Prognostic importance of central thrombus in hemodynamically stable patients with pulmonary embolism.

Cardiol J 2017 1;24(5):508-514. Epub 2017 Mar 1.

Ankara Atatürk Training and Research Hospital, Department of Pulmonary Medicine, Ankara, Turkey.

Background: The association between mortality and localization of central thrombus in hemodynamically stable patients with pulmonary embolism (PE) is unclear. Sufficient data are not available to help clinicians to select between low molecular weight heparin (LMWH), unfractionated heparin (UFH) and thrombolytics for the management of central thrombus. The present study aims to investigate whether central thrombus in the pulmonary artery affects 30-day mortality rate, and to compare the outcomes of different treatment approaches in patients with central thrombus.

Methods: This multi-central, prospective, observational study included 874 hemodynamically stable patients with PE confirmed by multidetector computed tomography scan. The localization of the emboli was evaluated and categorized as central (saddle or at least one main pulmonary artery), lobar or distal. The primary study outcome was 30-day all-cause mortality.

Results: Localization of the emboli was central in 319 (36.5%) patients, lobar in 264 (30.2%) and distal in 291 (33.2%) patients. Seventy-four (8.5%) patients died during the 30-day follow-up period. All-cause mortality rate was 11.9%, 6.8% and 6.2% in patients with central, lobar, and distal emboli, respectively (p < 0.001). Multivariate analysis did not show that hemodynamically stable central thrombus was an independent predictor of mortality. Additionally, mortality rate was not significantly different between UFH, LMWH and thrombolytic therapy groups.

Conclusions: The present study showed that central thrombus was not an independent predictor of mortality in hemodynamically stable PE patients. LMWH and UFH were similarly effective in the treatment of this patient group.

Download full-text PDF

Source
http://dx.doi.org/10.5603/CJ.a2017.0021DOI Listing
June 2018
Save 15% Survey

Similar Publications

Venous thromboembolic events in T-cell lymphoma patients: Incidence, risk factors and clinical features.

Leuk Res 2021 Feb 15;103:106537. Epub 2021 Feb 15.

Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China; Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guandong, 510060, China. Electronic address:

Introduction: Patients with hematologic malignancies are prone to developing thromboembolism. The incidence, risk factors and clinical features for developing venous thromboembolism (VTE) are not well-elucidated in patients with T-cell lymphoma.

Materials And Methods: The present study retrospectively analyzed 668 patients with VTE, including pulmonary embolism (PE) and deep vein thrombosis (DVT), who were admitted to Tianjin Medical University Cancer Institute and Hospital and Sun Yat-sen University Cancer Center from January 2006 to December 2018. Read More

View Article and Full-Text PDF
February 2021

Computational fluid dynamics of the right atrium: Assessment of modelling criteria for the evaluation of dialysis catheters.

PLoS One 2021 25;16(2):e0247438. Epub 2021 Feb 25.

Department of Mechanical Engineering, University of Birmingham, Birmingham, United Kingdom.

Central venous catheters are widely used in haemodialysis therapy, having to respect design requirements for appropriate performance. These are placed within the right atrium (RA); however, there is no prior computational study assessing different catheter designs while mimicking their native environment. Here, a computational fluid dynamics model of the RA, based on realistic geometry and transient physiological boundary conditions, was developed and validated. Read More

View Article and Full-Text PDF
February 2021

Multiple strokes and cerebral microangiopathy in a patient with Churg-Strauss syndrome.

Med Pharm Rep 2021 Jan 29;94(1):121-124. Epub 2021 Jan 29.

Department of Neurology Science, University of Medicine and Pharmacy Cluj-Napoca, Romania.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a multisystemic disease that mainly affects the lungs and skin. It is considered to be a small and medium-vessel vasculitis. Although neurologic manifestations of EGPA are reported, usually consisting of peripheral neuropathy, central nervous system manifestations are quite rare, those described being cerebral infarctions or hemorrhages. Read More

View Article and Full-Text PDF
January 2021

Delayed Intravitreal Anti-VEGF Therapy for Patients During the COVID-19 Lockdown: An Ethical Endeavor.

Clin Ophthalmol 2021 17;15:661-669. Epub 2021 Feb 17.

Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman, Jordan.

Purpose: To assess the impact of Jordanian's Corona Virus Disease (COVID-19) lockdown on visual acuity and macular thickness in patients with macular edema receiving intravitreal injections, and to assess the ethical endeavor of lockdown among serious sight threatening conditions.

Patients And Methods: This retrospective observational study included patients planned for intravitreal injections who did not complete the planned course before the lockdown (ie, before 20th of March 2020). Data included demographics, indication for the intravitreal injection, corrected distance visual acuity (CDVA), and central macular thickness on Optical Coherence Tomography (OCT) before and after the lockdown. Read More

View Article and Full-Text PDF
February 2021

Thrombosis and Bleeding in Extracorporeal Membrane Oxygenation (ECMO) Without Anticoagulation: A Systematic Review.

ASAIO J 2021 Mar;67(3):290-296

From the Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, OR.

Extracorporeal membrane oxygenation (ECMO) causes both thrombosis and bleeding. Major society guidelines recommend continuous, systemic anticoagulation to prevent thrombosis of the ECMO circuit, though this may be undesirable in those with active, or high risk of, bleeding. We aimed to systematically review thrombosis and bleeding outcomes in published cases of adults treated with ECMO without continuous systemic anticoagulation. Read More

View Article and Full-Text PDF