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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Even with the new fibrin-specific plasminogen activators thrombolytic therapy remains burdened with numerous side effects, some of them being severe or even life threatening, therapists being horrified if in rare cases the patient dies from severe haemorrhage subsequent to thrombolysis. The incidence and severity of bleeding increase with increasing aggressiveness of the therapeutic regimen and with increasing time during which the thrombolytic state is maintained. Furthermore, side effects related either to the plasminogen activator used (allergic reactions and systemic fibrinogen breakdown e.g.) or related to the underlying disease (pulmonary embolism and reperfusion arrhythmias e.g.) have to be considered. In order not to let thrombolysis become a double-edged sword, the risks of thrombolytic therapy should carefully be weighted against the benefits before thrombolysis is commenced.
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PMID:[Undesirable side effects in thrombolytic therapy]. 833 26

Acute pulmonary embolism has a wide prognostic spectrum, ranging from sudden death within minutes of a thromboembolic episode to a benign treatable condition associated with a stable clinical course and no long-term sequelae. In patients who survive an initial thromboembolic episode and receive antithrombotic therapy, the clinical course can be complicated by recurrent nonfatal venous thromboembolism, fatal pulmonary embolism, the postthrombotic syndrome, and chronic thromboembolic pulmonary hypertension. Identifying which patients are at increased risk of experiencing these sequelae is important in decision making relating to the aggressiveness of initial antithrombotic therapy, the duration of antithrombotic therapy, and the frequency of clinical surveillance. In addition, this information may be helpful to clinicians in discussing disease prognosis with patients. The objectives of this review are to provide reasonable estimates of the risks of recurrent nonfatal venous thromboembolism, fatal pulmonary embolism, the postthrombotic syndrome, and chronic thromboembolic pulmonary hypertension in patients with treated pulmonary embolism, and to identify risk factors for these sequelae.
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PMID:Prognosis in pulmonary embolism. 1158 89

Management of venous thromboembolism (VTE) in patients with cancer is challenging. In addition, cancer-associated thrombosis (CAT) is becoming an increasingly prevalent condition because of the aging population, the aggressiveness of anticancer therapies, and the improved survival of patients with cancer. Diagnosis of CAT can be difficult because many cancer patients without acute thrombosis often have with signs and symptoms that mimic those of deep vein thrombosis or pulmonary embolism, while others are found to have clinically silent VTE incidentally on routine staging investigations for their cancer. Prevention of CAT is important for reducing the burden of disease but it has received very little attention from clinicians and researchers. Treatment of CAT is also challenging because oncology patients have a high risk of recurrent thrombosis and major bleeding even while receiving anticoagulant therapy. This review will focus on the current standards of practice for the diagnosis, prevention and treatment of VTE in patients with cancer.
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PMID:VTE in patients with cancer--diagnosis, prevention, and treatment. 1882 56

Acute pulmonary embolism (PE) is a common and potentially highly morbid disease. However, there are a broad range of clinical presentations, varying from asymptomatic to life-threatening hemodynamic compromise. Accordingly, the aggressiveness of treatment for acute PE must be adjusted to the acuity of the presentation and patient-specific comorbidities. Thrombolysis is FDA approved for massive PE with hemodynamic compromise. However, this therapy has associated risk, most notably intracranial hemorrhage and other bleeding complications. This has prompted interest in catheter-directed therapies to mechanically remove thrombus and to locally deliver reduced doses of thrombolytics. Guidelines support use of this catheter-based strategy in cases of increased bleeding risk or high acuity with insufficient time for systemic pharmacologic therapy to be effective. We present the case of an 83-year-old man with acute high-risk PE and worsening hemodynamic and respiratory status who was treated with catheter-directed thrombolysis and rheolytic thrombectomy. There was significant improvement in thrombus burden, symptoms, and hemodynamic parameters including right ventricular function and pulmonary artery pressures. However, his course was complicated by intracranial hemorrhage and access site hematoma, demonstrating that even reduced doses and local delivery of thrombolytics do not ensure freedom from bleeding complications.
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PMID:Catheter directed lysis and thrombectomy of submassive pulmonary embolism. 2118 75

A suicide bomb blast in 2013 at a distant city of Pakistan killed 84 and wounded more than 150 people. Some patients were transferred to our tertiary care hospital because of extreme load on medical services there. This patient arrived at the Aga Khan Hospital, 2 days after the bomb blast injury and underwent an orthopedic procedure. Next day, he developed sudden tachypnea, desaturation, and circulatory collapse. After initial cardiopulmonary resuscitation, he was immediately transferred to surgical intensive care unit. Based on history, echocardiography findings and patient parameters, a clinical diagnosis of massive pulmonary embolism was made and immediate thrombolytic therapy with alteplase was started. The immediate improvement in hemodynamic status was evident following 2 hours of alteplase infusion. This case also highlights the aggressiveness of resuscitation, decision making in initiating thrombolytic therapy on clinical grounds, importance of deep venous thrombosis prophylaxis, and exhaustion of health resources due to blast related mass destruction.
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PMID:Bomb Blast and Its Consequences: Successful Intensive Care Management of Massive Pulmonary Embolsim. 2737 30