Related Articles

Computed tomography to assess risk of death in acute pulmonary embolism: a meta-analysis.

Eur Respir J. 2014 Mar 6;

Authors: Becattini C, Agnelli G, Germini F, Vedovati MC

Abstract
The aim of this study was to evaluate whether right ventricle dilation at computed tomography (CT) angiography can be used to assess the risk of death in patients with acute pulmonary embolism.Medline and EMBASE were searched up to April 30, 2013. Studies reporting on the association between right ventricle dilation (right-to-left ventricle diameter) or dysfunction (inter-ventricular septal bowing) at CT angiography and death at 30 days, as well as at 3 months in patients with acute pulmonary embolism, were included in a systematic review and meta-analysis.CT-detected right ventricle dilation was associated with an increased 30 day-mortality in all-comers with pulmonary embolism (OR 2.08 (95% CI 1.63-2.66); p<0.00001) and in haemodynamically stable patients (OR 1.64 (95% CI 1.06-2.52); p = 0.03), as well as with death due to pulmonary embolism (OR 7.35 (95% CI 3.59-15.09); p<0.00001). An association between right ventricle dilation and 3-month mortality was also observed (OR 4.65 (95% CI 1.79-12.07); p = 0.002).Right-to-left ventricle dilation as assessed by CT angiography can be used to evaluate risk of death in all-comers with pulmonary embolism and in haemodynamically stable patients.

PMID: 24603813 [PubMed - as supplied by publisher]

Systematic review and meta-analysis for thrombolysis treatment in patients with acute submassive pulmonary embolism.

Patient Prefer Adherence. 2014;8:275-82

Authors: Cao Y, Zhao H, Gao W, Wang Y, Cao J

Abstract
PURPOSE: The aim of this systematic review was to evaluate the efficacy and safety of thrombolytic treatment in patients with submassive pulmonary embolism (PE).
METHODS: An electronic search was carried out based on the databases from MEDLINE, Embase, Science Citation Index (SCI), and the Cochrane Library. We included prospective, randomized, and clinical trials in thrombolysis with heparin alone in adults who had evidence of right ventricular dysfunction and normotension. The main endpoints consist of mortality, recurrent PE, and bleeding risk. The relative risk (RR) and the relevant 95% confidence intervals were determined by the dichotomous variable.
RESULTS: Only seven studies involving 594 patients met the inclusion criteria for further review. The cumulative effect of thrombolysis, compared with intravenous heparin, demonstrated no statistically significant difference in mortality (2.7% versus 4.3%; RR=0.64 [0.29-1.40]; P=0.27) or recurrent PE (2% versus 5%; RR=0.44 [0.19-1.05]; P=0.06). Thrombolytic therapy did not increase major hemorrhage compared with intravenous heparin (4.5% versus 3.3%; RR=1.16 [0.51-2.60]; P=0.73), but it was associated with an increased minor hemorrhage (41% versus 9%; RR=3.91 [1.46-10.48]; P=0.007).
CONCLUSION: Compared with heparin alone, neither mortality nor recurrent PE is reduced by thrombolysis in patients with submassive PE, and it does not reveal an increasing risk of major bleeding. In addition, thrombolysis also produces the increased risk of minor bleeding; however, no sufficient evidence verifies the thrombolytic benefit in this review, because the number of patients enrolled in the trials is limited. Therefore, a large, double-blind clinical trial is required to prove the outcomes of this meta-analysis.

PMID: 24611003 [PubMed]

Incidence and impact outcome of pulmonary embolism in critically ill patients with severe exacerbation of chronic obstructive pulmonary diseases.

Clin Respir J. 2014 Mar 10;

Authors: Bahloul M, Chaari A, Tounsi A, Baccouche N, Abid H, Chtara K, Hamida CB, Ghadhoune H, Dammak H, Chelly H, Bouaziz M

Abstract
PURPOSE: We aimed to determine the incidence and the prognostic impact (mortality and length of ICU stay (LOS)) of pulmonary embolism (PE) in critically-ill patients with severe acute exacerbation of chronic obstructive pulmonary disease (COPD).
METHODS: This is a retrospective study performed during a 5-year period in the intensive care unit of the Habib Bourguiba university hospital (Sfax-Tunisia). All patients with severe acute exacerbation of COPD were included. The diagnosis of PE is confirmed by spiral computed tomography (CT) scan showing one or more filling defects or obstruction in the pulmonary artery or its branches.
RESULTS: During the study's period, 131 patients with acute exacerbation of COPD were admitted in our ICU. The mean age (± SD) was 68.6 ± 9.2 years ranging from 39 to 99 years (median: 70 years). During their ICU stay, 23 patients (17.5%) developed PE. The diagnosis was confirmed within 48 hours from ICU admission in all cases but one. The comparison between the two groups (with and without PE) showed that they had the same base line characteristics. However, all PE group developed shock on ICU admission or during ICU stay. Signs of right heart failure were more observed in the PE group. ICU mortality was significantly higher in the PE group (69.5 % Vs 44 %; p= 0.029). In addition the ICU LOS was significantly higher in the PE group than the PE free group (p= 0.007). Finally PE was identified as an independent factor predicting poor outcome (OR= 3.49, CI95% [1.01-11.1; p = 0,035).
CONCLUSION: Our study showed that PE is common in patients with severe COPD exacerbation requiring ICU admission. Moreover, PE was significantly associated with higher mortality and ICU LOS in critically-ill patients with severe COPD exacerbation.

PMID: 24612880 [PubMed - as supplied by publisher]

Outpatient management of pulmonary embolism in cancer: data on a prospective cohort of 138 consecutive patients.

J Natl Compr Canc Netw. 2014 Mar 1;12(3):365-73

Authors: Font C, Carmona-Bayonas A, Fernández-Martinez A, Beato C, Vargas A, Gascon P, Otero R

Abstract
The purpose of this prospective cohort study was to assess the feasibility of outpatient treatment in patients with cancer and objectively confirmed pulmonary embolism (PE), and to compare the performance of the different prognostic scales available in this setting. Patients were selected for outpatient management according to a set of exclusion criteria. Outcomes at 30 and 90 days of follow-up included thromboembolic recurrences, major bleeding, and all-cause death. The performance of 4 prognostic scales (Pulmonary Embolism Severity Index, Geneva Prognostic Score, POMPE-C, and Registro Informatizado de Enfermedad Tromboembólica [RIETE registry]) was evaluated. Of 138 patients, 62 (45%) were managed as outpatients. Incidental PE constituted 47% of the sample. Most patients treated at home had an incidentally detected PE (89%). The rate of recurrence and major bleeding events was similar in both groups. Mortality rates were higher for patients admitted to the hospital compared with outpatients at 30 days (18% vs 3%; P=.06) and 90 days (34% vs 10%; P=.001) of follow-up. None of the patients selected for home treatment required further admission because of PE complications. None of the prognostic models developed for symptomatic PE was significantly associated with 30-day mortality. Improved survival outcomes were observed in incidentally detected PEs compared with acute symptomatic events (overall mortality rates, 3.2% vs 18.4%; P=.006). A large proportion of patients with cancer and PE may be safely treated as outpatients, especially those with incidental PE. Cancer-specific prognostic scales including incidental PE should be developed for the optimal management of PE in this setting.

PMID: 24616542 [PubMed - in process]