TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS最新文献_第4页

SARS-CoV-2 Associated Submassive Pulmonary Embolism Even with the Use of Dabigatran 即使使用达比加群，SARS-CoV-2相关的亚块状肺栓塞

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3504

Z. Chauhan, H. Asif, H. Vazquez

{"title":"SARS-CoV-2 Associated Submassive Pulmonary Embolism Even with the Use of Dabigatran","authors":"Z. Chauhan, H. Asif, H. Vazquez","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3504","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3504","url":null,"abstract":"Introduction: The SARS-CoV-2 infection has been associated with a hypercoagulable state with a higher incidence of venous thromboembolic complications including deep venous thrombosis (DVT) and pulmonary embolisms (PE). The use of anticoagulation therapy has been suggested to prevent these complications with SARS-CoV-2 Infection. We present a case of submassive PE in the setting of SARS-CoV-2 infection while using, a direct thrombin inhibitor, dabigatran. Case Presentation: 69 y/o male with a history of DVT, on lifelong dabigatran (PRADAXA), presented with a worsening dry cough, dyspnea, chest pain, headache, nausea, and diarrhea for the past 3 days. The patient denied fever or known sick contact. He endorsed medication compliance with dabigatran 150 mg twice-daily dose. The social history was negative for smoking or illicit drug use. Initial blood work noted for high D-dimer, inflammatory markers like CRP and ferritin as well as high troponin, and pro-BNP with positive SARS-CoV-2 RT-PCR. CTA Chest showed right lower lobe patchy ground-glass opacities as well as large filling defects within the bilateral main pulmonary arteries representing acute bilateral PEs with CT evidence of right-sided cardiac strain (Figure-1). Lower extremities doppler ultrasound also showed acute DVT involving the right popliteal vein as well as partially occlusive DVT in the left superficial femoral vein and left popliteal vein. He was started on UF-heparin infusion for submissive PE. Given increased clot burden and evidence of right heart strain, he underwent successful catheter-directed thrombolysis by IR without complications. He also completed a course of Remdesivir and steroids (Decadron) for COVID-19 pneumonia. His respiratory status remained stable with minimal oxygen requirement and subsequently had negative SARS-CoV-2 RT-PCR. The patient was discharged home on long-term Apixaban anticoagulation therapy. Discussion: Dabigatran, a direct inhibitor of free and fibrin-bound thrombin, has been frequently used as an anticoagulation therapy for its good tolerance, predictable pharmacokinetics, and lack of necessity for coagulation monitoring. Dabigatran has been associated with a 92% reduction in the incidence of VTE in the general population. The SARS-CoV-2 infection has been reported for a higher incidence of 23% of VTE compared to non-SARS-CoV-2 critically ill patients. Our patient presented with submassive PE and DVT even with the use of a therapeutic dose of dabigatran in the setting of SARS-CoV-2 infection. This raises the concern about the anticoagulation effect of direct thrombin inhibitors like dabigatran with SARS-CoV-2 infection.","PeriodicalId":244282,"journal":{"name":"TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133960505","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

Venoarterial Extracorporeal Membrane Oxygenation as a Bridge to Therapy in Acute Massive Pulmonary Embolism with Clot-In-Transit: A Case Series 静脉体外膜氧合作为治疗急性大块肺栓塞的桥梁:一个病例系列

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3514

D. Sacher, O. O'corragain, B. Lashari, D. Fleitas Sosa, S. Gayen, P. Desai, G. Criner, P. Rali

引用次数: 0

Double the tPA, Double the Fun tPA加倍，乐趣加倍

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3493

B. Kwok, A. Katz, J. Hagedorn, S. Brosnahan, N. Amoroso, R. Goldenberg

引用次数: 0

Interesting Case of Post- COVID Thromboprophylaxis Failure COVID后血栓预防失败的有趣案例

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3507

C. Tejera, J. Baek, G. Avila, A. Klougan, A. Fischer

{"title":"Interesting Case of Post- COVID Thromboprophylaxis Failure","authors":"C. Tejera, J. Baek, G. Avila, A. Klougan, A. Fischer","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3507","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3507","url":null,"abstract":"Introduction:Venous thromboembolism (VTE) is a leading cause of morbidity and mortality worldwide, with an annual incidence of 1 to 2 per 1000 per year in the US. Data support that this incidence is often secondary to thromboprophylaxis failure more than omission. Studies have demonstrated that an extensive pro-inflammatory and hypercoagulable state is present in COVID-19 patients, however the duration of this state post-infection is unclear. Early identification of additional risk factors for thromboprophylaxis failure warrants a closer follow up.Case Description:A 47-year-old man with obesity, recent COVID-19 pneumonia with ventilator dependent respiratory failure (VDRF) presents with one-day history of worsening abdominal pain and bloating due to pneumoperitoneum secondary to PEG tube placement 9 days prior. Patient was discharged after a prolonged admission for management of respiratory failure in the setting of COVID-19 infection that was complicated with severe hemodynamic compromising, subsequently managed with mechanical ventilation and V-V ECMO. Patient received DVT prophylaxis since admission. On presentation, patient was tachycardic in moderate respiratory distress and SpO2 of 94% on 75% FiO2. Further work-up revealed COVID PCR negative, elevated Ferritin of 1130 ng/mL, elevated NT-proB type Natriuretic peptide (NT-Pro BNP) of 467 pg/mL and elevated D-Dimer of 914 ng/mL. ABG revealed decreased PO2 and elevated A-a gradient. Computed tomography angiogram revealed moderate sized right upper lobe pulmonary embolism with no evidence of right heart strain. Patient was started on heparin drip.Discussion:The development of VTE despite prophylaxis is not uncommon. The rates of DVT in the absence of prophylaxis range between 40 and 60% and 2-5% in its presence. It is pertinent learning to identify high risk patients to develop VTE and consider anticoagulation at a higher dose or for a longer period of time even after discharge. Patients with COVID-19 infection possess and additional risk from the underlying hypercoagulable state and a worse outcome is expected. The high risk of thrombosis in COVID-19 is demonstrated by the increase in d-dimer, which was found to be the most significant change in coagulation parameters in these group, suggesting increased thrombin production and activation of fibrinolysis. There is therefore a need to identify the increased risk of VTE at an early stage and to prevent thrombotic events and organ damage as far as possible. More data is needed on how long this hypercoagulability period persist, but definite steps need to be taken to address this common complication in this special population.","PeriodicalId":244282,"journal":{"name":"TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125930218","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

Cough as an Initial Presentation of Saddle Pulmonary Embolism (SPE) 咳嗽作为鞍型肺栓塞(SPE)的初始表现

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3496

Mohsin Sheraz Mughal, I. Kaur, R. Rehman, H. Mirza, H. Jagdey, W. Ghali, P. Jariwala

引用次数: 0

Case of Pseudo Pulmonary Embolism in VA-ECMO VA-ECMO中假性肺栓塞1例

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3513

R. Subramaniyam, A. Go, S. Patolia

引用次数: 0

Combined VA-ECMO and Catheter-Directed Embolectomy for Massive Pulmonary Embolism VA-ECMO联合导管导向栓塞术治疗大面积肺栓塞

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3511

J. Fouad, A. Khosla

引用次数: 0

Case Series of TpA Use in COVID-19 Patients with Venous Thromboembolism at a Community Hospital- Benefits and Outcomes TpA用于社区医院COVID-19静脉血栓栓塞患者的病例系列-益处和结果

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3510

I. Omore, T. Sulaiman, A. M. Aung, N. Jayachamarajapura Onkaramurthy, I. Brimah

{"title":"Case Series of TpA Use in COVID-19 Patients with Venous Thromboembolism at a Community Hospital- Benefits and Outcomes","authors":"I. Omore, T. Sulaiman, A. M. Aung, N. Jayachamarajapura Onkaramurthy, I. Brimah","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3510","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3510","url":null,"abstract":"Introduction: In December 2019, the WHO was notified of a novel Coronavirus otherwise known as COVID-19. The disease rapidly spread across multiple borders with a significant toll on loss of human life and a high degree of burden on medical systems across the world. As clinical data, laboratory studies and autopsy reports emerged, the underlying pathophysiological hypotheses evolved to include the eliciting of a hypercoagulable state as being amongst the key factor for the disease progression. In COVID-19 pneumonia, worsening hypoxemia despite maximal ventilator support should prompt evaluation for Pulmonary Embolism (PE) and thrombolytics (tPA) may be a life saver. Here we report 5 cases of severe COVID-19 Pneumonia with presumed pulmonary embolism and worsening hypoxemia successfully treated with thrombolytics with favorable response. Case report 1: 37-year-old Hispanic male with no known medical history presented with 3 days history of symptoms suggestive of COVID-19 Pneumonia including worsening shortness of breath. On admission he was in moderate respiratory distress, saturating at 78 % on room air (RA), which increased to low 90s on 15L oxygen (O2) on non-rebreather mask and subsequently intubated. COVID 19 PCR swab resulted positive and CXR showed characteristics of typical COVID 19 pneumonia with bilateral patchy reticular interstitial opacities. Patient was managed in the for Acute Severe Hypoxemic Respiratory Failure secondary to COVID 19 Pneumonia. Point-of-Care-Ultrasound (POCUS) (Image 1) showing moderately decreased LVEF and signs of RV volume and pressure overload with thrombus-in-situ. Patient developed clinically refractory hypoxia and newly developing shock for which he received a 100mg IV infusion of alteplase along with commencement of nitric oxide to enhance pulmonary vasodilation for better oxygenation with continued lung protective ventilatory support. After the systemic thrombolysis, the patient's oxygen requirement reduced markedly with subsequent POCUS showing return of the normal RV function and absent cardiac thrombus. Case report 2-5: Age range 43-75 years, all admitted with COVID-19 pneumonia and refractory hypoxemia with evidence if VTE. Thrombolytics was given to all the patients with good response and eventually discharge from the hospital. Discussion: Although most patients with COVID-19 predominantly have a respiratory tract infection, a proportion of patients progress to a more severe and systemic disease including but not limited to widespread coagulopathies. Despite covering for anticoagulation, there has been report of incidence of thromboembolic events in such patients. Therefore, it is very important to recognize increasing oxygen requirement and acute deterioration in this patients.","PeriodicalId":244282,"journal":{"name":"TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128975338","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

Almost Missed: Multiple Bilateral Pulmonary Emboli and Saddle Embolus Presenting as Syncope with No Other Signs of Pulmonary Embolism 差点错过:多发双侧肺栓塞和鞍状栓塞表现为晕厥，没有其他肺栓塞的迹象

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3494

M. Nicholson, S. Khetani, A. Rangasamy

引用次数: 0

A Rare Case of Bilateral Pulmonary Venous Thrombosis 一例罕见的双侧肺静脉血栓形成

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3495

M. Azeem

引用次数: 0