 95% CI, 0.0-3.6) and imaging tests (mean weekly rate, 32.5; 95% CI, 27.5-37.6 vs. 17.3; 95% CI, 11.6-23.1) was observed from week 12, with beginning of the containment measures and public lockdown in Austria. Compared to weeks 12 to 17 of 2018 and 2019, PE incidence and imaging tests were similarly decreased from 5.3 (95% CI, 3.6-7.1) to 1.8 (95% CI, 0.0-3.6) and 31.5 (95% CI, 27.1-35.9) to 17.3 (95% CI, 11.6-23.1), respectively. The median simplified pulmonary embolism severity index (sPESI) score of PE patients during the pandemic was higher than in all other PE patients (3; interquartile range, 1-3 vs 1; interquartile range, 0-2; P = .002). CONCLUSION Our study demonstrates that the COVID-19 pandemic has an impact on non-COVID-19-related acute diseases as shown by the decline in incidence of PE and imaging procedures for diagnostic workup. Further studies from other hospitals are needed to confirm our findings.
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Affiliation(s)
- Stephan Nopp
- Clinical Division of Haematology and Haemostaseology, Department of Medicine IMedical University of ViennaViennaAustria
| | | | - Helmut Prosch
- Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
| | - Ihor Shulym
- IT4Science, IT‐Systems & CommunicationsMedical University of ViennaViennaAustria
| | - Oliver Königsbrügge
- Clinical Division of Haematology and Haemostaseology, Department of Medicine IMedical University of ViennaViennaAustria
| | - Ingrid Pabinger
- Clinical Division of Haematology and Haemostaseology, Department of Medicine IMedical University of ViennaViennaAustria
| | - Cihan Ay
- Clinical Division of Haematology and Haemostaseology, Department of Medicine IMedical University of ViennaViennaAustria
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1976
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Barnes GD, Burnett A, Allen A, Blumenstein M, Clark NP, Cuker A, Dager WE, Deitelzweig SB, Ellsworth S, Garcia D, Kaatz S, Minichiello T. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum. J Thromb Thrombolysis 2020. [PMID: 32440883 DOI: 10.1007/s11239-020-02138-z6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a viral infection that can, in severe cases, result in cytokine storm, systemic inflammatory response and coagulopathy that is prognostic of poor outcomes. While some, but not all, laboratory findings appear similar to sepsis-associated disseminated intravascular coagulopathy (DIC), COVID-19- induced coagulopathy (CIC) appears to be more prothrombotic than hemorrhagic. It has been postulated that CIC may be an uncontrolled immunothrombotic response to COVID-19, and there is growing evidence of venous and arterial thromboembolic events in these critically ill patients. Clinicians around the globe are challenged with rapidly identifying reasonable diagnostic, monitoring and anticoagulant strategies to safely and effectively manage these patients. Thoughtful use of proven, evidence-based approaches must be carefully balanced with integration of rapidly emerging evidence and growing experience. The goal of this document is to provide guidance from the Anticoagulation Forum, a North American organization of anticoagulation providers, regarding use of anticoagulant therapies in patients with COVID-19. We discuss in-hospital and post-discharge venous thromboembolism (VTE) prevention, treatment of suspected but unconfirmed VTE, laboratory monitoring of COVID-19, associated anticoagulant therapies, and essential elements for optimized transitions of care specific to patients with COVID-19.
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Affiliation(s)
- Geoffrey D Barnes
- University of Michigan, Ann Arbor, MI, 2800 Plymouth Rd, B14 G214, Ann Arbor, MI, 48109-2800, USA.
| | - Allison Burnett
- University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Arthur Allen
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | | | - Nathan P Clark
- Kaiser Permanente Colorado, Colorado University Skaggs School of Pharmacy, Aurora, CO, USA
| | - Adam Cuker
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | - Tracy Minichiello
- University of California, San Francisco, San Francisco VA Medical Center, San Francisco, CA, USA
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1977
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Catella J, Bertoletti L, Mismetti P, Ollier E, Samperiz A, Soler S, Suriñach JM, Mahé I, Lorente MA, Braester A, Monreal M. Severe renal impairment and risk of bleeding during anticoagulation for venous thromboembolism. J Thromb Haemost 2020; 18:1728-1737. [PMID: 32299150 DOI: 10.1111/jth.14837] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 08/31/2023]
Abstract
BACKGROUND Detection of severe renal impairment in patients with venous thromboembolism (VTE) is mandatory both for selecting anticoagulant therapy and for evaluating major bleeding risk, increased by severe renal impairment. OBJECTIVES To determine whether the Cockcroft and Gault (CG) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas identify severe renal impairment in the same VTE patients presenting the same risk of major bleeding. PATIENTS/METHODS We compared clinical characteristics and outcomes during the first 3 months of anticoagulation between VTE patients in the RIETE registry with severe renal impairment according to the CG and/or CKD-EPI formula (estimated glomerular filtration rate <30 mL/min and <30 mL/min/1.73 m2 , respectively). The primary outcome was major bleeding. RESULTS Up to October 2017, 41 796 patients were included in RIETE. Among the 4676 patients with severe renal impairment according to at least one of the formulas, this was not confirmed by the other formula in 1904 (40.7%). Major bleeding risk was increased in every patient subgroup with severe renal impairment vs patients without this condition (CG or CKD-EPI < 30: odds ratio [OR] = 2.26, 95% confidence interval [CI 2.01-2.53], only CG < 30: OR = 1.72, 95% CI [1.37-2.13], only CKD-EPI < 30: OR = 2.34, 95% CI [1.77-3.05], CG+CKD-EPI < 30: OR = 2.47, 95% CI [2.16-2.83], all vs CG+CKD-EPI > 30). CONCLUSION The CG and CKD-EPI formulas identify different subgroups of patients with severe renal impairment, leading to discordant results in 40.7% of these patients. Irrespective of the formula used for their identification, patients with severe renal impairment have a higher risk of major bleeding under anticoagulant therapy.
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Affiliation(s)
- Judith Catella
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
- INSERM, CIC-1408, CHU Saint-Etienne, Saint-Etienne, France
- F-CRIN INNOVTE network, Saint-Etienne, France
| | - Patrick Mismetti
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
- INSERM, CIC-1408, CHU Saint-Etienne, Saint-Etienne, France
- F-CRIN INNOVTE network, Saint-Etienne, France
| | - Edouard Ollier
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
- URCIP, CHU de St-Etienne, Saint-Etienne, France
| | - Angel Samperiz
- Department of Internal Medicine, Hospital Reina Sofía, Tudela, Spain
| | - Silvia Soler
- Department of Internal Medicine, Hospital Olot i Comarcal de la Garrotxa, Gerona, Spain
| | - José Maria Suriñach
- Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Isabelle Mahé
- F-CRIN INNOVTE network, Saint-Etienne, France
- Department of Internal Medicine, Hôpital Louis Mourier (APHP), University Paris 7, Colombes, France
| | | | - Andrei Braester
- Department of Haematology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Spain
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1978
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Fauvel C, Weizman O, Trimaille A, Mika D, Pommier T, Pace N, Douair A, Barbin E, Fraix A, Bouchot O, Benmansour O, Godeau G, Mecheri Y, Lebourdon R, Yvorel C, Massin M, Leblon T, Chabbi C, Cugney E, Benabou L, Aubry M, Chan C, Boufoula I, Barnaud C, Bothorel L, Duceau B, Sutter W, Waldmann V, Bonnet G, Cohen A, Pezel T. Pulmonary embolism in COVID-19 patients: a French multicentre cohort study. Eur Heart J 2020; 41:3058-3068. [PMID: 32656565 PMCID: PMC7528952 DOI: 10.1093/eurheartj/ehaa500] [Citation(s) in RCA: 190] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/18/2020] [Accepted: 06/07/2020] [Indexed: 12/13/2022] Open
Abstract
AIMS While pulmonary embolism (PE) appears to be a major issue in COVID-19, data remain sparse. We aimed to describe the risk factors and baseline characteristics of patients with PE in a cohort of COVID-19 patients. METHODS AND RESULTS In a retrospective multicentre observational study, we included consecutive patients hospitalized for COVID-19. Patients without computed tomography pulmonary angiography (CTPA)-proven PE diagnosis and those who were directly admitted to an intensive care unit (ICU) were excluded. Among 1240 patients (58.1% men, mean age 64 ± 17 years), 103 (8.3%) patients had PE confirmed by CTPA. The ICU transfer and mechanical ventilation were significantly higher in the PE group (for both P < 0.001). In an univariable analysis, traditional venous thrombo-embolic risk factors were not associated with PE (P > 0.05), while patients under therapeutic dose anticoagulation before hospitalization or prophylactic dose anticoagulation introduced during hospitalization had lower PE occurrence [odds ratio (OR) 0.40, 95% confidence interval (CI) 0.14-0.91, P = 0.04; and OR 0.11, 95% CI 0.06-0.18, P < 0.001, respectively]. In a multivariable analysis, the following variables, also statistically significant in univariable analysis, were associated with PE: male gender (OR 1.03, 95% CI 1.003-1.069, P = 0.04), anticoagulation with a prophylactic dose (OR 0.83, 95% CI 0.79-0.85, P < 0.001) or a therapeutic dose (OR 0.87, 95% CI 0.82-0.92, P < 0.001), C-reactive protein (OR 1.03, 95% CI 1.01-1.04, P = 0.001), and time from symptom onset to hospitalization (OR 1.02, 95% CI 1.006-1.038, P = 0.002). CONCLUSION PE risk factors in the COVID-19 context do not include traditional thrombo-embolic risk factors but rather independent clinical and biological findings at admission, including a major contribution to inflammation.
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Affiliation(s)
- Charles Fauvel
- Rouen University Hospital, FHU REMOD-VHF, F-76000 Rouen, France
| | - Orianne Weizman
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
- Université de Paris, PARCC, INSERM, 75015 Paris, France
| | - Antonin Trimaille
- Nouvel Hôpital Civil, Centre Hospitalier Régional Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Delphine Mika
- Université Paris-Saclay, Inserm, UMR-S 1180, 92296 Chatenay-Malabry, France
| | - Thibaut Pommier
- Centre hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Nathalie Pace
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
| | - Amine Douair
- Centre Hospitalier Annecy Genevois, 74370 Epagny Metz-Tessy, France
| | - Eva Barbin
- Centre Hospitalier Régionnal de Orléans, 45100 Orléans, France
| | - Antoine Fraix
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
| | - Océane Bouchot
- Centre Hospitalier Annecy Genevois, 74370 Epagny Metz-Tessy, France
| | | | | | - Yasmine Mecheri
- Centre Hospitalier Régionnal de Orléans, 45100 Orléans, France
| | - Romane Lebourdon
- Centre Hospitalier Universitaire de Bordeaux, 33076 Bordeaux, France
| | - Cédric Yvorel
- Centre Hospitalier Universitaire de Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
| | - Michael Massin
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
| | - Tiphaine Leblon
- Centre Hospitalier Universitaire de Lille, Université Catholique de Lille, 59000 Lille, France
| | - Chaima Chabbi
- Centre Hospitalier Régionnal de Orléans, 45100 Orléans, France
| | - Erwan Cugney
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
| | - Léa Benabou
- Centre Hospitalier Universitaire de Bordeaux, 33076 Bordeaux, France
| | - Matthieu Aubry
- Hospices Civils de Lyon, Centre Hospitalier Universitaire, 69003 Lyon, France
| | - Camille Chan
- Centre Hospitalier Universitaire de Bordeaux, 33076 Bordeaux, France
| | - Ines Boufoula
- Centre Hospitalier Régionnal de Orléans, 45100 Orléans, France
| | - Clement Barnaud
- Centre Hospitalier Régionnal de Orléans, 45100 Orléans, France
| | - Léa Bothorel
- Centre Hospitalier Régionnal de Orléans, 45100 Orléans, France
| | | | - Willy Sutter
- Université de Paris, PARCC, INSERM, 75015 Paris, France
| | - Victor Waldmann
- Université de Paris, PARCC, INSERM, 75015 Paris, France
- Hôpital Européen Georges Pompidou, Université de Paris, 75015 Paris, France
| | - Guillaume Bonnet
- Université de Paris, PARCC, INSERM, 75015 Paris, France
- Hôpital Européen Georges Pompidou, Université de Paris, 75015 Paris, France
| | | | - Théo Pezel
- Lariboisiere hospital, APHP, University of Paris, 75010 Paris, France
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1979
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Holzmann‐Littig C, Lorenz G, Wen M, Heemann U, Renders L. A case of pulmonary embolism caused by compression of the vena cava by intra-abdominal masses in autosomal polycystic kidney disease. Clin Case Rep 2020; 8:1149-1152. [PMID: 32695346 PMCID: PMC7364094 DOI: 10.1002/ccr3.2852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/06/2020] [Accepted: 03/19/2020] [Indexed: 12/15/2022] Open
Abstract
Dyspnea can have among other reasons pulmonological and cardiological causes. In cases with intra-abdominal masses such as in severe autosomal dominant polycystic kidney disease, mechanical occlusion of the vena cava may result in pulmonary embolism.
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Affiliation(s)
- Christopher Holzmann‐Littig
- Department of NephrologySchool of MedicineKlinikum Rechts der IsarTechnical University of MunichMunichGermany
| | - Georg Lorenz
- Department of NephrologySchool of MedicineKlinikum Rechts der IsarTechnical University of MunichMunichGermany
| | - Ming Wen
- Department of NephrologySchool of MedicineKlinikum Rechts der IsarTechnical University of MunichMunichGermany
| | - Uwe Heemann
- Department of NephrologySchool of MedicineKlinikum Rechts der IsarTechnical University of MunichMunichGermany
| | - Lutz Renders
- Department of NephrologySchool of MedicineKlinikum Rechts der IsarTechnical University of MunichMunichGermany
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1980
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Perrone MA, Zaninotto M, Masotti S, Musetti V, Padoan A, Prontera C, Plebani M, Passino C, Romeo F, Bernardini S, Clerico A. The combined measurement of high-sensitivity cardiac troponins and natriuretic peptides: a useful tool for clinicians? J Cardiovasc Med (Hagerstown) 2020; 21:953-963. [DOI: 10.2459/jcm.0000000000001022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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1981
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Hendriks SV, den Exter PL, Zondag W, Brouwer R, Eijsvogel M, Grootenboers MJ, Faber LM, Heller-Baan R, Hofstee HMA, Iglesias del Sol A, Kruip MJHA, Mairuhu ATA, Melissant CF, Peltenburg HG, van de Ree MA, Serné EH, Huisman MV, Klok FA. Reasons for Hospitalization of Patients with Acute Pulmonary Embolism Based on the Hestia Decision Rule. Thromb Haemost 2020; 120:1217-1220. [DOI: 10.1055/s-0040-1713170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Background The Hestia criteria can be used to select pulmonary embolism (PE) patients for outpatient treatment. The subjective Hestia criterion “medical/social reason for admission” allows the treating physician to consider any patient-specific circumstances in the final management decision. It is unknown how often and why this criterion is scored.
Methods This is a patient-level post hoc analysis of the combined Hestia and Vesta studies. The main outcomes were the frequency of all scored Hestia items in hospitalized patients and the explicit reason for scoring the subjective criterion. Hemodynamic parameters and computed tomography-assessed right ventricular (RV)/left ventricular (LV) ratio of those only awarded with the subjective criterion were compared with patients treated at home.
Results From the 1,166 patients screened, data were available for all 600 who were hospitalized. Most were hospitalized to receive oxygen therapy (45%); 227 (38%) were only awarded with the subjective criterion, of whom 51 because of “intermediate to intermediate-high risk PE.” Compared with patients with intermediate risk PE (RV/LV ratio > 1.0) treated at home (179/566, 32%), hospitalized patients with only the subjective criterion had a higher mean RV/LV ratio (mean difference +0.30, 95% confidence interval [CI] 0.19–0.41) and a higher heart rate (+18/min, 95% CI 10–25). No relevant differences were observed for other hemodynamic parameters.
Conclusion The most frequent reason for hospital admission was oxygen therapy. In the decision to award the subjective criterion as sole argument for admission, the severity of the RV overload and resulting hemodynamic response of the patient was taken into account rather than just abnormal RV/LV ratio.
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Affiliation(s)
- Stephan V. Hendriks
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | - Paul L. den Exter
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Wendy Zondag
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Rolf Brouwer
- Department of Internal Medicine, Reinier de Graaff Gasthuis, Delft, The Netherlands
| | - Michiel Eijsvogel
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Laura M. Faber
- Department of Pulmonary Medicine, Rode Kruis Hospital, Beverwijk, The Netherlands
| | - Roxanne Heller-Baan
- Department of Pulmonary Medicine, Ikazia Hospital, Rotterdam, The Netherlands
| | - Herman M. A. Hofstee
- Department of Internal Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| | | | - Marieke J. H. A. Kruip
- Department of Haematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Albert T. A. Mairuhu
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | | | - Henny G. Peltenburg
- Department of Internal Medicine, Groene Hart Hospital, Gouda, The Netherlands
| | | | - Erik H. Serné
- Department of Internal Medicine, VU Medical Center, Amsterdam, The Netherlands
| | - Menno V. Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederikus A. Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
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1982
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An international survey of clinicians regarding their management of venous thromboembolism following the initial 3-6 months of anticoagulation. J Thromb Thrombolysis 2020; 51:17-24. [PMID: 32592081 DOI: 10.1007/s11239-020-02193-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
After an initial treatment period for venous thromboembolism (VTE), indefinite anticoagulation may be considered, depending upon individual risks. The aim of the study was to determine if there is consensus amongst clinicians that manage VTE regarding which patients require 3-6 months versus indefinite anticoagulation. The importance of VTE site and severity in decision making was also evaluated. An international survey of clinicians involved in VTE management was undertaken. Respondents were asked about long-term treatment of six patients that had completed 3-6 months initial anticoagulation. These included four cases of VTE not associated with a major reversible risk factor and two control cases; one unprovoked VTE and one VTE associated with a major reversible risk factor. For consensus, there was a pre-defined equivalence boundary whereby at least 70% of clinicians had to decide either to stop or consider indefinite anticoagulation for each case. 351 responses were collected. In the control cases, there was a ≥ 95% consensus on long-term management (stop versus indefinite anticoagulation). In three of the four test cases, there was no consensus about duration of anticoagulation. In case 3, 78% (99% confidence interval 73-84%) would stop anticoagulation after 3-6 months. When analysed by grade or specialty of doctor, a lack of consensus remained. Opinion on whether site or severity of VTE influenced decision making was variable. For patients with unprovoked VTE or VTE associated with a major transient risk factor there is treatment consensus. For the remainder, there is a lack consensus regarding the need for indefinite anticoagulation.
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1983
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Barco S, Münger M, Sebastian T, Kucher N. Reperfusion treatment for high-risk pulmonary embolism associated with COVID-19. VASA 2020; 49:257-258. [PMID: 32578520 DOI: 10.1024/0301-1526/a000884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Stefano Barco
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland.,Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mario Münger
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Tim Sebastian
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Nils Kucher
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
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1984
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Porfidia A, Pola R. Venous Thromboembolism and Heparin Use in COVID-19 Patients: Juggling between Pragmatic Choices, Suggestions of Medical Societies and the Lack of Guidelines. J Thromb Thrombolysis 2020; 50:68-71. [PMID: 32367471 PMCID: PMC7196627 DOI: 10.1007/s11239-020-02125-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Angelo Porfidia
- Division of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberto Pola
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy. .,Istituto di Medicina Interna e Geriatria, 9th Floor, C Wing, Room C907 Policlinico A. Gemelli L.go A. Gemelli 8, Rome, 00168, Italy.
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1985
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Kerget B, Afşin DE, Aksakal A, Aşkin S, Araz Ö. Could HIF-1α be a novel biomarker for the clinical course and treatment of pulmonary embolism? Turk J Med Sci 2020; 50:963-968. [PMID: 32421278 PMCID: PMC7379473 DOI: 10.3906/sag-1908-93] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 05/16/2020] [Indexed: 11/03/2022] Open
Abstract
Background/aim Pulmonary embolism (PE) is associated with high morbidity and mortality rates if not diagnosed and treated rapidly. The aim of our study was to investigate the relationship between levels of hypoxia-induced factor-1 alpha (HIF-1α) and clinical course and prognosis in patients with intermediate low-risk, intermediate high-risk, and high-risk PE. Materials and methods The study included 240 subjects in 4 groups: a healthy control group (n = 60, mean age = 60 ± 15.2, female/male = 30/30 ), intermediate low-risk PE group (n = 60, mean age = 60 ± 12,5, female/male = 27/33), intermediate high-risk PE group (n = 60, mean age = 61,4 ± 14,8, female/male = 36/24), and high-risk PE group (n = 60, mean age = 62,3 ± 15, female/male = 33/27). Plasma HIF-1α levels were measured using commercial enzyme-linked immunosorbent assay (ELISA) kit. Results Comparison of HIF-1α levels revealed a statistically significant difference between the groups in proportion to clinical scoring (P = 0.001 for all). Comparison of initial HIF-1α and troponin levels in intermediate high-risk PE patients given thrombolytic therapy and those treated with enoxaparin sodium showed that HIF-1α levels were significantly higher in the group that received thrombolytic therapy (P = 0.001), while there was no difference in troponin levels (P = 0.146). Conclusion HIF-1α can be used in the PE clinical risk stratification and monitoring of PE and may also serve as a valuable early indicator in intermediate high-risk PE, for which early reperfusion therapy is important.
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Affiliation(s)
- Buğra Kerget
- Department of Pulmonary Diseases, Health Sciences University Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | | | - Alperen Aksakal
- Department of Pulmonary Diseases, School of Medicine, Atatürk University, Erzurum, Turkey
| | - Seda Aşkin
- Department of Biochemistry, School of Medicine, Atatürk University, Erzurum, Turkey
| | - Ömer Araz
- Department of Pulmonary Diseases, School of Medicine, Atatürk University, Erzurum, Turkey
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1986
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Analysis of pulmonary embolism patients treated with EkoSonic™ endovascular system. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:301-307. [PMID: 32551160 DOI: 10.5606/tgkdc.dergisi.2020.19133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/04/2020] [Indexed: 11/21/2022]
Abstract
Background The aim of this study was to evaluate the efficacy and the safety of the EkoSonic™ endovascular system applications in patients hospitalized with the diagnosis of intermediate-high-risk pulmonary embolism. Methods Between January 2018 and March 2019, a total of 15 patients (7 males, 8 females; mean age 64.7±17.8 years, range, 35 to 90 years) who underwent ultrasound-accelerated thrombolysis using the EkoSonic™ endovascular system for pulmonary embolism were retrospectively analyzed. The diagnosis of pulmonary embolism was made based on pulmonary computed tomography angiography. All patients were evaluated by echocardiography for right ventricular dysfunction and serum levels of troponin I and brain natriuretic peptide were recorded. Results The mean arterial blood gas oxygen saturation values of the patients before and after the procedure were 86.3±3.5% and 94.2±2.5%, respectively, indicating a statistically significant difference (p=0.001). The mean partial oxygen pressure values before and after the procedure were 73.3±7.7 mmHg and 90.7±5.0 mmHg, respectively, indicating a statistically significant difference (p=0.001). There was also a statistically significant difference in the mean right ventricular diameter before and after the procedure (p=0.001). The mean pre- and post-procedural pulmonary arterial pressure was 44±7.1 mmHg and 36.3±4.5 mmHg, respectively, indicating a statistically significant difference (p=0.001). Of the patients, 93.7% were free from post-procedural complications. Conclusion The EkoSonic™ endovascular system improved right ventricular dysfunction, decreased pulmonary arterial pressure, and improved oxygenation in patients with intermediate-high-risk pulmonary embolism without increasing the risk for bleeding.
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1987
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1988
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Barnes GD, Burnett A, Allen A, Blumenstein M, Clark NP, Cuker A, Dager WE, Deitelzweig SB, Ellsworth S, Garcia D, Kaatz S, Minichiello T. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum. J Thromb Thrombolysis 2020; 50:72-81. [PMID: 32440883 PMCID: PMC7241581 DOI: 10.1007/s11239-020-02138-z] [Citation(s) in RCA: 307] [Impact Index Per Article: 76.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a viral infection that can, in severe cases, result in cytokine storm, systemic inflammatory response and coagulopathy that is prognostic of poor outcomes. While some, but not all, laboratory findings appear similar to sepsis-associated disseminated intravascular coagulopathy (DIC), COVID-19- induced coagulopathy (CIC) appears to be more prothrombotic than hemorrhagic. It has been postulated that CIC may be an uncontrolled immunothrombotic response to COVID-19, and there is growing evidence of venous and arterial thromboembolic events in these critically ill patients. Clinicians around the globe are challenged with rapidly identifying reasonable diagnostic, monitoring and anticoagulant strategies to safely and effectively manage these patients. Thoughtful use of proven, evidence-based approaches must be carefully balanced with integration of rapidly emerging evidence and growing experience. The goal of this document is to provide guidance from the Anticoagulation Forum, a North American organization of anticoagulation providers, regarding use of anticoagulant therapies in patients with COVID-19. We discuss in-hospital and post-discharge venous thromboembolism (VTE) prevention, treatment of suspected but unconfirmed VTE, laboratory monitoring of COVID-19, associated anticoagulant therapies, and essential elements for optimized transitions of care specific to patients with COVID-19.
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Affiliation(s)
- Geoffrey D Barnes
- University of Michigan, Ann Arbor, MI, 2800 Plymouth Rd, B14 G214, Ann Arbor, MI, 48109-2800, USA.
| | - Allison Burnett
- University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Arthur Allen
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | | | - Nathan P Clark
- Kaiser Permanente Colorado, Colorado University Skaggs School of Pharmacy, Aurora, CO, USA
| | - Adam Cuker
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | - Tracy Minichiello
- University of California, San Francisco, San Francisco VA Medical Center, San Francisco, CA, USA
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1989
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Direct oral anticoagulant versus low-molecular-weight heparin for treatment of venous thromboembolism in cancer patients: An updated meta-analysis of randomized controlled trials. Thromb Res 2020; 194:57-65. [PMID: 32788122 DOI: 10.1016/j.thromres.2020.06.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cancer associated venous thromboembolism (VTE) results in significant morbidity and mortality. Low molecular weight heparin (LMWH) has been standard of care for treatment of cancer-associated VTE, however direct oral anticoagulants (DOACs) are emerging as alternative treatment options. OBJECTIVE To compare the benefits and harms of DOACs versus LMWH for treatment of VTE in cancer. DATA SOURCES MEDLINE, Embase, and the Cochrane Collaboration Central Register of Controlled Trials from inception to April 2020. STUDY SELECTION Randomized controlled trials (RCT) comparing DOACs with LMWH for treatment of VTE in cancer patients. DATA SYNTHESIS Four good-quality RCTs, met inclusion criteria. Compared with LMWH, DOACs were associated with lower rates of VTE recurrence (RR 0.62; 95% CI: 0.44-0.87; P = 0.006), and DVT recurrence (RR 0.61; 95% CI: 0.4-0.94; P = 0.02) but not PE recurrence (RR 0.73; 95% CI: 0.51-1.04; P = 0.08), in cancer patients. However, the risk of clinically relevant non-major bleeding (CRNMB) (RR 1.58; 95% CI: 1.11-2.24; P = 0.01), and major bleeding in gastrointestinal cancer (RR 2.55; 95% CI 1.24-5.27, P = 0.01), were higher with DOACs. The risk of overall major bleeding (RR 1.33; 95% CI: 0.84-2.1; P = 0.22), all-cause mortality (RR 0.99; 95% CI: 0.84-1.17; P = 0.92), VTE-related mortality (RR: 1; 95% CI: 0.29-3.44; P = 1) and bleeding-related mortality (RR: 0.71; 95% CI: 0.17-2.91; P = 0.63), were similar in both treatment groups. CONCLUSION Among cancer patients with VTE, treatment with DOACs is associated with a significant reduction of VTE and DVT recurrence, compared to LMWH. These benefits were offset by an increased risk of CRNMB, and major bleeding in gastrointestinal cancer.
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1990
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Adverse Events and Mortality in Anticoagulated Patients with Different Categories of Pulmonary Embolism. Mayo Clin Proc Innov Qual Outcomes 2020; 4:249-258. [PMID: 32542216 PMCID: PMC7283932 DOI: 10.1016/j.mayocpiqo.2020.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective To determine whether the pulmonary embolism (PE) categories of massive, submassive, PE with no right ventricle dysfunction (NRVD), and subsegmental only (SSO) adequately predict clinical outcome. Methods Patients treated for acute PE (March 1, 2013, through July 31, 2019) were followed forward prospectively to compare venous thromboembolism (VTE) recurrence, all-cause mortality, major bleeding, and clinically relevant nonmajor bleeding (CRNMB) across 4 PE categories. Results Of 2703 patients with VTE, 1188 (44%) had PE, of which 1021 (85.9%) completed at least 3 months of therapy or had clinical outcomes precluding further treatment (27 with massive, 217 submassive, 557 NRVD, and 220 SSO PE). One patient with massive, 8 with submassive, 23 with NRVD, and 5 with SSO PE had recurrent VTE (3.90, 5.33, 5.36, and 3.66 per 100 person-years, respectively; P=.84). There were 3 deaths in massive, 27 in submassive, 140 in NRVD, and 34 in SSO PE groups (11.59, 17.37, 31.74, and 24.74 per 100 person-years, respectively; P=.02); when adjusted for cancer, the relationship was no longer significant (P=.27). One patient with massive, 5 with submassive, 22 with NRVD, and 5 with SSO PE had major bleeding (3.90, 3.31, 5.24, and 3.75 per 100 person-years, respectively; P=.66). Similar cumulative rates for CRNMB were observed (P=.87). Three-month rates of VTE recurrence, death, major bleeding, and CRNMB did not differ by PE category. Conclusion In the setting of anticoagulation therapy with maximal standardization and evidence-based practice, there is no evidence of a difference between PE categories and outcomes. Trial Registration clinicaltrials.gov Identifier: NCT03504007.
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Key Words
- AHA, American Heart Association
- CRNMB, clinically relevant nonmajor bleeding
- CT, computed tomography
- DVT, deep vein thrombosis
- HR, hazard ratio
- NRVD, no right ventricle dysfunction
- PE, pulmonary embolism
- PESI, Pulmonary Embolism Severity Index
- RV, right ventricle
- SSO, subsegmental only
- VTE, venous thromboembolism
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1991
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Montemerani S, Donati V, Di Pietra N, Iannelli G. Point-of-care ultrasound (POCUS) as the keystone investigation in undifferentiated dyspnoea. BMJ Case Rep 2020; 13:13/6/e234602. [PMID: 32554451 DOI: 10.1136/bcr-2020-234602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Dyspnoea is defined as a subjective perception of laboured breathing. It is a common cause of access to the emergency department (ED), it has a high rate of intensive care unit admission and a high mortality. The most common causes of dyspnoea in the adult include pneumonia, heart failure, chronic obstructive pulmonary disease, pulmonary embolism and asthma. Due to the high variety of dyspnoea's causes, the need for a rapid and accurate diagnosis puts the emergency physician in trouble. Moreover, standard tests such as chest radiography, B-type natriuretic peptide and d-dimer require time and may be less useful in patients with respiratory failure who require urgent therapy. Point-of-care ultrasound (POCUS) is rapid, non-invasive, repeatable and a useful tool in evaluating patients with acute and severe dyspnoea. This case report demonstrates the usefulness of POCUS in a patient with undifferentiated respiratory failure presenting to the ED.
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Affiliation(s)
- Sara Montemerani
- UOC Medicina e Chiururgia d'accettazione e d'urgenza, Azienda Ospedaliera Universitaria Senese, Siena, Toscana, Italia
| | - Valeria Donati
- UOC Medicina e Chiururgia d'accettazione e d'urgenza, Ospedale San Donato, Arezzo, Toscana, Italia
| | - Nicola Di Pietra
- UOC Medicina e Chiururgia d'accettazione e d'urgenza, Ospedale San Donato, Arezzo, Toscana, Italia
| | - Giovanni Iannelli
- UOC Medicina e Chiururgia d'accettazione e d'urgenza, Ospedale San Donato, Arezzo, Toscana, Italia
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1992
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Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, Nigoghossian CD, Ageno W, Madjid M, Guo Y, Tang LV, Hu Y, Giri J, Cushman M, Quéré I, Dimakakos EP, Gibson CM, Lippi G, Favaloro EJ, Fareed J, Caprini JA, Tafur AJ, Burton JR, Francese DP, Wang EY, Falanga A, McLintock C, Hunt BJ, Spyropoulos AC, Barnes GD, Eikelboom JW, Weinberg I, Schulman S, Carrier M, Piazza G, Beckman JA, Steg PG, Stone GW, Rosenkranz S, Goldhaber SZ, Parikh SA, Monreal M, Krumholz HM, Konstantinides SV, Weitz JI, Lip GYH. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 75:2950-2973. [PMID: 32311448 PMCID: PMC7164881 DOI: 10.1016/j.jacc.2020.04.031] [Citation(s) in RCA: 2100] [Impact Index Per Article: 525.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus disease-2019 (COVID-19), a viral respiratory illness caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), may predispose patients to thrombotic disease, both in the venous and arterial circulations, because of excessive inflammation, platelet activation, endothelial dysfunction, and stasis. In addition, many patients receiving antithrombotic therapy for thrombotic disease may develop COVID-19, which can have implications for choice, dosing, and laboratory monitoring of antithrombotic therapy. Moreover, during a time with much focus on COVID-19, it is critical to consider how to optimize the available technology to care for patients without COVID-19 who have thrombotic disease. Herein, the authors review the current understanding of the pathogenesis, epidemiology, management, and outcomes of patients with COVID-19 who develop venous or arterial thrombosis, of those with pre-existing thrombotic disease who develop COVID-19, or those who need prevention or care for their thrombotic disease during the COVID-19 pandemic.
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Affiliation(s)
- Behnood Bikdeli
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York; Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Connecticut; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
| | - Mahesh V Madhavan
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
| | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal and Medicine Department, Universidad de Alcalá (Instituto de Ramón y Cajal de Investigación Sanitaria), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Taylor Chuich
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Isaac Dreyfus
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Elissa Driggin
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | | | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Mohammad Madjid
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Yutao Guo
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Liang V Tang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jay Giri
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Mary Cushman
- University of Vermont Medical Center, Burlington, Vermont
| | - Isabelle Quéré
- Department of Vascular Medicine, University of Montpellier, Centre Hospitalier Universitaire Montpellier, InnoVTE F-CRIN Network, Montpellier, France
| | - Evangelos P Dimakakos
- Oncology Unit GPP, Sotiria General Hospital Athens School of Medicine, Athens, Greece
| | - C Michael Gibson
- Harvard Medical School, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Giuseppe Lippi
- Laboratory of Clinical Chemistry and Hematology, University Hospital of Verona, Verona, Italy
| | - Emmanuel J Favaloro
- Haematology Laboratory, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia; Sydney Centres for Thrombosis and Haemostasis, Westmead, New South Wales, Australia
| | - Jawed Fareed
- Loyola University Medical Center, Chicago, Illinois
| | - Joseph A Caprini
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Alfonso J Tafur
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois; Division of Vascular Medicine, Department of Medicine, NorthShore University HealthSystem, Skokie, Illinois
| | - John R Burton
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Dominic P Francese
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Elizabeth Y Wang
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Anna Falanga
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, University of Milan Bicocca, Bergamo, Italy
| | | | | | - Alex C Spyropoulos
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, New York
| | - Geoffrey D Barnes
- Center for Bioethics and Social Science in Medicine, University of Michigan, Ann Arbor, Michigan; Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - John W Eikelboom
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ido Weinberg
- Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts
| | - Sam Schulman
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; McMaster University, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Marc Carrier
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gregory Piazza
- Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | | | - P Gabriel Steg
- INSERM U1148, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, FACT (French Alliance for Cardiovascular Trials), Paris, France; Université Paris, Paris, France; Royal Brompton Hospital, Imperial College London, London, United Kingdom
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephan Rosenkranz
- Cologne Cardiovascular Research Center, Heart Center, Department of Cardiology, University of Cologne, Cologne, Germany
| | - Samuel Z Goldhaber
- Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - Sahil A Parikh
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trials i Pujol, Universidad Católica San Antonio de Murcia, Barcelona, Spain
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Connecticut; Department of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Jeffrey I Weitz
- McMaster University, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, United Kingdom; Aalborg University, Aalborg, Denmark
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1993
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Schulman S, Konstantinides S, Hu Y, Tang LV. Venous Thromboembolic Diseases: Diagnosis, Management and Thrombophilia Testing: Observations on NICE Guideline [NG158]. Thromb Haemost 2020; 120:1143-1146. [PMID: 32526791 DOI: 10.1055/s-0040-1712913] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Sam Schulman
- Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada.,Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.,Department of Cardiology, Democritus University of Thrace, Thrace, Greece
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang V Tang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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1994
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Outpatient Pulmonary Rehabilitation in Patients with Persisting Symptoms after Pulmonary Embolism. J Clin Med 2020; 9:jcm9061811. [PMID: 32532020 PMCID: PMC7355580 DOI: 10.3390/jcm9061811] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/28/2020] [Accepted: 06/09/2020] [Indexed: 12/01/2022] Open
Abstract
Background: Patients with pulmonary embolism (PE) may suffer from long-term consequences, including decreased functional capacity. Data on pulmonary rehabilitation (PR) in patients with PE are scarce, and no data on outpatient PR are available so far. Methods: We analyzed data of 22 PE patients who attended outpatient PR due to exertional dyspnea. Patients underwent a multi-professional 6-week PR program. The primary outcome was change in 6-min walk test (6MWT). Secondary outcomes included changes in strength and endurance tests. To assess long-term benefits, follow-up was performed a median of 39 months after PR. Results: Patients started PR a median of 19 weeks after the acute PE event. Their median age was 47.5 years, 33% were women and all presented with NYHA (New York Heart Association) class II and higher. After PR, patients showed significant and clinically relevant improvements in 6MWT (mean difference: 49.4 m [95% CI 32.0−66.8]). Similarly, patients increased performance in maximum strength, endurance and inspiratory muscle strength. At long-term follow-up, 78% of patients reported improved health. Conclusion: We observed significant improvements in exercise capacity in PE patients undergoing outpatient PR. The majority of patients also reported a long-term improvement in health status. Prospective studies are needed to identify patients who would benefit most from structured PR.
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1995
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Brown LB, Streiff MB, Haut ER. Venous Thromboembolism Prevention and Treatment in Cancer Surgery. Adv Surg 2020; 54:17-30. [PMID: 32713428 DOI: 10.1016/j.yasu.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Lawrence B Brown
- Department of Surgery, The Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, 1800 Orleans Street - Tower 110, Baltimore, MD 21287, USA. https://twitter.com/lawrenceb_brown
| | - Michael B Streiff
- Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7300, Baltimore, MD 21205, USA; Department of Pathology, The Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7300, Baltimore, MD 21205, USA; The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA. https://twitter.com/mstreif1
| | - Elliott R Haut
- The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA; Anesthesiology and Critical Care Medicine (ACCM), Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7300, Baltimore, MD 21205, USA; Emergency Medicine, Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Health Policy & Management, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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1996
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Mauro C, Vriz O, Romano L, Citro R, Russo V, Ranieri B, Alamro B, Aladmawi M, Granata R, Galzerano D, Bellino M, Cocchia R, Mehta RM, Dellegrottaglie S, Alsergani H, Mehta RH, Bossone E. Imaging Cardiovascular Emergencies: Real World Clinical Cases. Heart Fail Clin 2020; 16:331-346. [PMID: 32503756 DOI: 10.1016/j.hfc.2020.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Cardiovascular emergencies represent life-threatening conditions requiring a high index of clinical suspicion. In an emergency scenario, a simple stepwise biomarker/imaging diagnostic algorithm may help prompt diagnosis and timely treatment along with related improved outcomes. This article describes several clinical cases of cardiovascular emergencies, such as coronary stent thrombosis-restenosis, takotsubo syndrome, acute myocarditis, massive pulmonary embolism, type A acute aortic dissection, cardiac tamponade, and endocarditis.
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Affiliation(s)
- Ciro Mauro
- Cardiology Division, A Cardarelli Hospital, Via Cardarelli 9, Naples I-80131, Italy
| | - Olga Vriz
- Cardiology Department, Heart Centre, King Faisal Specialist Hospital & Research Centre, MBC-16, PO Box 3354, Riyadh 11211, Saudi Arabia
| | - Luigia Romano
- Department of General and Emergency Radiology, A Cardarelli Hospital, Via Cardarelli 9, Naples I-80131, Italy
| | - Rodolfo Citro
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Largo Città d'Ippocrate, Salerno 84131, Italy
| | - Valentina Russo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini 5, Naples I-80131, Italy
| | | | - Bandar Alamro
- Cardiology Department, Heart Centre, King Faisal Specialist Hospital & Research Centre, MBC-16, PO Box 3354, Riyadh 11211, Saudi Arabia
| | - Mohammed Aladmawi
- Cardiology Department, Heart Centre, King Faisal Specialist Hospital & Research Centre, MBC-16, PO Box 3354, Riyadh 11211, Saudi Arabia
| | - Riccardo Granata
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini 5, Naples I-80131, Italy
| | - Domenico Galzerano
- Cardiology Department, Heart Centre, King Faisal Specialist Hospital & Research Centre, MBC-16, PO Box 3354, Riyadh 11211, Saudi Arabia
| | - Michele Bellino
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Largo Città d'Ippocrate, Salerno 84131, Italy
| | - Rosangela Cocchia
- Division of Cardiac Rehabilitation - Echo Lab, A Cardarelli Hospital, Naples, Italy
| | - Rahul M Mehta
- ProMedica Monroe Regional Hospital, 718 North Macomb Street, Monroe, MI 48162, USA
| | - Santo Dellegrottaglie
- Division of Cardiology, Clinica Villa dei Fiori, C.so Italia 157, 80011, Acerra, Naples, Italy
| | - Hani Alsergani
- Cardiology Department, Heart Centre, King Faisal Specialist Hospital & Research Centre, MBC-16, PO Box 3354, Riyadh 11211, Saudi Arabia
| | - Rajendra H Mehta
- Duke Clinical Research Institute, Durham, 300 West Morgan Street, Durham, NC 27701, USA
| | - Eduardo Bossone
- Division of Cardiac Rehabilitation - Echo Lab, A Cardarelli Hospital, Naples, Italy.
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1997
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Patelis N, Bisdas T, Tsiachris D, Stefanadis CI. The role of vascular surgeons in the treatment of COVID-19-associated pulmonary embolism. J Vasc Surg 2020; 72:1148. [PMID: 32497750 PMCID: PMC7263233 DOI: 10.1016/j.jvs.2020.05.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/22/2020] [Indexed: 11/28/2022]
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1998
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Chez les sujets ambulatoires avec embolie pulmonaire suspectée, une nouvelle stratégie diagnostique utilisant les D-dimères ajustés en fonction de la probabilité clinique permet-elle d’exclure de façon sécuritaire ce diagnostic sans avoir recours à l’imagerie ? Rev Med Interne 2020; 41:429-430. [DOI: 10.1016/j.revmed.2020.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/06/2020] [Indexed: 11/24/2022]
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1999
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Galastri FL, Valle LGM, Affonso BB, Silva MJ, Garcia RG, Junior MR, Ferraz LJR, de Matos GFJ, de la Cruz Scarin FC, Nasser F. COVID-19 complicated by pulmonary embolism treated with catheter directed thrombectomy. VASA 2020; 49:333-337. [DOI: 10.1024/0301-1526/a000880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Summary: COVID-19 is a recently identified illness that is associated with thromboembolic events. We report a case of pulmonary embolism in a patient with COVID-19, treated by catheter directed thrombectomy. A 57 year old patient presented to the emergency center with severe COVID-19 symptoms and developed massive pulmonary embolism. The patient was treated with catheter directed thrombolysis (CDT) and recovered completely. Coagulopathy associated with COVID-19 is present in all severe cases and is a dynamic process. We describe a case of massive/high risk pulmonary embolism, in a patient with COVID-19 receiving full anticoagulation, who was treated by percutaneous intervention. CDT can be an additional therapeutic option in patients with COVID-19 and pulmonary embolism that present with rapid clinical collapse.
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Affiliation(s)
| | | | - Breno Boueri Affonso
- Interventional Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcela Juliano Silva
- Interventional Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rodrigo Gobbo Garcia
- Interventional Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | | | | | - Felipe Nasser
- Interventional Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil
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2000
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Deokar K, Niwas R, Chawla G, Chauhan N. Post partum female with sudden-onset breathlessness. Breathe (Sheff) 2020; 16:190366. [PMID: 33304398 PMCID: PMC7714549 DOI: 10.1183/20734735.0366-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 31-year-old, married female was admitted with complaints of sudden-onset shortness of breath and dry cough since that morning. It was not associated with chest tightness, wheezing or pleuritic chest pain. There was no history of fever, running nose or haemoptysis. The patient had undergone lower-segment caesarean section 2 weeks previously and had reduced mobility since then. She was known to have hypothyroidism for the past 3 years, which was well controlled on thyroxine. On admission, the patient had a respiratory rate of 30 per min, pulse rate of 130 per min, blood pressure of 110/70 mmHg and oxygen saturation by finger pulse oximetry of 89% on room air. Arterial blood gases on ambient air revealed pH of 7.48, carbon dioxide tension of 30 mmHg, oxygen tension of 58 mmHg and bicarbonate of 22 mEq·L−1. Chest radiography did not reveal any significant abnormality. ECG revealed sinus tachycardia, right-axis deviation and T-wave inversion in leads V1–V4. Management of pulmonary embolism in post partum females is a challenge. Lower segment caesarean section in past 3 weeks is a contraindication to systemic thrombolysis. Heparin, fondaparinux and warfarin can be safely used in breast-feeding mothers.http://bit.ly/39Nr7qY
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