The Experts below are selected from a list of 125772 Experts worldwide ranked by ideXlab platform
Paul D. Stein - One of the best experts on this subject based on the ideXlab platform.
-
Diagnosis and management of Pulmonary Embolism.
Current opinion in cardiology, 1996Co-Authors: Paul D. SteinAbstract:The prevalence of acute Pulmonary Embolism in a general hospital was evaluated. Importantly, the prevalence of unrecognized Pulmonary Embolism at autopsy has not changed in three decades. Further evaluation was made of the alveolar-arterial oxygen difference in the diagnosis of acute Pulmonary Embolism. As with the partial pressure of oxygen in arterial blood, the alveolar arterial oxygen difference is usually abnormal, but a normal value does not exclude Pulmonary Embolism. The criteria used for a low probability interpretation of ventilation-perfusion lung scans in the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) were modified. Criteria for a very low probability assessment (< 10% positive predictive value) were also determined. Progress was made with helical computed tomography and contrast-enhanced electron-beam computed tomography, but with present technology their role is limited. Selective digital subtraction angiography with a flow directed catheter seems to have been useful in some patients. A strategy for diagnosis of thromboembolic disease that uses serial noninvasive leg tests was described. The strategy reduces the number of Pulmonary angiograms required. The Fourth American College of Chest Physicians Conference on Antithrombotic Therapy was published. Extensive and detailed analysis was made of the literature related to the antithrombotic treatment of Pulmonary Embolism and the use of antithrombotic therapy during pregnancy.
-
Diagnosis of Pulmonary Embolism
Current opinion in pulmonary medicine, 1996Co-Authors: Paul D. SteinAbstract:Present opinion combines the diagnosis and management of deep venous thrombosis and Pulmonary Embolism. Regarding deep venous thrombosis, clinical assessment based on major and minor diagnostic points in combination with ultrasound of the lower extremities showed useful positive predictive values when the clinical assessments and ultrasound were concordant. Subtle calf asymmetry may call attention to the possibility of thromboembolic disease. The prevalence of acute Pulmonary Embolism at a general hospital was evaluated. Importantly, the prevalence of unrecognized Pulmonary Embolism at autopsy has not changed in three decades. Further evaluation was made of the alveolar arterial oxygen difference in the diagnosis of acute Pulmonary Embolism. As with the partial pressure of oxygen in arterial blood, the alveolar arterial oxygen difference is usually abnormal, but a normal value does not exclude Pulmonary Embolism. The criteria used for a low probability interpretation of ventilation-perfusion lung scans in the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) were modified. Criteria for a very low probability assessment (< 10% positive predictive value) were also determined. Progress was made with helical CT and contrast-enhanced electron-beam CT, but with present technology their roles are limited. Selective digital subtraction angiography with a flow-directed catheter was useful in some patients. A strategy for diagnosis of thromboembolic disease that uses serial noninvasive leg tests was described. This strategy reduces the number of Pulmonary angiograms required.
Harry R Buller - One of the best experts on this subject based on the ideXlab platform.
-
Deep Vein Thrombosis and Pulmonary Embolism - Deep-vein thrombosis and Pulmonary Embolism.
The Lancet, 2016Co-Authors: Marcello Di Nisio, Harry R BullerAbstract:Summary Deep vein thrombosis and Pulmonary Embolism, collectively referred to as venous thromboEmbolism, constitute a major global burden of disease. The diagnostic work-up of suspected deep vein thrombosis or Pulmonary Embolism includes the sequential application of a clinical decision rule and D-dimer testing. Imaging and anticoagulation can be safely withheld in patients who are unlikely to have venous thromboEmbolism and have a normal D-dimer. All other patients should undergo ultrasonography in case of suspected deep vein thrombosis and CT in case of suspected Pulmonary Embolism. Direct oral anticoagulants are first-line treatment options for venous thromboEmbolism because they are associated with a lower risk of bleeding than vitamin K antagonists and are easier to use. Use of thrombolysis should be limited to Pulmonary Embolism associated with haemodynamic instability. Anticoagulant treatment should be continued for at least 3 months to prevent early recurrences. When venous thromboEmbolism is unprovoked or secondary to persistent risk factors, extended treatment beyond this period should be considered when the risk of recurrence outweighs the risk of major bleeding.
-
Biomarkers in Pulmonary Embolism.
Current opinion in cardiology, 2004Co-Authors: Maaike Söhne, Marije Ten Wolde, Harry R BullerAbstract:Purpose of review Controversy exists about the precise role of thrombolytic therapy in normotensive patients with Pulmonary Embolism. To resolve this controversy two major questions must be addressed. First, can a subgroup of normotensive Pulmonary Embolism patients with a high risk for adverse outcomes, such as in-hospital mortality or early recurrent venous thromboEmbolism, be identified? Second, is there convincing evidence that the benefits of more aggressive therapy counterbalance its risks? Troponin I and T as well as brain natriuretic peptide (BNP) have recently been introduced as promising tools in the risk assessment of patients with Pulmonary Embolism. Recent findings The studies in series of patients with Pulmonary Embolism showed prevalences of elevated cardiac biomarkers of 16 to 84%. Positive predictive values for in-hospital mortality varied from 6 to 44%, whereas negative predictive values for uneventful outcome were above 93% in all studies. Summary Although a correlation between elevated biomarkers and in-hospital mortality in Pulmonary Embolism patients is present in most of the studies, the positive predictive value appears to be insufficient to extend the indication for thrombolytic therapy to all patients with elevated biomarkers. Future research is necessary to show whether combining different biomarkers with echocardiography is more useful
Khalid F. Almoosa - One of the best experts on this subject based on the ideXlab platform.
-
Is thrombolytic therapy effective for Pulmonary Embolism
American family physician, 2002Co-Authors: Khalid F. AlmoosaAbstract:Pulmonary Embolism is a disorder that is associated with significant morbidity and mortality. Right-sided heart failure and recurrent Pulmonary Embolism are the main causes of death associated with Pulmonary Embolism in the first two weeks after the embolic event. Thrombolysis is a potentially lifesaving therapy when used in conjunction with standard anticoagulation. However, it has significant side effects and must therefore be used with caution. Indications for thrombolysis are not well defined and are thus controversial. The only current absolute indication is massive Pulmonary Embolism with hypotension. Other potential indications include right heart dysfunction, recurrent Pulmonary Embolism and the prevention of Pulmonary hypertension. However, no evidence exists to show benefit of thrombolytic therapy over standard anticoagulation therapy for recurrent Pulmonary Embolism, mortality or chronic complications. Bleeding is the most common complication of thrombolysis and may be fatal.
Stephanie B. Abbuhl - One of the best experts on this subject based on the ideXlab platform.
-
Massive Pulmonary Embolism.
Clinics in chest medicine, 1994Co-Authors: Stephanie B. AbbuhlAbstract:Massive Pulmonary Embolism remains a clinical challenge where rapid diagnosis and appropriate therapy have a critical impact on patient outcome. This article reviews the pathophysiology, diagnosis, and therapeutic options involved in the management of Pulmonary Embolism. Clinical case discussions illustrate the principles that are described by the authors.
-
Passive Pulmonary Embolism
Clinics in Chest Medicine, 1994Co-Authors: M. A. Kelley, Stephanie B. AbbuhlAbstract:Massive Pulmonary Embolism remains a clinical challenge where rapid diagnosis and appropriate therapy have a critical impact on patient outcome. This article reviews the pathophysiology, diagnosis, and therapeutic options involved in the management of Pulmonary Embolism. Clinical case discussions illustrate the principles that are described by the authors.
Alison S. Witkin - One of the best experts on this subject based on the ideXlab platform.
-
Acute and chronic Pulmonary Embolism: the role of the Pulmonary Embolism response team.
Current opinion in cardiology, 2017Co-Authors: Alison S. WitkinAbstract:PURPOSE OF REVIEW Acute Pulmonary Embolism is a life-threatening condition that can lead to both acute and long-term morbidity and mortality. Patients with acute Pulmonary Embolism are at risk for significant complications including the development of chronic Pulmonary Embolism and chronic thromboembolic Pulmonary hypertension. This review will describe the rationale for and structure of Pulmonary Embolism response teams, with a focus on the recognition and treatment of patients with persistent morbidity following Pulmonary Embolism. RECENT FINDINGS For patients with intermediate and high-risk Pulmonary Embolism, a myriad of treatment options exist, ranging from anticoagulation alone to surgical embolectomy and hemodynamic support with extracorporeal membrane oxygenation. Optimizing treatment for these patients requires rapid assessment and multidisciplinary cooperation. Over the last five years, the Pulmonary Embolism response team has emerged as a mechanism to facilitate this care. SUMMARY Pulmonary Embolism response teams can streamline and expedite care for patients with intermediate and high-risk Pulmonary Embolism. However, the care for patients with acute Pulmonary Embolism does not end at hospital discharge. It is essential to ensure adequate follow-up and identify patients with persistent symptoms and impaired quality of life, particularly those who may have symptomatic chronic Pulmonary Embolism or chronic thromboembolic Pulmonary hypertension.
