Anticoagulant Drugs in the Treatment of Pulmonary Embolism

Barritt, D W; Jordan, S.C.

doi:10.1016/s0140-6736(60)92299-6

Cited by 1,226 publications

(471 citation statements)

References 7 publications

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“…Anticoagulation in postoperative patients carries obvious risks. However, the need for treatment of PEs, and the reduction in mortality that this treatment affords, has been definitively established [2,3,15]. LMWHs have supplanted UFH as the treatment of choice for PE and hold a 1A recommendation from the American College of Chest Physicians for this indication [8].…”

Section: Discussionmentioning

confidence: 99%

High Incidence of Complications From Enoxaparin Treatment After Arthroplasty

Neviaser

Chang

Lyman

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Pulmonary embolism (PE) complicates 1% to 10% of total joint arthroplasties and generally requires immediate anticoagulation. Low-molecular-weight heparins have supplanted unfractionated heparin as the treatment of choice for PE and hold a 1A recommendation from the American College of Chest Physicians for this indication. However, the complications of enoxaparin treatment begun in close proximity to arthroplasty surgery are not well described. We examined the records of 135 patients who underwent total joint arthroplasty, experienced an in-hospital PE, and received treatment with enoxaparin at therapeutic doses (1 mg/kg body weight). The type and frequency of complications were determined and classified as major or minor. Twenty-seven percent of patients experienced minor complications and 10% experienced major complications. The incidence of major bleeding was substantially higher than rates reported for nonsurgical patients. The overall complication rate of enoxaparin treatment is similar to the rate of complications reported for unfractionated heparin treatment in this setting, but the complications are less severe.

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Section: Discussionmentioning

confidence: 99%

High Incidence of Complications From Enoxaparin Treatment After Arthroplasty

Neviaser

Chang

Lyman

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…43 Notwithstanding, surgical embolectomy requires unstable patients to be exposed to the risks of thoracotomy and cardiopulmonary bypass. Consequently, variable mortality estimates (7% to 29.2%) associated with surgical embolectomy can be found in the literature.…”

Section: Surgerymentioning

confidence: 99%

A critical review of thromboembolic complications associated with central venous catheters

Burns

McLaren

2008

Can J Anesth/J Can Anesth

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Purpose: Central venous catheters (CVC) are commonly used in critical care. While thrombosis is a well-recognized and frequent complication associated with their use, CVC-related thromboembolic complications, including pulmonary embolism (PE) and right heart thromboembolism (RHTE), occur less frequently and often evade diagnosis. Little information exists to guide clinicians in the diagnosis and management of CVC-related thromboembolic complications. Source:We critically review and synthesize the literature highlighting the incidence of CVC-related thrombosis. We highlight the risk for developing thromboembolic complications and provide approaches to diagnosing and managing RHTE. Principle findings:The incidence of CVC-related thrombosis varies depending on patient, site, instrument, and infusaterelated factors. Central venous catheters-related thrombosis represents an important source of morbidity and mortality for affected patients. Pulmonary embolism occurs in approximately 15% of patients with CVC-related upper extremity deep venous thrombosis (UEDVT). More frequent use of transesophageal echocardiography, in patients with suspected and confirmed PE, has resulted in increased detection of RHTE. While it is recognized that the occurrence of RHTE, in association with PE, increases mortality, the optimal strategy for their management has not been established in a clinical trial. Conclusion:Central venous catheter-related thrombosis occurs frequently and represents an important source of morbidity and mortality for affected patients. Our review supports that surgery and thrombolysis have both been demonstrated to enhance survival in patients with RHTE and PE. However, important patient, clot, and institutional considerations mandate that treatment for patients with RHTE and PE be individualized.

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“…While the consensus is that immediate anticoagulation improves survival in patients with pulmonary embolism, there is a paucity of evidence from randomized trials to support this assumption. To my knowledge, the only randomized placebo-controlled trial of anticoagulation for acute pulmonary embolism that suggested a reduction in mortality was a 1960 study [1] that included only 35 patients. I am not aware of any prospective data on the mortality of untreated pulmonary embolism diagnosed following total joint arthroplasty.…”

mentioning

confidence: 99%

Reply to the Letter to the Editor: Editor’s Spotlight/Take 5: CT Pulmonary Angiography After Total Joint Arthroplasty: Overdiagnosis and Iatrogenic Harm?

Browne

2013

Clinical Orthopaedics &Amp; Related Research

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Anticoagulant Drugs in the Treatment of Pulmonary Embolism

Cited by 1,226 publications

References 7 publications

High Incidence of Complications From Enoxaparin Treatment After Arthroplasty

High Incidence of Complications From Enoxaparin Treatment After Arthroplasty

A critical review of thromboembolic complications associated with central venous catheters

Reply to the Letter to the Editor: Editor’s Spotlight/Take 5: CT Pulmonary Angiography After Total Joint Arthroplasty: Overdiagnosis and Iatrogenic Harm?

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