Left Atrial Appendage Occlusion,A Misnomer?: Where Do We Go From Here?

The importance of the left atrial appendage (LAA) as the source of thromboembolism including stroke in patients with nonvalvular atrial fibrillation is well documented, with more than 90% of ischemic strokes related to a LAA thrombus. Although oral anticoagulation has been the standard of care, approximately 50% to 60% of patients either have contraindications to oral anticoagulation or do not continue the medication beyond the first year. This led to the development of local site-specific therapy to occlude the LAA by either surgical or transcatheter means. Despite marked advancements, incomplete LAA closure with surgical and transcatheter approaches remains frequent. The etiology of incomplete LAA closure and its clinical implications remain unclear. Multiple strategies are in development including changes in deployment techniques, a new device design, and alternative approaches to leak closure.     

Ovine Iliac Vein Model for Endovascular Thrombectomy of Acute Deep Venous Thrombosis

An ovine iliac vein thrombosis model was devised to test a wall-contacting rotational thrombectomy device. Thrombosis was successfully induced in 9 sheep with an average clot length of 31 mm ± 12 and >60% vessel occlusion on angiography. The thrombus was subsequently removed, maintaining normal intraoperative pulmonary arterial pressure (5.9 mm Hg ± 3.6) and complete distal reperfusion after thrombectomy. Additionally, the sheep were without signs of vascular trauma or embolic complications on gross necropsy and histopathologic analysis. The findings from this study support the use of an ovine iliac deep vein thrombosis model for testing of a lower extremity thrombectomy device.     

7例羊水栓塞诊断与抢救的临床分析

目的 分析7例羊水栓塞的临床诊断与抢救,提供临床诊治羊水栓塞的参考,以提高抢救成功率。方法选取2011年1月～2019年10月于本院住院治疗的7例羊水栓塞的产妇临床资料、救治措施、预后及有无并发症进行回顾性分析。结果 7例羊水栓塞患者中,4例行剖宫产术,3例阴道分娩,经多学科合作积极抢救,4例抢救成功,1例有肺挫裂伤、胸骨、肋骨骨折,其余3例无并发症,1例植物人状态,2例死亡(死于严重的DIC、多器官功能衰竭)。结论 羊水栓塞起病急骤、表现不一、进展快,死亡率高,因此早期识别、积极治疗,多学科合作,必要时及时行子宫切除术,可提高抢救成功率,改善预后、减少并发症的发生。     

中西医结合治疗肺栓塞的临床疗效观察

目的:探析中西医结合治疗肺栓塞的临床疗效。方法:选取2017年3月-2019年3月期间我院收治的92例肺栓塞患者,按信封法分为联合组与对照组,每组46例。两组患者均接受常规溶栓、抗凝治疗,对照组在常规治疗基础上增加低分子肝素治疗,联合组在对照组基础上增加疏血通注射液治疗,对比两组治疗效果、不良反应,并对比两组患者治疗前后血气指标[氧分压(Partial Pressure of Oxygen,PaO2)、二氧化碳分压(Partial Pressure of Carbon Dioxide,PaCO2)]及D-二聚体水平的变化情况。结果:对照组治疗总有效率较联合组更低;治疗后,两组患者PaO2、PaCO2均显著上升,其中联合组PaO2上升幅度大,而两组患者D-二聚体水平均显著下降,其中联合组下降幅度大,差异有统计学意义(P<0.05);而两组患者治疗后PaCO2相比,差异无统计学意义(P>0.05);对照组不良反应发生率略低于联合组,差异无统计学意义(P>0.05)。结论:在常规溶栓、抗凝治疗基础上增加低分子肝素结合疏血通注射液治疗肺栓塞的效果显著,可有效改善血气功能,降低机体D-二聚体水平,且不增加不良反应。     

COVID-19 and Acute Pulmonary Embolism: A Case Series and Brief Review

The SARS-CoV-2 virus, or COVID-19, is responsible for the current global pandemic and has resulted in the death of over 400,000 in the United States. Rates of venous thromboembolism have been noted to be much higher in those infected with COVID-19. Here we report a case-series of COVID-19 patients with diverse presentations of pulmonary embolism (PE). We also briefly describe the pathophysiology and mechanisms for pulmonary embolism in COVID-19. These cases indicate a need to maintain a high index of suspicion for PE in patients with COVID-19, as well as the need to consider occult COVID-19 infection in patients with PE in the right clinical circumstance.     

Riesgo de recurrencia tras retirada de la anticoagulación en pacientes con enfermedad tromboembólica venosa no provocada: validación externa del nomograma de Viena y del modelo predictivo DASH

IntroductionScales for predicting venous thromboembolism (VTE) recurrence are useful for deciding the duration of the anticoagulant treatment. Although there are several scales, the most appropriate for our setting has not been identified. For this reason, we aimed to validate the DASH prediction score and the Vienna nomogram at 12 months.MethodsThis was a retrospective study of unselected consecutive VTE patients seen between 2006 and 2014. We compared the ability of the DASH score and the Vienna nomogram to predict recurrences of VTE. The validation was performed by stratifying patients as low-risk or high-risk, according to each scale (discrimination) and comparing the observed recurrence with the expected rate (calibration).ResultsOf 353 patients evaluated, 195 were analyzed, with an average age of 53.5 ± 19 years. There were 21 recurrences in 1 year (10.8%, 95% CI: 6.8%-16%). According to the DASH score, 42% were classified as low risk, and the rate of VTE recurrence in this group was 4.9% (95% CI: 1.3%-12%) vs. the high-risk group that was 15% (95% CI: 9%-23%) (p <.05). According to the Vienna nomogram, 30% were classified as low risk, and the rate of VTE recurrence in the low risk group vs. the high risk group was 4.2% (95% CI:0.5%-14%) vs. 16.2% (95% CI: 9.9%-24.4%) (p <.05).ConclusionsOur study validates the DASH score and the Vienna nomogram in our population. The DASH prediction score may be the most advisable, both because of its simplicity and its ability to identify more low-risk patients than the Vienna nomogram (42% vs. 30%).     

Consenso multidisciplinar para el manejo de la tromboembolia de pulmón

We have updated recommendations on 12 controversial topics that were published in the 2013 National Consensus on the diagnosis, risk stratification and treatment of patients with pulmonary embolism (PE). A comprehensive review of the literature was performed for each topic, and each recommendation was evaluated in two teleconferences. For diagnosis, we recommend against using the Pulmonary Embolism Rule Out Criteria (PERC) rule as the only test to rule out PE, and we recommend using a D-dimer cutoff adjusted to age to rule out PE. We suggest using computed tomography pulmonary angiogram as the imaging test of choice for the majority of patients with suspected PE. We recommend using direct oral anticoagulants (over vitamin K antagonists) for the vast majority of patients with acute PE, and we suggest using anticoagulation for patients with isolated subsegmental PE. We recommend against inserting an inferior cava filter for the majority of patients with PE, and we recommend using full-dose systemic thrombolytic therapy for PE patients requiring reperfusion. The decision to stop anticoagulants at 3 months or to treat indefinitely mainly depends on the presence (or absence) and type of risk factor for venous thromboembolism, and we recommend against thrombophilia testing to decide duration of anticoagulation. Finally, we suggest against extensive screening for occult cancer in patients with PE.