Seminars in Respiratory and Critical Care Medicine
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Venous thromboembolism (VTE) is a major cause of morbidity and mortality throughout the world. Up to one half of patients who present with VTE will have an underlying thrombophilic defect. This knowledge has led to a widespread practice of testing for such defects in patients who develop VTE. However, identifying a hereditary thrombophilia by itself does not necessarily change outcomes or dictate therapy. Furthermore, family history of VTE by itself can increase an asymptomatic person's VTE risk...
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#1An Thi Nhat Ho (SLU: Saint Louis University)
#2Nelly Bellamy (SLU: Saint Louis University)
Last. Soophia Naydenov (SLU: Saint Louis University)H-Index: 6
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Despite substantial advances in the diagnosis and management, pulmonary embolism (PE) continues to be a significant cause of mortality. In this article, we provide a concise overview of the evolution of worldwide mortality trends related to PE. Despite the data being derived mainly from observational studies, there is a clear trend toward decreasing mortality over time from PE. Whether this truly represents a treatment effect or is more related to increased diagnosis of small PEs is not fully cl...
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#1Hannah Stevens (Monash University)H-Index: 4
#2James D. McFadyen (Monash University)H-Index: 14
Last. Noel Chan (McMaster University)
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Important advances in the understanding and management of venous thromboembolism (VTE) have enhanced our ability to diagnose, prevent, and treat VTE. In this narrative review, we discuss how recent advances in the understanding and management of VTE are changing practice, highlight ongoing unmet needs in VTE management, and outline how novel therapeutic targets with little or no influence on hemostasis may help address these unmet needs.
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#1Paul P. Dobesh (UNMC: University of Nebraska Medical Center)H-Index: 17
#2Molly M. Kernan (UNMC: University of Nebraska Medical Center)
Last. Jenni J. Lueshen (UNMC: University of Nebraska Medical Center)
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There are currently more than 7 million patients taking a direct oral anticoagulant (DOAC), with more new prescriptions per year than warfarin. Despite impressive efficacy and safety data for the treatment of venous thromboembolism, patients with obesity or advanced renal impairment represented a small portion of the patients enrolled in the phase 3 clinical trials. Therefore, to evaluate the potential use of DOACs in these special populations, clinicians need to have an understanding of the pha...
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#1John L. Murray (Emory University)
#2David Zapata (Emory University)H-Index: 1
Last. William B. Keeling (Emory University)H-Index: 5
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Pulmonary embolism (PE) is a common medical condition associated with significant morbidity and mortality. It is the third most common cause of death in the United States. Historically, surgery for PE was associated with a high mortality rate, and this led to a significant decrease in the volume of operations being performed. However, significant improvements in patient selection and outcomes for surgical pulmonary embolectomy (SPE) at the end of the 20th century led to a renewed interest in the...
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#1Delphine Douillet (University of Angers)H-Index: 3
#2Pierre-Marie Roy (University of Angers)H-Index: 32
Last. A Penaloza (Cliniques Universitaires Saint-Luc)H-Index: 6
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Pulmonary embolism (PE) remains a diagnostic challenge in 2021. As the pathology is potentially fatal and signs and symptoms are nonspecific, further investigations are classically required. Based on the Bayesian approach, clinical probability became the keystone of the diagnostic strategy to rule out PE in the case of a negative testing. Several clinical probability assessment methods are validated: gestalt, the Wells score, or the revised Geneva score. While the debate persists as to the best ...
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#1Richard N. Channick (UCLA: University of California, Los Angeles)H-Index: 47
Treatment of patients with intermediate and high-risk pulmonary embolism (PE) is a controversial area. Many therapeutic options exist, and deciding on appropriate treatment can be difficult. In addition, multiple specialties are often involved in the care of PE patients. To better organize the response to serious PE patients, several hospitals and academic centers throughout the world have created pulmonary embolism response teams (PERTs). The goal of a PERT is to have a single multidisciplinary...
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#1Samuel A. Berkman (UCLA: University of California, Los Angeles)H-Index: 3
#2Victor F. Tapson (Cedars-Sinai Medical Center)H-Index: 79
Venous thromboembolism, occlusion of dialysis catheters, circuit thrombosis in extracorporeal membrane oxygenation (ECMO) devices, acute limb ischemia, and isolated strokes, all in the face of prophylactic and even therapeutic anticoagulation, are features of novel coronavirus disease 2019 (COVID-19) coagulopathy. It seems well established at this time that a COVID-19 patient deemed sick enough to be hospitalized, should receive at least prophylactic dose anticoagulation. However, should some ho...
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#1Kira MacDougall (Staten Island University Hospital)H-Index: 1
#2Alex C. Spyropoulos (Hofstra University)H-Index: 35
Venous thromboembolism (VTE) is the leading preventable cause of death in hospitalized patients and data consistently show that acutely ill medical patients remain at increased risk for VTE-related morbidity and mortality in the post-hospital discharge period. Prescribing extended thromboprophylaxis for up to 45 days following an acute hospitalization in key patient subgroups that include more than one-quarter of hospitalized medically-ill patients represents a paradigm shift in the way hospital...
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#1Georgios A. Triantafyllou (University of Pittsburgh)H-Index: 12
#2Oisin A. O’Corragain (TU: Temple University)H-Index: 4
Last. Parth Rali (TU: Temple University)H-Index: 5
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Pulmonary embolism (PE) is a common clinical entity, which most clinicians will encounter. Appropriate risk stratification of patients is key to identify those who may benefit from reperfusion therapy. The first step in risk assessment should be the identification of hemodynamic instability and, if present, urgent patient consideration for systemic thrombolytics. In the absence of shock, there is a plethora of imaging studies, biochemical markers, and clinical scores that can be used to further ...
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