Management Strategies and Determinants of Outcome in Acute Major Pulmonary Embolism: Results of a Multicenter Registry

Kasper, Wolfgang; Konstantinides, Stavros; Geibel, Annette; Olschewski, Manfred; Heinrich, Fritz; Grosser, K. D.; Rauber, K.; Iversen, Stein; Redecker, Matthias; Kienast, Joachim

doi:10.1016/s0735-1097(97)00319-7

Cited by 932 publications

(663 citation statements)

References 18 publications

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“…60 Thrombolysis should be carefully considered in postoperative patients, because the mortality of acute life threatening PE usually outweighs the risk of bleeding. 61 An early meta-analysis 35 and a recent systematic review 36 and international registry 34 compared outcomes in patients with RHTE treated with surgery and thrombolysis. The meta-analysis included 119 patients with echocardiographically detected RHTE, with and without PE, and including CVC-related events, reported an overall mortality of 31% (39% without, and 28% with, a heart wall attachment site).…”

Section: Systemic Thrombolysismentioning

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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Section: Systemic Thrombolysismentioning

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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“…In recent years, many attempts have been made to stratify patients according to their risk of death due to PTE. From the results of large retrospective registries (3,4), and randomized trials of thrombolytics (5), clinical presentation is considered the most powerful predictor of death due to PTE. However, there have been attempts at further risk stratification of patients by means of imaging.…”

mentioning

confidence: 99%

Dynamic MR perfusion imaging: Capability for quantitative assessment of disease extent and prediction of outcome for patients with acute pulmonary thromboembolism

Ohno

Koyama

Matsumoto

et al. 2010

Magnetic Resonance Imaging

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Purpose: To compare directly the capabilities of multidetector-row computed tomography (MDCT) and MRI for disease severity assessment and outcome prediction for acute pulmonary thromboembolism (APTE) patients. Materials and Methods:Fifty consecutive APTE patients underwent MDCT, MR angiography, dynamic perfusion MRI, treatment and follow-up examination. Pulmonary blood flow (PBF), pulmonary blood volume, and mean transit time maps were generated from perfusion MRI, and all segmental parameters were determined by using region of interest measurements. Receiver operator curve analyses were used to determine the most accurate parameter for diagnosis of the APTE segment. Then, APTE index from perfusion MRI (PE perfusion MRI index), right ventricle/left ventricle (RV/LV) diameter ratio and APTE indexes from embolic burdens observed on MDCT (PE CT index) and MR angiography (PE MRA index) were calculated. Finally, ability to differentiate mortality (n ¼ 8) from survival (n ¼ 42) groups and to predict patient outcome were statistically assessed.Results: PBF was a significantly more accurate parameter than others (P < 0.05). When feasible threshold value was applied, specificity and accuracy of RV/LV diameter ratio and PE Perfusion MRI index were significantly higher than those of PE CT and PE MRA indexes (P < 0.05). Logistic regression analysis demonstrated that each index was a significant predictor (P < 0.05).Conclusion: Dynamic perfusion MRI can be effective for disease extent assessment and outcome prediction for APTE patients.

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“…1 Although most late deaths are due to underlying disease, such as cancer, chronic lung disease, or congestive heart failure, the main cause of death within 30 days is right ventricular (RV) failure. [2][3][4] Rapid risk stratification is paramount for identifying high-risk patients and helps select the appropriate treatment strategy. Thrombolysis, [5][6][7] catheter intervention, 8,9 or surgical embolectomy 5,10 as adjuncts to anticoagulation may rapidly reverse RV failure and reduce the risk of recurrence and death.…”

mentioning

confidence: 99%

Right Ventricular Enlargement on Chest Computed Tomography

et al. 2004

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Management Strategies and Determinants of Outcome in Acute Major Pulmonary Embolism: Results of a Multicenter Registry

Cited by 932 publications

References 18 publications

A critical review of thromboembolic complications associated with central venous catheters

A critical review of thromboembolic complications associated with central venous catheters

Dynamic MR perfusion imaging: Capability for quantitative assessment of disease extent and prediction of outcome for patients with acute pulmonary thromboembolism

Right Ventricular Enlargement on Chest Computed Tomography

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