Where to treat patients with acute pulmonary embolism?

Pruszczyk, Piotr; Konstantinides, Stavros

doi:10.33963/kp.15143

Cited by 7 publications

(7 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These include intensive treatments such as systemic thrombolysis (ST), cardiac surgery, or catheter-directed therapies (CDT), sometimes assisted by extracorporeal circulatory support (ECMO) or a combination of these strategies [4][5][6][7][8]. The heterogeneity of the clinical course of PE and comorbidities cause significant difficulties in the diagnosis and selection of appropriate therapeutic approaches [3,9]. Simultaneously, significant progress can be observed in both pharmacological and interventional treatment of PE [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Pulmonary embolism response team: A multidisciplinary approach to pulmonary embolism treatment. Polish PERT Initiative Report

Araszkiewicz

Kurzyna²,

Kopeć

et al. 2021

Kardiol Pol

Self Cite

View full text Add to dashboard Cite

Background: A pulmonary embolism response team (PERT) is a multidisciplinary team established to improve clinical care for patients with pulmonary embolism (PE). However, data regarding detailed institutional experience and clinical outcomes from such teams are sparse. Aims:We aim to assess the frequency of activations, patients' characteristics, PE severity, applied treatments, and outcomes of PE patients treated by Polish PERTs. Methods:The survey registry was conducted between June 2018 and July 2020. All consecutive PERT activations of four institutionalized PERTs in Poland were analyzed. Patients' characteristics, therapies applied, and in-hospital outcomes were evaluated.Results: There were 680 unique PERT activations. Most activations originated from Emergency Departments (44.9%), and the remaining originated from internal medicine/cardiology units (31.1%), surgery/orthopedics (9.1 %), oncology (6.3%), intensive care units (6.0%), and others (2.5%). The origin of activation varied significantly among institutions (P <0.01). Most PERT cases were patients with intermediate-high risk PE (42.9%), whereas high-risk PE occurred in 10% of patients. Anticoagulation alone was delivered to 80.3% of patients, and 23.3% of patients received at least one advanced therapy: catheter-directed therapies (11.3%), systemic thrombolysis (5.3%), surgical embolectomy (2.4%), vena cava filter placement (3.7%), and extracorporeal membrane oxygenation (0.6%). In-hospital mortality in the whole study group was 5.1%, with significant differences between institutions (P = 0.01). Conclusions:The frequency of PE severity, type of delivered catheter-directed treatment, and in-hospital mortality vary between institutions without significant discrepancies in PERT activations. This variation between expert centers highlights the local differences in PERTs' organizational and operational forms.

show abstract

Section: Introductionmentioning

confidence: 99%

Pulmonary embolism response team: A multidisciplinary approach to pulmonary embolism treatment. Polish PERT Initiative Report

Araszkiewicz

Kurzyna²,

Kopeć

et al. 2021

Kardiol Pol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Due to prespecified exclusion criteria 14 , our results cannot be extrapolated to high-risk PE patients or those with cancer. Therefore, the utility of the markers for post-PE syndrome prediction, including GDF-15, demonstrated in the present study should also be assessed in high-risk PE patients 28 . Second, the concept of the post-PE syndrome involved different combinations of symptoms and clinical findings, including functional and haemodynamic abnormalities 1,4,29 , and the results should be interpreted with caution.…”

Section: Discussionmentioning

confidence: 99%

Isoprostane‐8 and GDF‐15 as novel markers of post‐PE syndrome: Relation with prothrombotic factors

Ząbczyk

Natorska

Janion−Sadowska

et al. 2021

Eur J Clin Investigation

View full text Add to dashboard Cite

Background: Post-pulmonary embolism (PE) syndrome occurs in up to 50% of PE patients. The pathophysiology of this syndrome is obscure. Objective: We investigated whether enhanced oxidative stress and prothrombotic state may be involved in post-PE syndrome. Methods: We studied 101 normotensive noncancer PE patients (aged 56.5 ± 13.9 years) on admission, after 5-7 days and after a 3-month anticoagulation, mostly with rivaroxaban. A marker of oxidative stress, 8-isoprostane, endogenous thrombin potential, fibrinolysis proteins, clot lysis time (CLT) and fibrin clot permeability (K s ), along with PE biomarkers, were determined. Results: Patients who developed the post-PE syndrome (n = 31, 30.7%) had at baseline 77.6% higher N-terminal brain natriuretic propeptide and 46.8% higher growth differentiation factor 15, along with 14.1% longer CLT associated with 34.4% higher plasminogen activator inhibitor-1 as compared to subjects without post-PE syndrome (all P < .05). After 5-7 days, only hypofibrinolysis was noted in post-PE syndrome patients. When measured at 3 months, prolonged CLT and reduced K s were observed in post-PE syndrome patients, accompanied by 23.8% higher growth differentiation factor 15 and 35.8% higher plasminogen activator inhibitor-1 (all P < .05).8-isoprostane levels ≥108 pg/ml (odds ratio=4.36; 95% confidence interval 1.63-12.27) and growth differentiation factor 15 ≥ 1529 pg/ml (odds ratio=3.89; 95% confidence interval 1.29-12.16) measured at 3 months were associated with higher risk of developing post-PE syndrome. Conclusions: Enhanced oxidative stress and prothrombotic fibrin clot properties could be involved in the pathogenesis of the post-PE syndrome. Elevated growth differentiation factor 15 assessed at 3 months might be a new biomarker of this syndrome.

show abstract

“…Taken together, FXIII appears to be of key importance in manifestations of acute VTE, affecting the likelihood of acute PE [65].…”

Section: Figure 1 Factor XIII Subunit a (Fxiiimentioning

confidence: 96%

Factor XIII and Fibrin Clot Properties in Acute Venous Thromboembolism

Ząbczyk

Natorska

Undas

2021

IJMS

View full text Add to dashboard Cite

Coagulation factor XIII (FXIII) is converted by thrombin into its active form, FXIIIa, which crosslinks fibrin fibers, rendering clots more stable and resistant to degradation. FXIII affects fibrin clot structure and function leading to a more prothrombotic phenotype with denser networks, characterizing patients at risk of venous thromboembolism (VTE). Mechanisms regulating FXIII activation and its impact on fibrin structure in patients with acute VTE encompassing pulmonary embolism (PE) or deep vein thrombosis (DVT) are poorly elucidated. Reduced circulating FXIII levels in acute PE were reported over 20 years ago. Similar observations indicating decreased FXIII plasma activity and antigen levels have been made in acute PE and DVT with their subsequent increase after several weeks since the index event. Plasma fibrin clot proteome analysis confirms that clot-bound FXIII amounts associated with plasma FXIII activity are decreased in acute VTE. Reduced FXIII activity has been associated with impaired clot permeability and hypofibrinolysis in acute PE. The current review presents available studies on the role of FXIII in the modulation of fibrin clot properties during acute PE or DVT and following these events. Better understanding of FXIII’s involvement in the pathophysiology of acute VTE might help to improve current therapeutic strategies in patients with acute VTE.

show abstract

Where to treat patients with acute pulmonary embolism?

Cited by 7 publications

References 12 publications

Pulmonary embolism response team: A multidisciplinary approach to pulmonary embolism treatment. Polish PERT Initiative Report

Pulmonary embolism response team: A multidisciplinary approach to pulmonary embolism treatment. Polish PERT Initiative Report

Isoprostane‐8 and GDF‐15 as novel markers of post‐PE syndrome: Relation with prothrombotic factors

Factor XIII and Fibrin Clot Properties in Acute Venous Thromboembolism

Contact Info

Product

Resources

About