Pulmonary embolism最新文献_第8页

Half-dose thrombolysis for intermediate-high risk pulmonary embolism: Case series from a London hospital 半剂量溶栓治疗中高风险肺栓塞:来自伦敦一家医院的病例系列

Pulmonary embolism Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa3652

Rishi K. Gupta, K. Philip, T. Harris

{"title":"Half-dose thrombolysis for intermediate-high risk pulmonary embolism: Case series from a London hospital","authors":"Rishi K. Gupta, K. Philip, T. Harris","doi":"10.1183/13993003.congress-2019.pa3652","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3652","url":null,"abstract":"Introduction: Early mortality from intermediate-high risk pulmonary embolism (PE) remains high. Full-dose thrombolysis reduces mortality at 7 days, but increases major bleeding, and does not reduce pulmonary hypertension incidence. An alternative approach may be ‘half-dose’ thrombolysis, which is not known to increase bleeding risk vs. anticoagulation alone. Our hospital protocol includes consideration of half-dose thrombolysis (alteplase 50mg) for intermediate-high risk PE. We describe a case-series of patients presenting with intermediate-high risk PE, aiming to assess the safety, outcomes and patient selection for half-dose thrombolysis. Methods: Records of medical admissions were reviewed retrospectively to identify cases of PE (1/3/15-28/2/17). Intermediate-high risk PE was defined according to ESC guidance. Results: 120 patients had confirmed PEs; 36 were intermediate-high risk. Of these, 22 received half-dose thrombolysis. Of those thrombolysed, median age was 40 years. All 22 were normotensive, had an sPESI score >1, and evidence of right heart strain on CT and/or echocardiogram (median troponin 80ng//L; median D-dimer 7.61mg/L). All 22 thrombolysed patients survived with no significant bleeding (median length of stay 5 days). No patients had evidence of CTEPH at follow-up. Among the 14 patients with intermediate-high risk PE who were not thrombolysed, reasons documented included age, clinical stability, and bleeding risks. Conclusions: Half-dose thrombolysis has appeared safe in our case-series, though careful patient selection is required. Further evaluation of half-dose thrombolysis to reduce early haemodynamic collapse in intermediate-high risk PE may be warranted.","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90501325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Efficacy and safety of inferior vena cava filters in patients with surgically treated chronic thromboembolic pulmonary hypertension 下腔静脉过滤器在手术治疗慢性血栓栓塞性肺动脉高压患者中的疗效和安全性

Pulmonary embolism Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa1463

Akane Sasaki, Rika Suda, N. Tanabe, Ryogo Ema, Keiko Yamamoto, H. Miwa, A. Naito, H. Kasai, T. Jujo, T. Sugiura, Naoko Kawata, S. Sakao, K. Ishida, K. Tatsumi

引用次数: 2

Unusual Presentation of a Systemic Disease: A Case Report 全身性疾病的异常表现:1例报告

Pulmonary embolism Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa1461

Harshil Alwani, A. Mohapatra, Saswat Subhankar, D. P. Dash

引用次数: 0

Prevalence of pulmonary embolism in patients with isolated syncope in the emergency department: the PEEPS multicenter prospective cohort study 急诊科孤立性晕厥患者肺栓塞患病率:PEEPS多中心前瞻性队列研究

Pulmonary embolism Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa3645

Y. Freund, A. Philippon, A. Feral-Pierssens, Clara Damas Perrichet, S. Boussouar, V. Donciu, M. Cachanado, Pierre-Alexis Raynal

{"title":"Prevalence of pulmonary embolism in patients with isolated syncope in the emergency department: the PEEPS multicenter prospective cohort study","authors":"Y. Freund, A. Philippon, A. Feral-Pierssens, Clara Damas Perrichet, S. Boussouar, V. Donciu, M. Cachanado, Pierre-Alexis Raynal","doi":"10.1183/13993003.congress-2019.pa3645","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3645","url":null,"abstract":"Introduction: The prevalence of pulmonary embolism (PE) in patients that present to the Emergency Department (ED) with isolated syncope is unclear. Conflicting results were recently reported with a prevalence ranging from less than 1% to up to 17%. However, these studies included patients that may also have had other symptoms suggestive of PE (chest pain or dyspnea), or patients that had no systematic assessment for the presence of PE. Since a low prevalence ( Aims: to evaluate the prevalence of PE in ED patients with isolated syncope. Methods: Multicenter prospective cohort study in seven EDs in France. Adult patients who presented to the ED with syncope (transient loss of consciousness) were included. Patients with chest pain or dyspnea were excluded. Included patients underwent formal work-up for PE, including D-dimer testing and further imaging if positive. Cases of PE were adjudicated by two independent expert radiologists with the review of imaging studies. Results: 411 patients were recruited and tested with D-dimer, in whom 137 (33%) underwent a computed tomographic pulmonary angiogram or a ventilation-perfusion scan. A PE was confirmed in nine patients (prevalence of 2.2%, 95% confidence interval 1.1% to 4.3%), including one sub-segmental PE. Conclusion: In our sample of patients with isolated syncope, the prevalence of PE was 2.2%. This value is not sufficiently low to negate the requirement for a formal work up in the ED, even in the absence of chest pain or dyspnea.","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73711782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Outpatient management of PE PE的门诊管理

Pulmonary embolism Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa1454

B. Vijayakumar, C. Davies, M. Gibson

引用次数: 0

A preliminary study on CT quantitative evaluation of small pulmonary vessels area in patients with acute pulmonary embolism 急性肺栓塞患者肺小血管面积CT定量评价的初步研究

Pulmonary embolism Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa1464

Li Zhu

引用次数: 0

A single centre experience of low dose direct oral anticoagulants (DOAC) after unprovoked venous thromboembolism (VTE) 非诱发性静脉血栓栓塞(VTE)后低剂量直接口服抗凝剂(DOAC)的单中心治疗经验

Pulmonary embolism Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa1457

W. Thomas, E. Symington, M. Besser, K. Sheares

引用次数: 0

COPD is an indipendent risk factor for in-situ pulmonary artery thrombosis COPD是原位肺动脉血栓形成的独立危险因素

Pulmonary embolism Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa3649

P. Intiglietta, Maria Peragine, P. Buonamico, G. Castellana, O. Resta

{"title":"COPD is an indipendent risk factor for in-situ pulmonary artery thrombosis","authors":"P. Intiglietta, Maria Peragine, P. Buonamico, G. Castellana, O. Resta","doi":"10.1183/13993003.congress-2019.pa3649","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3649","url":null,"abstract":"Introduction: Pulmonary embolism (PE) is described in 25% of Chronic Obstructive Pulmonary Disease (COPD) hospitalized patients and may simulate or worsen an episode of acute exacerbation. It should be taken into account in COPD patients with clinical worsening. Aim: To assess whether COPD may be an independent risk factor for PE. Methods: We investigated 91 patients (M:F=1:2, mean age of 69 years) hospitalized for PE at our department from January 2014 to February 2016 and divided them in two groups according to the presence of COPD defined according to GOLD guideline: Group1, PE with COPD (54 patients); Group2, PE without COPD (37 patients). We searched the presence of deep vein thrombosis (DVT), with compression ultrasound sonography plus eco-color doppler, and PE risk factors in all patients. Statistical significance: p ≤0.05. Results: Group1 had less prevalence of DVT (49% vs 66%), next the significance (p=0,09), and of male sex (p=0,009), higher prevalence of smokers (p=0,000), proximal PE (0,04), mean age (p=0,03), paO2 and paCO2 (0,0003) and diabetes than Group2 (p=0,000). No difference was documented in risk factor of PE, i.e. obesity, cancer, atrial fibrillation, liver disease, bed rest and contraceptives. Limiting the analysis to proximal PE, the difference of prevalence of DVT increases (33% Group1 vs. 70% Group2) and becomes significant (p = 0,04). COPD patients without DVT (37) had higher age, lower PaCO2, minor increase in Ddimers, the lower FE, lower prevalence of renal failure (p Conclusion: COPD may be an indipendent risk factor for PE, in particular with proximal location. Absence of DVT is more frequent than in patient without COPD.","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"158 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83843056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The impact of implementing a modified YEARS algorithm on the diagnosis of pulmonary embolism 实施改进的YEARS算法对肺栓塞诊断的影响

Pulmonary embolism Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa3638

T. Lim, J. Zhang, Y. G. Goh

{"title":"The impact of implementing a modified YEARS algorithm on the diagnosis of pulmonary embolism","authors":"T. Lim, J. Zhang, Y. G. Goh","doi":"10.1183/13993003.congress-2019.pa3638","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3638","url":null,"abstract":"A low test threshold for pulmonary embolism(PE) and over reliance on imaging, especially CT pulmonary angiograms(CTPA) is a common behaviour pattern among physicians. Interventions to improve this low threshold for CTPA testing have been mostly ineffective. The innovative Dutch YEARS study reported fewer CTPA examinations in PE diagnosis(van der Hulle et al. Lancet 2017;390:289). However, the YEARS algorithm have not been evaluated in routine clinical practice. Thus, we examined the effects of implementing a pragmatic, modified version of the YEARS algorithm in PE diagnosis. Methods: This is a prospective study of consecutive hospitalized adult patients who underwent CTPA for PE in an acute medicine department. In 2016 we initiated an audit-feedback program to improve the adherence to evidence based guidelines for PE diagnosis and thus, increase the diagnostic rate of PE from CTPA. In 2018 we implemented a modified YEARS protocol. Results: In 2016 the PE detection rate from CTPA was 7.8%. This was associated with more frequent assessment of pre-test risks and D-dimer testing but an insignificant increase in PE diagnosis from CTPA compared with 2015(7%). In 2018, following the introduction of the modified YEARS protocol, this PE diagnosis rate increased to 25%(p Conclusions: Physician education and real-time feedback had a small effect in improving adherence to PE diagnostic protocols and reducing CTPA testing. Implementation of the YEARS protocol resulted in further improvements and merits more extensive evaluation in secular practice.","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"94 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83885499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pulmonary Embolism (PE) in women with hormonal contraception (WHC) primarily diagnosed via endobronchial ultrasound angiography (EBUS-A) 激素避孕(WHC)妇女肺栓塞(PE)主要通过支气管超声血管造影(EBUS-A)诊断。

Pulmonary embolism Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa1459

Christiane Meyer-Aumiller, J. Aumiller

引用次数: 0