Pulmonary Embolism / DVT / VTE Archives - Page 2 of 3 - PulmCCM
Advertisement


Pulmonary Embolism / DVT / VTE Articles

Apr 232012
 
Thrombolytics for acute pulmonary embolism (Guidelines)

Thrombolytics for Acute Pulmonary Embolism from the ACCP Guidelines, 9th Ed. PulmCCM is not affiliated with ACCP. These are PulmCCM’s interpretation of the ACCP guidelines. They are appropriate only for those who have read and are familiar with the original ACCP guideline document, which is linked below. The ACCP’s recommendation classification system: 1 = “recommendation” 2 [... read more]

Apr 092012
 
Treating acute pulmonary embolism with anticoagulant therapy (Guideline)

Treating Acute Pulmonary Embolism with Anticoagulant Therapy from the ACCP Guidelines, 9th Ed.   The ACCP‘s new 9th edition of their authoritative clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE) were published in February 2012. PulmCCM’s commentary is only appropriate as a reference for those who have read and are familiar with the original document, which is linked [... read more]

Mar 172012
 

Managing Anticoagulation in the Perioperative Period from the ACCP Guidelines, 9th Ed. The ACCP‘s new 9th edition of their authoritative clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE) were published in February 2012. PulmCCM is not affiliated with ACCP. These summaries are only appropriate for those who have read and are familiar with [... read more]

Mar 112012
 

Preventing DVT and PE in Nonsurgical Patients from the ACCP Guidelines, 9th Ed. The ACCP‘s new 9th edition of their authoritative clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE) were published in February 2012. PulmCCM is not affiliated with ACCP. The commentary provided here is only appropriate for use as a reference by those [... read more]

Mar 052012
 

Starting and Managing Warfarin/Coumadin for Initial Treatment of DVT/PE from the ACCP Guidelines, 9th Ed. The ACCP’s new 9th edition of their clinical practice guidelines for prevention and treatment of DVT/PE were published in February 2012.  Here we review their update on how to start a patient on warfarin (Coumadin) for deep venous thrombosis or pulmonary [... read more]

Mar 012012
 

American College of Chest Physicians (ACCP)’s Guidelines for Diagnosis & Management of DVT / PE, 9th Ed. The ACCP‘s new 9th edition of their authoritative clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE, DVT, PE) were published in February 2012. PulmCCM is not affiliated with ACCP; the commentary here is only appropriate for use as a reference [... read more]

Feb 282012
 

For unclear reasons, people receiving chemotherapy for solid tumors are at particularly increased risk for deep venous thrombosis and pulmonary embolism (DVT/PE). Semuloparin is an ultra-low-molecular weight heparin with a long half life of 16-20 hours that (like enoxaparin) is renally excreted. Sanofi, makers of Lovenox, report in the February 16 New England Journal of [... read more]

Feb 232012
 
For most, plane flights add no DVT/PE risk (just stretch your legs)

As we were all taught in med school, long-distance flights, or even a long car trip, greatly increase your risk for deep venous thrombosis and pulmonary embolism … right? (I feel like I’ve answered about 8 board questions featuring this scenario.) The CDC even has a whole page of guidelines detailing the travel-DVT-risk-connection and the [... read more]

Feb 062012
 

Januel et al report findings of a systematic review and meta-analysis to estimate the total incidence of acute symptomatic venous thromboembolism (symptomatic DVT or pulmonary embolism) among patients receiving proper thromboprophylaxis after hip or knee replacements. They came up with rates of 1.1% after knee replacements, and 0.5% after hip replacements. The rate of pulmonary [... read more]

Jan 282012
 
Apixaban for thromboprophylaxis post-discharge causes bleeding (ADOPT Trial, NEJM)

For years, Pharma have been itching to prove a benefit of extended chemoprophylaxis against DVT / PE in medically ill patients after hospital discharge. Three weeks or more of enoxaparin after surgical knee or hip replacement is standard care, since it reduces the high risk of serious venous thromboembolism with a relatively low risk of [... read more]

Jan 212012
 
Omitting heparin prophylaxis in first 24 ICU hours associated with higher mortality (CHEST)

As you know, the risk for DVT and PE in the ICU are high. How high? Depends on how you count them. Asymptomatic, ultrasound-surveillance-detected DVTs have an incidence of 5-10% during the ICU stay (from the PROTECT trial and a 2005 series), even when patients receive proper thromboprophylaxis. The incidence is even higher (up to 80%) in trauma [... read more]

Jan 012012
 
ACP advises against universal DVT/PE prophylaxis! "Quality" quagmire thickens (Guideline/Review, Ann Intern Med)

Daunted by the seeming impossibility of measuring and comparing hospitals on real outcomes (given our primitive state of data collection and heterogeneity in patient populations, among many other challenges), well-meaning bureaucrats and non-profiteering safety advocates like the Institute for Healthcare Improvement have created directives based on surrogate measures in an attempt to standardize and improve [... read more]

Dec 262011
 

Using the Nationwide Inpatient Sample and the national Multiple Cause-of-Death files, Wiener et al found that since the inception of CT-angiography in 1998, the number of CT-PE scans have risen 11-fold, and age-adjusted incidence of pulmonary embolism rose from 62 to 112 per 100,000 (an 81% increase). Over the same period, the mortality rate (presence of PE [... read more]

Dec 262011
 

Moores LK et al. Current Approach to the Diagnosis of Acute Nonmassive Pulmonary Embolism. CHEST 2011;140:509-518.  Review. Where is the best area under the curve, or the “overdiagnosis sweet spot?” It seems no approach gets us off the hook as we seek to avoid anticoagulating people without PEs (without missing any, of course): CT-angiography  is more sensitive [... read more]

Dec 182011
 

Dalteparin is a low-molecular weight heparin that, unlike enoxaparin, is safe for people with renal failure. Among 3,746 ICU patients in 6 countries, followed until hospital discharge, there was no difference in the rate of proximal deep venous thrombosis (5.1% vs 5.8%, 1′ endpoint) between once-daily dalteparin and twice-daily UFH, as detected by twice-weekly ultrasounds. [... read more]

Dec 182011
 

A 44-page guideline from the American Heart Association on the management of massive & submassive pulmonary embolism; proximal deep venous thrombosis, and chronic thromboembolic pulmonary hypertension. Circulation 2011;123:1788-1830. FREE FULL TEXT

Dec 082011
 

A handful of people with pulmonary embolism have absolute contraindications to anticoagulation. Authors here describe these as: Any prior intracranial hemorrhage, known structural intracranial cerebrovascular disease (eg, arteriovenous malformation), known malignant intracranial neoplasm, ischemic stroke within 3 months, suspected aortic dissection, active bleeding or bleeding diathesis, recent surgery encroaching on the spinal canal or brain, [... read more]

Nov 162011
 

Chronic thromboembolic pulmonary hypertension is a “new” condition (in terms of our recognition and understanding of it), whose true prevalence, natural history, and response to therapies continue to be elucidated. Meanwhile, specialized surgical centers continually make thromboendarterectomy safer, providing definitive cures that are nothing short of miraculous for those affected by this otherwise usually fatal [... read more]