Search results for "embolism"
showing 10 items of 457 documents
Ambulatory treatment of low-risk pulmonary embolism in fragile patients: a subgroup analysis of the multinational Home Treatment of Pulmonary Embolis…
2020
Pulmonary embolism is the third most frequent acute cardiovascular disease with an annual incidence of approximately 100 cases per 100 000 population and an annual mortality of ≥7 deaths per 100 000 population in the European region [1, 2]. Initial management is adjusted to the risk of in-hospital death or early complications, which depend both on the severity of pulmonary embolism and the presence of comorbidities [3]. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors hav…
Optimizing the Personalized, Risk-Adjusted Management of Pulmonary Embolism: An Integrated Clinical Trial Programme
2018
Acute pulmonary embolism (PE) contributes significantly to the global burden of cardiovascular disease. The severity of the acute PE event determines the expected estimated risk of early death. This risk is influenced by the degree of dysfunction of the right ventricle (RV), as assessed by the presence of acute RV pressure overload on imaging and/or elevated cardiac biomarkers, and by demographic and clinical factors, including relevant comorbidities. Haemodynamic instability and cardiogenic shock is at the top of the PE severity spectrum, as it represents the most extreme manifestation of RV failure and a key determinant of poor prognosis. Ideally, risk-adjusted treatment should implement:…
Risk-adapted management of pulmonary embolism
2017
The presence and severity of right ventricular (RV) dysfunction is a key determinant of prognosis in the acute phase of pulmonary embolism (PE). Risk-adapted treatment strategies continue to evolve, tailoring initial management to the clinical presentation and the functional status of the RV. Beyond pharmacological and, if necessary, mechanical circulatory support, systemic thrombolysis remains the mainstay of treatment for hemodynamically unstable patients; in contrast, it is not routinely recommended for intermediate-risk PE. Catheter-directed pharmacomechanical reperfusion treatment represents a promising option for minimizing bleeding risk; for reduced-dose intravenous thrombolysis, the…
Neue orale Antikoagulanzien zur Therapie der venösen Thromboembolie
2011
In the current treatment of venous thromboembolism most patients are treated with vitamin K antagonists (VKA). VKA have many disadvantages including slow onset of action, multiple food and drug interactions and a large inter-individual variability in their efficacy. Recently several alternative oral anticoagulants have been developed, which have several advantages in comparison to VKA. So far two large randomized studies comparing new oral anticoagulants with VKA in patients with venous thromboembolism have been published: the RECOVER study with the oral direct thrombin antagonist dabigatran and the EINSTEIN-DVT study with the oral direct factor Xa-antagonist rivaroxaban. With regard to rec…
Verlängerte Sekundärprophylaxe nach venöser Thromboembolie
2018
Was ist neu? Aktuelle Studien Kurz nach Absetzen der oralen Antikoagulation kommt es zu einem etwa 2- bis 3-fachen Anstieg von VTE-Rezidiven. Das Rezidivrisiko ist besonders hoch nach einer VTE, die ohne identifizierbaren Auslöser aufgetreten war oder wenn nur weiche, unsichere auslösende Risikofaktoren vorlagen, sowie bei fortbestehenden Risikofaktoren, wie z. B. einer Krebserkrankung. Konsensusdokument über auslösende Risikofaktoren für venöse Thromboembolie In einem aktuellen Konsensusdokument wurden die zugrundeliegenden Risikofaktoren definiert und in 3 Gruppen klassifiziert. Direkte orale Antikoagulanzien Eine reduzierte Dosis von DOAK ermöglicht eine wirksame verlängerte Sekundärprop…
The risk for cardiovascular disease in women: from estrogens to selective estrogen receptor modulators.
2006
Cardiovascular disease, a generic denomination including coronary heart disease (CHD), stroke, and venous thromboembolic disease (VTED), has shown sensitivity to estrogens. The relative protection of women as compared with men has nourished a debate about a possible protective role for estrogens, but the prejudicial effects detected in clinical trials has created confusion on the risk/benefit ratio induced by hormone administration. The hypothesis that agonists distinct to estrogens might improve the effects associated with estrogens is at the base of the increasing interest on the role of selective estrogen receptor modulators (SERMs). There is a lack of definitive clearcut clinical data o…
Power of the Wilcoxon–Mann–Whitney test for non‐inferiority in the presence of death‐censored observations
2017
In clinical trials with patients in a critical state, death may preclude measurement of a quantitative endpoint of interest, and even early measurements, for example for intention-to-treat analysis, may not be available. For example, a non-negligible proportion of patients with acute pulmonary embolism will die before 30 day measurements on the efficacy of thrombolysis can be obtained. As excluding such patients may introduce bias, alternative analyses, and corresponding means for sample size calculation are needed. We specifically consider power analysis in a randomized clinical trial setting in which the goal is to demonstrate noninferiority of a new treatment as compared to a reference t…
Compliance with the Surgery Safety Checklist: An Update on the Status
2022
WHO has recommended the implementation of the Surgery Safety Checklist (SSC) to reign in often simple logistic errors that lead to numerous complications, some of them being fatal, in the perioperative period. This study aims to discuss doubts presented in the medical literature concerning the effectiveness of SSC in the currently existing form. The article is based on the literature search performed in PubMed using the command phrase “Surgery Safety Checklist”. The search yielded 1,476 articles up to March 2021. Out of this group, we selected 811 articles for further detailed analysis. The selection was based on the meritorious SSC-related topicality and scrutinized content of the articles…
Results of isolated posterolateral corner reconstruction
2010
Abstract Background Isolated posterolateral corner (PLC) tears are relatively rare events. Various surgical techniques to treat posterolateral knee instability have been described; because surgical results are linked to cruciate reconstructions it has been difficult to date to define whether one surgical procedure has better prognosis than another. The goal of this study is to determine the clinical outcome of PLC reconstruction following fibular-based technique. Materials and methods We retrospectively evaluated a case series of patients who received isolated PLC reconstruction between March 2005 and January 2007. Ten patients were surgically treated for isolated injuries and were availabl…
Definition of tachycardia for risk stratification of pulmonary embolism
2020
Tachycardia is a reliable predictor of adverse outcomes in normotensive patients with acute pulmonary embolism (PE). However, different prognostic relevant heart rate thresholds have been proposed. The aim of the study was to investigate the prognostic performance of different thresholds used for defining tachycardia in normotensive PE patients.We performed a post-hoc analysis of normotensive patients with confirmed PE consecutively included in a single-centre and a multi-centre registry. An adverse outcome was defined as PE-related death, need for mechanical ventilation, cardiopulmonary resuscitation or administration of catecholamines.Of 1567 patients (median age: 72 [IQR, 59-79] years; f…