[Usefulness of preemptive anticoagulation in patients with suspected pulmonary embolism].

Rev Med Suisse. 2013 Feb 6;9(372):306-8, 310

Authors: Blondon M, Le Gal G, Aujesky D, Righini M, Perrier A

Abstract
The usefulness of anticoagulation in patients with suspected non-massive pulmonary embolism (PE) is uncertain. We recently published a decision analysis model suggesting a benefit for preemptive anticoagulation in patients with an intermediate or high probability of PE, even with short diagnostic delays (0-3 h). In case of a low probability of PE, the decision to treat or not could partly rely on the expected diagnostic delay. Once the diagnosis is confirmed, achieving rapidly therapeutic anticoagulation levels decreases future thrombotic complications.

PMID: 23469397 [PubMed - in process]

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Volumetric evaluation of dual-energy perfusion CT by the presence of intrapulmonary clots using a 64-slice dual-source CT.

Acta Radiol. 2013 Mar 10;

Authors: Okada M, Nakashima Y, Kunihiro Y, Nakao S, Morikage N, Sano Y, Suga K, Matsunaga N

Abstract
BackgroundDual-energy perfusion CT (DEpCT) directly represents the iodine distribution in lung parenchyma and low perfusion areas caused by intrapulmonary clots (IPCs) are visualized as low attenuation areas.PurposeTo evaluate if volumetric evaluation of DEpCT can be used as a predictor of right heart strain by the presence of IPCs.Material and MethodsOne hundred and ninety-six patients suspected of having acute pulmonary embolism (PE) underwent DEpCT using a 64-slice dual-source CT. DEpCT images were three-dimensionally reconstructed with four threshold ranges: 1-120 HU (V120), 1-15 HU (V15), 1-10 HU (V10), and 1-5 HU (V5). Each relative ratio per V120 was expressed as the %V15, %V10, and %V5. Volumetric data-sets were compared with D-dimer, pulmonary arterial (PA) pressure, right ventricular (RV) diameter, RV/left ventricular (RV/LV) diameter ratio, PA diameter, and PA/aorta (PA/Ao) diameter ratio. The areas under the ROC curves (AUCs) were examined for their relationship to the presence of IPCs. This study was approved by the local ethics committee.ResultsPA pressure and D-dimer were significantly higher in the patients who had IPCs. In the patients with IPCs, V15, V10, V5, %V15, %V10, and %V5 were also significantly higher than those without IPC (P ≤ 0.001). %V5 had a better correlation with D-dimer (r = 0.30, P < 0.001) and RV/LV diameter ratio (r = 0.27, P < 0.001), and showed a higher AUC (0.73) than the other CT measurements.ConclusionThe volumetric evaluation by DEpCT had a correlation with D-dimer and RV/LV diameter ratio, and the relative ratio of volumetric CT measurements with a lower attenuation threshold might be recommended for the analysis of acute PE.

PMID: 23474766 [PubMed - as supplied by publisher]

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Thrombolysis for the management of massive pulmonary embolism in pregnancy.

Int J Obstet Anesth. 2013 Mar 4;

Authors: Tawfik MM, Taman ME, Motawea AA, Abdel-Hady E

Abstract
Massive pulmonary embolism in pregnancy is a major cause of maternal mortality; the management is challenging, and often requires aggressive therapy. Thrombolysis has been used, often with favorable outcome, but has not been previously reported in a patient presenting with an intrauterine death. We present a 29-year-old nulliparous patient who had a massive pulmonary embolus associated with fetal death in the third trimester of pregnancy. Diagnosis of pulmonary embolus was aided by transthoracic echocardiography and the patient was successfully treated with streptokinase.

PMID: 23481414 [PubMed - as supplied by publisher]

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Prevention of venous thromboembolism in hospitalized patients: Analysis of reduced cost and improved clinical outcomes.

J Vasc Nurs. 2013 Mar;31(1):9-14

Authors: Duff J, Walker K, Omari A, Stratton C

Abstract
The impact of implementing a guideline on venous thromboembolism (VTE) prophylaxis was evaluated in a metropolitan private hospital with a before- and after-intervention study. This subsequent study aimed to identify if improved prophylaxis rates translated into cost savings and improved clinical outcomes. A conceptual decision-tree analytical model incorporating local treatment algorithms and clinical trial data was used to compare prophylaxis costs and clinical outcomes before and after the guideline implementation. The study analyzed data from 21,942 medical and surgical patients admitted to a 250-bed acute-care private hospital in Sydney, Australia. The modeled simulation estimated the incidence of symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) as well as adverse events such as heparin-induced thrombocytopenia (HIT), post-thrombotic syndrome (PTS), major bleeding, and mortality. The costs of prophylaxis therapy and treating adverse events were also calculated. The improvement in prophylaxis rates following the implementation of the guideline was estimated to result in 13 fewer deaths, 84 fewer symptomatic DVTs, 19 fewer symptomatic PEs, and 512 fewer hospital-bed days. Improved adherence to evidence-based prophylaxis regimens was associated with overall cost savings of $245,439 over 12 months. We conclude that improved adherence to evidence-based guidelines for VTE prophylaxis is achievable and is likely to result in fewer deaths, fewer VTE events, and a significant overall cost saving.

PMID: 23481876 [PubMed - in process]