Pulmonary Embolism / DVT / VTE Archives - PulmCCM
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Pulmonary Embolism / DVT / VTE Articles

Sep 052014
 
New 2014 Pulmonary Hypertension guidelines released

The American College of Chest Physicians (unaffiliated with PulmCCM) published its new consensus guidelines in August 2014 for the drug treatment of pulmonary arterial hypertension (PAH). They’re free to view on the Chest website, and well worth a look. Remember that pulmonary arterial hypertension (PAH) is but one small subset (“Group 1″) of the much larger [... read more]

Aug 162014
 
Which cancer patients need prophylaxis for DVT and pulmonary embolism?

People with cancer have the highest rates of deep venous thrombosis (DVT) and pulmonary embolism (PE). However, the risk of venous thromboembolism varies widely by cancer type and between patients. Daily anticoagulant use can reduce the risk of DVT and pulmonary embolism, but at a cost of increased bleeding risk, patient inconvenience and discomfort, and cost. [... read more]

Jun 052014
 
Tenecteplase for submassive PE: more conflicting evidence (TOPCOAT)

By Parth Rali, MD and Marvin Balaan, MD Submassive pulmonary emboli (PE) are those that are severe enough to produce right ventricular dysfunction on echocardiogram or elevated biomarkers (mainly troponin), but not hemodynamic instability (i.e., systemic blood pressure and cardiac output are preserved). The management of the patient with submassive PE is a matter of controversy with several [... read more]

Apr 182014
 
Thrombolytics (tPA) improve intermediate risk PE outcomes, with a few head bleeds (PEITHO Trial)

The use of thrombolytics for pulmonary embolism is not controversial — that is, if the PE is massive with hypotension (give thrombolytics) or mild, with normal blood pressure and right ventricular function (don’t give them). It’s the patients with intermediate risk pulmonary emboli — with normal blood pressure but with evidence of right ventricular dysfunction [... read more]

Apr 042014
 
Catheter directed thrombolysis for submassive PE: better than heparin? (RCT)

Image: EKOS Patients with acute pulmonary embolism (PE) fall into three general clinical categories: Massive PE, most often defined as hypotension due to right ventricular dysfunction. Short-term mortality is high (more than 1 in 7 die in-hospital). Systemic thrombolytic therapy (tissue plasminogen activator or tPA) is considered standard care by AHA and ACCP, because it [... read more]

Jan 192014
 
Macitentan for IPF falls short in MUSIC trial

Blair Westerly, MD Effective treatment for idiopathic pulmonary fibrosis continues to elude patients and clinicians alike.  Multiple classes of medications have been studied, none with convincing data demonstrating efficacy.  Because of the proposed  contribution of endothelin-1 to the pathogenesis of IPF, receptor antagonists of this growth factor have previously been evaluated in IPF, but with [... read more]

Oct 182013
 
Riociguat (Adempas) approved for PAH and CTEPH (pulmonary hypertension)

Riociguat (Adempas) Gets FDA Indications for Pulmonary Hypertension That was fast. The US Food and Drug Administration (FDA) approved riociguat (brand name Adempas, by Bayer) for the treatment of pulmonary arterial hypertension (PAH) and the treatment of chronic thromboembolic pulmonary hypertension (CTEPH), on October 8 2013. Adempas is the first of a class of drugs for pulmonary hypertension [... read more]

Jun 072013
 
Managing anticoagulation for surgery and invasive procedures (Review)

Managing Anticoagulation Therapy For Surgery and Procedures (NEJM) See also: How to manage anticoagulation perioperatively (ACCP Guidelines) NOTE: This is a summary of an article in a medical journal, provided as a service to physicians. It is not medical advice. No one should ever make changes to their anticoagulation treatment except under a physician’s supervision. [... read more]

May 182013
 
Taking Apixaban (Eliquis) after completing Coumadin prevents recurrent DVT/PE

Apixaban (Eliquis) Prevents Recurrent DVT-PE Long-Term People with unprovoked venous thromboembolic disease (pulmonary embolism or deep venous thrombosis, or DVT) are at high risk for recurrence, and current ACCP guidelines advise consideration of “indefinite” anticoagulation. Warfarin (Coumadin) is a wonder drug efficacy-wise, reducing the risk of pulmonary embolism and deep venous thrombosis by ~90%. However, [... read more]

Apr 122013
 
Inferior vena cava filters: debatable benefit; rarely removed

image: Wikimedia Inferior Vena Cava Filters: What’s the Harm? Do inferior vena cava filters actually create more harm than health? That’s the provocative question being posed by authors and editorialists in JAMA Internal Medicine. Inferior vena cava filters are frequently placed after a pulmonary embolism (PE) or deep venous thrombosis (DVT) in patients with a [... read more]

Mar 302013
 
Having a pulmonary embolism? Don't wait for the weekend

Why Patients with PEs Shouldn’t Love the Weekend Hospitals big and small struggle with weekend staffing models.  Mortality has been shown to be higher on the weekend for several common life-threatening illnesses, including CHF exacerbations, acute MI, upper GI bleeds and intracerebral hemorrhage. All these conditions are known to benefit from early intervention; however, whether [... read more]

Jan 292013
 
Forget "embolic burden" of pulmonary embolism: location is everything

In Most Patients with Pulmonary Embolism, Central Clot is Worse than Peripheral by Brett Ley, MD Pulmonary embolism (PE) presents with a wide range of clinical severity and course. Management decisions (level of care, length of observation, and aggressive therapies such as thrombolysis) are generally based on a patient’s risk of a poor outcome. Guidelines recommend risk [... read more]

Dec 292012
 
Xarelto (rivaroxaban) gets FDA indication for DVT and PE; no heparin bridging needed

Xarelto (rivaroxaban): New FDA Indication for DVT, PE The U.S. Food and Drug Administration (FDA) approved Bayer’s Xarelto (rivaroxaban) for a new indication for treating deep vein thrombosis (DVT) or pulmonary embolism (PE), and for long-term prophylaxis of recurrent DVT and PE. Xarelto already had FDA approval for prevention of DVTs and PEs after knee or [... read more]

Dec 292012
 
Oral rivaroxaban (Xarelto) noninferior to warfarin for PE (RCT)

(image: InPharm) Rivaroxaban (Xarelto) was noninferior to standard treatment (heparin and warfarin) in preventing recurrent VTE in patients with acute pulmonary embolism (PE), in the large EINSTEIN-PE randomized trial published in the April 5 New England Journal of Medicine. A once-daily oral factor Xa inhibitor that has already been demonstrated to be noninferior for treatment [... read more]

Dec 292012
 
An aspirin a day keeps recurrent DVT and PE away (RCT)

(image: Rex Parker) Among people with unprovoked deep venous thrombosis (DVT) or pulmonary embolism (PE), 1 in 5 will experience another DVT or PE within 2 years after stopping anticoagulation with warfarin (Coumadin). For this reason, the ACCP’s recommendations for treatment of unprovoked proximal DVT or PE suggest consideration of an “indefinite” period of anticoagulation [... read more]

Dec 182012
 
Enoxaparin prophylaxis: no effect on mortality or fatal pulmonary embolism (RCT)

Does Enoxaparin Prophylaxis Really Help Most Hospitalized Patients? A huge randomized trial (LIFENOX) stunned experts by showing no benefit of enoxaparin prophylaxis in preventing pulmonary embolism or all-cause mortality in acutely ill medical patients, compared to knee-length graduated compression stockings alone. Ajay Kakkar, Claudio Cimminiello, Jean-Francois Bergmann et al report their surprising results in the [... read more]

Nov 092012
 
Do people with pulmonary hypertension need in-flight oxygen?

Is In-Flight Oxygen for Pulmonary Hypertension Necessary? After finding a high rate of symptoms among people with pulmonary hypertension during commercial air flights, Nareg Roubinian, C. Gregory Elliott, and Hubert Chen are recommending that everyone with significant pulmonary hypertension planning to take a flight longer than 2.5 hours should be evaluated for supplemental in-flight oxygen. [... read more]

Sep 302012
 
Treatment of Acute Deep Vein Thrombosis (DVT) of the Arm (Review/Guideline)

The content previously here was removed at the request of the American College of Chest Physicians. For the ACCP 9th edition clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE), please visit the ACCP website. PulmCCM is not affiliated with ACCP or Chest.

Sep 162012
 
Initial Treatment of Acute Deep Venous Thrombosis (DVT) of the Leg (Guidelines)

The content previously here was removed at the request of the American College of Chest Physicians. For the ACCP 9th edition clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE), please visit the ACCP website. PulmCCM is not affiliated with ACCP or Chest.

Jul 152012
 
Superior Vena Cava Syndrome Review

Superior Vena Cava Syndrome: A Cancer-Related Medical Emergency (More PulmCCM Topic Updates) Multiple cancers are expected to rise in prevalence in the U.S. over the coming decades, and so is the risk for cancer-related medical emergencies. For a few, superior vena cava syndrome (SVC syndrome) will be the first manifestation of their cancer. It’s important [... read more]