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Pulmonary Embolism HELP
Based on 20,477 articles published since 2009
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These are the 20477 published articles about Pulmonary Embolism that originated from Worldwide during 2009-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
1 Guideline Hyperbaric treatment of air or gas embolism: current recommendations. 2019

Moon, Richard E. ·Depts. of Anesthesiology and Medicine, Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Durham, North Carolina U.S. ·Undersea Hyperb Med · Pubmed #31683367.

ABSTRACT: Gas can enter arteries (arterial gas embolism, AGE) due to alveolar-capillary disruption (caused by pulmonary over-pressurization, e.g. breath-hold ascent by divers) or veins (venous gas embolism, VGE) as a result of tissue bubble formation due to decompression (diving, altitude exposure) or during certain surgical procedures where capillary hydrostatic pressure at the incision site is subatmospheric. Both AGE and VGE can be caused by iatrogenic gas injection. AGE usually produces stroke-like manifestations, such as impaired consciousness, confusion, seizures and focal neurological deficits. Small amounts of VGE are often tolerated due to filtration by pulmonary capillaries; however VGE can cause pulmonary edema, cardiac "vapor lock" and AGE due to transpulmonary passage or right-to-left shunt through a patient foramen ovale. Intravascular gas can cause arterial obstruction or endothelial damage and secondary vasospasm and capillary leak. Vascular gas is frequently not visible with radiographic imaging, which should not be used to exclude the diagnosis of AGE. Isolated VGE usually requires no treatment; AGE treatment is similar to decompression sickness (DCS), with first aid oxygen then hyperbaric oxygen. Although cerebral AGE (CAGE) often causes intracranial hypertension, animal studies have failed to demonstrate a benefit of induced hypocapnia. An evidence based review of adjunctive therapies is presented.

2 Guideline New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboembolism. 2019

Tran, Huyen A / Gibbs, Harry / Merriman, Eileen / Curnow, Jennifer L / Young, Laura / Bennett, Ashwini / Tan, Chee Wee / Chunilal, Sanjeev D / Ward, Chris M / Baker, Ross / Nandurkar, Harshal. ·Alfred Health, Melbourne, VIC. · Monash University, Melbourne, VIC. · Waitemata District Health Board, Auckland, New Zealand. · Haemophilia Treatment Centre, Westmead Hospital, Sydney, NSW. · Auckland District Health Board, Auckland, New Zealand. · Monash Medical Centre, Melbourne, VIC. · Royal Adelaide Hospital, Adelaide, SA. · Monash Health, Melbourne, VIC. · Royal North Shore Hospital, Sydney, NSW. · Perth Blood Institute, Perth, WA. · Australian Centre of Blood Diseases, Melbourne, VIC. ·Med J Aust · Pubmed #30739331.

ABSTRACT: INTRODUCTION: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most common cardiovascular disease and, globally, more than an estimated 10 million people have it yearly. It is a chronic and recurrent disease. The symptoms of VTE are non-specific and the diagnosis should actively be sought once considered. The mainstay of VTE treatment is anticoagulation, with few patients requiring additional intervention. A working group of experts in the area recently completed an evidence-based guideline for the diagnosis and management of DVT and PE on behalf of the Thrombosis and Haemostasis Society of Australia and New Zealand (www.thanz.org.au/resources/thanz-guidelines). MAIN RECOMMENDATIONS: The diagnosis of VTE should be established with imaging; it may be excluded by the use of clinical prediction rules combined with D-dimer testing. Proximal DVT or PE caused by a major surgery or trauma that is no longer present should be treated with anticoagulant therapy for 3 months. Proximal DVT or PE that is unprovoked or associated with a transient risk factor (non-surgical) should be treated with anticoagulant therapy for 3-6 months. Proximal DVT or PE that is recurrent (two or more) and provoked by active cancer or antiphospholipid syndrome should receive extended anticoagulation. Distal DVT caused by a major provoking factor that is no longer present should be treated with anticoagulant therapy for 6 weeks. For patients continuing with extended anticoagulant therapy, either therapeutic or low dose direct oral anticoagulants can be prescribed and is preferred over warfarin in the absence of contraindications. Routine thrombophilia testing is not indicated. Thrombolysis or a suitable alternative is indicated for massive (haemodynamically unstable) PE. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINE: Most patients with acute VTE should be treated with a factor Xa inhibitor and be assessed for extended anticoagulation.

3 Guideline American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism. 2018

Monagle, Paul / Cuello, Carlos A / Augustine, Caitlin / Bonduel, Mariana / Brandão, Leonardo R / Capman, Tammy / Chan, Anthony K C / Hanson, Sheila / Male, Christoph / Meerpohl, Joerg / Newall, Fiona / O'Brien, Sarah H / Raffini, Leslie / van Ommen, Heleen / Wiernikowski, John / Williams, Suzan / Bhatt, Meha / Riva, John J / Roldan, Yetiani / Schwab, Nicole / Mustafa, Reem A / Vesely, Sara K. ·Department of Clinical Haematology, Royal Children's Hospital, University of Melbourne and Murdoch Children's Research Institute, VIC, Australia. · Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. · Tecnologico de Monterrey School of Medicine, Monterrey, Mexico. · Boston, MA. · Department of Hematology/Oncology, Hospital de Pediatria "Prof. Dr. Juan P. Garrahan," Buenos Aires, Argentina. · Division of Haematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada. · Melbourne, FL. · Department of Pediatrics, McMaster University, Hamilton, ON, Canada. · Department of Pediatrics, Medical College of Wisconsin and Critical Care Section, Children's Hospital of Wisconsin, Milwaukee, WI. · Department of Pediatrics, Medical University of Vienna, Vienna, Austria. · Department of Medical Biometry and Statistics, Institute of Medical Biometry and Medical Informatics, University of Freiburg and University Medical Center Freiburg, Freiburg, Germany. · Department of Clinical Haematology and. · Department of Nursing Research, Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, Australia. · Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH. · Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA. · Department of Pediatric Hematology, Sophia Children's Hospital Erasmus MC, Rotterdam, The Netherlands. · Division of Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada. · Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. · Department of Family Medicine, McMaster University, Hamilton, ON, Canada. · Division of Nephrology and Hypertension, Department of Medicine, University of Kansas Medical Center, Kansas City, KS; and. · Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. ·Blood Adv · Pubmed #30482766.

ABSTRACT: BACKGROUND: Despite an increasing incidence of venous thromboembolism (VTE) in pediatric patients in tertiary care settings, relatively few pediatric physicians have experience with antithrombotic interventions. OBJECTIVE: These guidelines of the American Society of Hematology (ASH), based on the best available evidence, are intended to support patients, clinicians, and other health care professionals in their decisions about management of pediatric VTE. METHODS: ASH formed a multidisciplinary guideline panel that included 2 patient representatives and was balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline-development process, including updating or performing systematic evidence reviews (up to April of 2017). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment. RESULTS: The panel agreed on 30 recommendations, covering symptomatic and asymptomatic deep vein thrombosis, with specific focus on management of central venous access device-associated VTE. The panel also addressed renal and portal vein thrombosis, cerebral sino venous thrombosis, and homozygous protein C deficiency. CONCLUSIONS: Although the panel offered many recommendations, additional research is required. Priorities include understanding the natural history of asymptomatic thrombosis, determining subgroup boundaries that enable risk stratification of children for escalation of treatment, and appropriate study of newer anticoagulant agents in children.

4 Guideline American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. 2018

Lim, Wendy / Le Gal, Grégoire / Bates, Shannon M / Righini, Marc / Haramati, Linda B / Lang, Eddy / Kline, Jeffrey A / Chasteen, Sonja / Snyder, Marcia / Patel, Payal / Bhatt, Meha / Patel, Parth / Braun, Cody / Begum, Housne / Wiercioch, Wojtek / Schünemann, Holger J / Mustafa, Reem A. ·Department of Medicine and. · Department of Pathology & Molecular Medicine, McMaster University, Hamilton, ON, Canada. · Department of Medicine, University of Ottawa/Ottawa Hospital Research Institute, Ottawa, ON, Canada. · Thrombosis and Atherosclerosis Research Institute (TaARI), McMaster University, Hamilton, ON, Canada. · Division of Angiology and Hemostasis, Department of Medical Specialties, Geneva University Hospitals, Geneva, Switzerland. · Faculty of Medicine, University of Geneva, Geneva, Switzerland. · Department of Radiology and. · Department of Medicine, Montefiore Medical Center/College of Medicine, Albert Einstein, Bronx, NY. · Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. · Rockyview General Hospital, Calgary, AB, Canada. · Department of Emergency Medicine, School of Medicine, Indiana University, Indianapolis, IN. · Fort Myers, FL. · Wheaton, IL. · Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL. · Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. · Department of Internal Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, MO. · Department of Medicine, Loyola University Medical Center, Maywood, IL; and. · Division of Nephrology and Hypertension, Department of Medicine, University of Kansas Medical Center, Kansas City, KS. ·Blood Adv · Pubmed #30482764.

ABSTRACT: BACKGROUND: Modern diagnostic strategies for venous thromboembolism (VTE) incorporate pretest probability (PTP; prevalence) assessment. The ability of diagnostic tests to correctly identify or exclude VTE is influenced by VTE prevalence and test accuracy characteristics. OBJECTIVE: These evidence-based guidelines are intended to support patients, clinicians, and health care professionals in VTE diagnosis. Diagnostic strategies were evaluated for pulmonary embolism (PE), deep vein thrombosis (DVT) of the lower and upper extremity, and recurrent VTE. METHODS: The American Society of Hematology (ASH) formed a multidisciplinary panel including patient representatives. The McMaster University GRADE Centre completed systematic reviews up to 1 October 2017. The panel prioritized questions and outcomes and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations. Test accuracy estimates and VTE population prevalence were used to model expected outcomes in diagnostic pathways. Where modeling was not feasible, management and accuracy studies were used to formulate recommendations. RESULTS: Ten recommendations are presented, by PTP for patients with suspected PE and lower extremity DVT, and for recurrent VTE and upper extremity DVT. CONCLUSIONS: For patients at low (unlikely) VTE risk, using D-dimer as the initial test reduces the need for diagnostic imaging. For patients at high (likely) VTE risk, imaging is warranted. For PE diagnosis, ventilation-perfusion scanning and computed tomography pulmonary angiography are the most validated tests, whereas lower or upper extremity DVT diagnosis uses ultrasonography. Research is needed on new diagnostic modalities and to validate clinical decision rules for patients with suspected recurrent VTE.

5 Guideline ACR Appropriateness Criteria 2018

Anonymous2821124 / Hanley, Michael / Steigner, Michael L / Ahmed, Osmanuddin / Azene, Ezana M / Bennett, Shelby J / Chandra, Ankur / Desjardins, Benoit / Gage, Kenneth L / Ginsburg, Michael / Mauro, David M / Oliva, Isabel B / Ptak, Thomas / Strax, Richard / Verma, Nupur / Dill, Karin E. ·Panel Chair, University of Virginia Health System, Charlottesville, Virginia. Electronic address: mhanley@virginia.edu. · Panel Vice-Chair, Brigham & Women's Hospital, Boston, Massachusetts. · Rush University Medical Center, Chicago, Illinois. · Gundersen Health System, La Crosse, Wisconsin. · X-Ray Associates of New Mexico, Albuquerque, New Mexico. · Scripps Green Hospital, La Jolla, California; Society for Vascular Surgery. · University of Pennsylvania, Philadelphia, Pennsylvania. · H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida. · Centegra Health System, McHenry, Illinois. · University of North Carolina School of Medicine, Chapel Hill, North Carolina. · Yale University School of Medicine, New Haven, Connecticut. · University of Maryland Medical Center, Baltimore, Maryland. · Baylor College of Medicine, Houston, Texas. · University of Florida, Gainesville, Florida. · Specialty Chair, UMass Memorial Medical Center, Worcester, Massachusetts. ·J Am Coll Radiol · Pubmed #30392609.

ABSTRACT: Suspected lower extremity deep venous thrombosis is a common clinical scenario which providers seek a reliable test to guide management. The importance of confidently making this diagnosis lies in the 50% to 60% risk of pulmonary embolism with untreated deep vein thrombosis and subsequent mortality of 25% to 30%, balanced with the risks of anticoagulation. The ACR Appropriateness Criteria Expert Panel on Vascular Imaging reviews the current literature regarding lower extremity deep venous thrombosis and compared various imaging modalities including ultrasound, MR venography, CT venography, and catheter venography. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

6 Guideline British Thoracic Society Guideline for the initial outpatient management of pulmonary embolism (PE). 2018

Howard, Luke S G E / Barden, Steven / Condliffe, Robin / Connolly, Vincent / Davies, Christopher W H / Donaldson, James / Everett, Bernard / Free, Catherine / Horner, Daniel / Hunter, Laura / Kaler, Jasvinder / Nelson-Piercy, Catherine / O-Dowd, Emma / Patel, Raj / Preston, Wendy / Sheares, Karen / Campbell, Tait. ·National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK. · Royal Sussex County Hospital, Brighton, UK. · Royal Hallamshire Hospital, Sheffield, UK. · South Tees Hospitals NHS Trust, Middlesbrough, UK. · Department of Respiratory Medicine, Royal Berkshire Hospital, Reading, UK. · Derby Teaching Hospitals NHS Foundation Trust. · Chesterfield, UK. · Department of Respiratory Medicine, George Eliot Hospital, Nuneaton, UK. · Emergency Department, Salford Royal NHS Foundation Trust, Salford, UK. · The Royal College of Emergency Medicine, London, UK. · St Thomas' Hospital, London, UK. · Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK. · Women's health academic centre, Guy's and Saint Thomas' NHS Foundation Trust, London, UK. · Department of Respiratory Medicine, Nottingham City Hospital, Nottingham, UK. · King's College Hospital NHS Foundation Trust, London, UK. · George Eliot Hospital NHS Trust, Nuneaton, UK. · Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK. · Haematology, Glasgow Royal Infirmary, Glasgow, UK. ·Thorax · Pubmed #29898978.

ABSTRACT: -- No abstract --

7 Guideline State of play and future direction with NOACs: An expert consensus. 2018

Cohen, A T / Lip, G Y / De Caterina, R / Heidbuchel, H / Zamorano, J L / Agnelli, G / Verheugt, F / Camm, A J. ·Department of Haematological Medicine, Guy's and St Thomas' Hospitals NHS Foundation Trust, King's College, London, UK. Electronic address: alexander.cohen@kcl.ac.uk. · Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. · Center of Excellence on Aging - CeSI-Met, "G. d'Annunzio" University, Chieti, Italy. · Antwerp University Hospital, Antwerp University, Antwerp, Belgium. · University Hospital Ramo'n y Cajal, Madrid, Spain. · Vascular and Emergency Medicine and Stroke Unit, University of Perugia, Perugia, Italy. · Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy. · Imperial College, St George's University of London, London, UK. ·Vascul Pharmacol · Pubmed #29656119.

ABSTRACT: Atrial fibrillation (AF) and venous thromboembolism (VTE) are cardiovascular conditions significant in contemporary practice. In both, the use of anticoagulation with vitamin K antagonists (VKAs) has been traditionally used to prevent adverse events. However, VKA therapy is associated with challenges relating to dose maintenance, the need to monitor anticoagulation, and bleeding risks. The non-vitamin K oral anticoagulants (NOACs) are becoming accepted as a clear alternative to VKA therapy for both AF and VTE management. The aim of this paper was to review contemporary evidence on the safety of NOACs in both conditions. A comprehensive literature review was conducted to explore key safety issues and expert consensus was achieved from eight professionals specialised in AF and VTE care. Consensus-based statements were formulated where available evidence was weak or contradictory. The expert statements in this paper form a key overview of the safety of NOACs compared with VKA therapy, and the comparative safety of different NOACs. It is apparent that a detailed patient work-up is required in order to identify and manage individual risk factors for bleeding and thrombosis prior to NOAC therapy. Additional measures, such as dose reductions, may also be used to maintain the safety of NOACs in practice.

8 Guideline Society of Interventional Radiology Position Statement on Catheter-Directed Therapy for Acute Pulmonary Embolism. 2018

Kuo, William T / Sista, Akhilesh K / Faintuch, Salomão / Dariushnia, Sean R / Baerlocher, Mark O / Lookstein, Robert A / Haskal, Ziv J / Nikolic, Boris / Gemmete, Joseph J. ·Division of Vascular and Interventional Radiology, Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr., H-3651, Stanford, CA 94305-5642. Electronic address: wkuo@stanford.edu. · Division of Vascular and Interventional Radiology, Department of Radiology, New York University Langone School of Medicine, New York, New York. · Division of Interventional Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts. · Department of Radiology, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, Georgia. · Department of Interventional Radiology, Royal Victoria Hospital, Barrie, Ontario, Canada. · Division of Vascular and Interventional Radiology, Mount Sinai Health System, New York, New York. · Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, Virginia. · Department of Radiology, Stratton Medical Center, Albany, New York. · Departments of Radiology and Neurosurgery, University of Michigan Hospitals, Ann Arbor, Michigan. ·J Vasc Interv Radiol · Pubmed #29422427.

ABSTRACT: -- No abstract --

9 Guideline The American Society of Colon and Rectal Surgeons Clinical Practice Guideline for the Prevention of Venous Thromboembolic Disease in Colorectal Surgery. 2018

Fleming, Fergal / Gaertner, Wolfgang / Ternent, Charles A / Finlayson, Emily / Herzig, Daniel / Paquette, Ian M / Feingold, Daniel L / Steele, Scott R. ·Prepared by the Clinical Practice Guidelines Committee of The American Society of Colon and Rectal Surgeons. ·Dis Colon Rectum · Pubmed #29219916.

ABSTRACT: -- No abstract --

10 Guideline European guidelines on perioperative venous thromboembolism prophylaxis: Inferior vena cava filters. 2018

Comes, Raquel Ferrandis / Mismetti, Patrick / Afshari, Arash / Anonymous2731497. ·From the Hospital Universitari i Politècnic La Fe, València, Spain (RFC), Unité de Recherche Clinique, Innovation et Pharmacologie, Centre Hospitalier Universitaire Saint-Etienne, Saint-Etienne, France (PM) and Department of Anesthesia, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (AA). ·Eur J Anaesthesiol · Pubmed #29112551.

ABSTRACT: : The indications for the use of an inferior vena cava filter (IVCF) in the context of deep venous thrombosis to prevent pulmonary embolism remain controversial. Despite wide use in clinical practice, great variation exists in national and international guidelines in regard to the indications. In addition, clinical practice is based on poor-quality data from trauma and bariatric surgery with a high incidence of complications. It is often difficult to assess their efficacy and lack of filter retrieval appears to be a substantial issue compared with a potential benefit by insertion of these devices. Complications usually refer to increased risk of deep venous thrombosis, filter perforation, filter penetration, filter migration, inferior vena cava occlusion and subsequently failure in pulmonary embolism prevention. Evidence from low-quality studies or registries, with small numbers of patients and conflicting findings, does not allow for a strong recommendation for or against the use of IVCFs. IVCFs should only be considered in cases of very high risk of pulmonary embolism and in perioperative situations at very high risk of bleeding, resulting in a prolonged contra-indication to pharmacological prophylaxis.

11 Guideline European guidelines on perioperative venous thromboembolism prophylaxis: Aspirin. 2018

Jenny, Jean-Yves / Pabinger, Ingrid / Samama, Charles Marc / Anonymous2701497. ·From the Orthopaedic Surgery Unit, Hôpitaux Universitaires de Strasbourg, CCOM, Illkirch, France (J-YJ), Clinical Division of Haematology & Haemostaseology, Department of Medicine I, Medical University Vienna, Waehringer Guertel, Vienna, Austria (IP) · and Department of Anaesthesia and Intensive Care Medicine, Cochin University Hospital, Assistance-Publique Hôpitaux de Paris, Université Paris Descartes, Paris, France (CMS). ·Eur J Anaesthesiol · Pubmed #29112548.

ABSTRACT: : There is a good rationale for the use of aspirin in venous thromboembolism prophylaxis in some orthopaedic procedures, as already proposed by the 9th American College of Chest Physicians' guidelines (Grade 1C). We recommend using aspirin, considering that it may be less effective than or as effective as low molecular weight heparin for prevention of deep vein thrombosis and pulmonary embolism after total hip arthroplasty, total knee arthroplasty and hip fracture surgery (Grade 1C). Aspirin may be less effective than or as effective as low molecular weight heparins for prevention of deep vein thrombosis and pulmonary embolism after other orthopaedic procedures (Grade 2C). Aspirin may be associated with a low rate of bleeding after total hip arthroplasty, total knee arthroplasty and hip fracture surgery (Grade 1B). Aspirin may be associated with less bleeding after total hip arthroplasty, total knee arthroplasty and hip fracture surgery than other pharmacological agents (Grade 1B). No data are available for other orthopaedic procedures. We do not recommend aspirin as thromboprophylaxis in general surgery (Grade 1C). However, this type of prophylaxis could be interesting especially in low-income countries (Grade 2C) and adequate large-scale trials with proper study designs should be carried out (Grade 1C).

12 Guideline European guidelines on perioperative venous thromboembolism prophylaxis: Surgery in the elderly. 2018

Kozek-Langenecker, Sibylle / Fenger-Eriksen, Christian / Thienpont, Emmanuel / Barauskas, Giedrius / Anonymous2581497. ·From the Sigmund Freud Private University and Department of Anaesthesia and Intensive Care, Evangelical Hospital Vienna, Vienna, Austria (SK-L), Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark (CF-E), Orthopaedic Surgery, University Hospital Saint Luc, Brussels, Belgium (ET), and Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania (GB). ·Eur J Anaesthesiol · Pubmed #28901992.

ABSTRACT: : The risk for postoperative venous thromboembolism (VTE) is increased in patients aged more than 70 years and in elderly patients presenting with co-morbidities, for example cardiovascular disorders, malignancy or renal insufficiency. Therefore, risk stratification, correction of modifiable risks and sustained perioperative thromboprophylaxis are essential in this patient population. Timing and dosing of pharmacoprophylaxis may be adopted from the non-aged population. Direct oral anti-coagulants are effective and well tolerated in the elderly; statins may not replace pharmacological thromboprophylaxis. Early mobilisation and use of non-pharmacological means of thromboprophylaxis should be exploited. In elderly patients, we suggest identification of co-morbidities increasing the risk for VTE (e.g. congestive heart failure, pulmonary circulation disorder, renal failure, lymphoma, metastatic cancer, obesity, arthritis, post-menopausal oestrogen therapy) and correction if present (e.g. anaemia, coagulopathy) (Grade 2C). We suggest against bilateral knee replacement in elderly and frail patients (Grade 2C). We suggest timing and dosing of pharmacological VTE prophylaxis as in the non-aged population (Grade 2C). In elderly patients with renal failure, low-dose unfractionated heparin (UFH) may be used or weight-adjusted dosing of low molecular weight heparin (Grade 2C). In the elderly, we recommend careful prescription of postoperative VTE prophylaxis and early postoperative mobilisation (Grade 1C). We recommend multi-faceted interventions for VTE prophylaxis in elderly and frail patients, including pneumatic compression devices, low molecular weight heparin (and/or direct oral anti-coagulants after knee or hip replacement) (Grade 1C). : This article is part of the European guidelines on perioperative venous thromboembolism prophylaxis. For details concerning background, methods, and members of the ESA VTE Guidelines Task Force, please, refer to:Samama CM, Afshari A, for the ESA VTE Guidelines Task Force. European guidelines on perioperative venous thromboembolism prophylaxis. Eur J Anaesthesiol 2018; 35:73-76.A synopsis of all recommendations can be found in the following accompanying article: Afshari A, Ageno W, Ahmed A, et al., for the ESA VTE Guidelines Task Force. European Guidelines on perioperative venous thromboembolism prophylaxis. Executive summary. Eur J Anaesthesiol 2018; 35:77-83.

13 Guideline Recommendations for standardized risk factor definitions in pediatric hospital-acquired venous thromboembolism to inform future prevention trials: communication from the SSC of the ISTH. 2017

Branchford, B R / Mahajerin, A / Raffini, L / Chalmers, E / van Ommen, C H / Chan, A K C / Goldenberg, N A / Anonymous3591006. ·Department of Pediatrics, Section of Hematology/Oncology and the Hemophilia and Thrombosis Center, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA. · Division of Hematology, CHOC Children's Specialists, Orange, CA, USA. · Department of Pediatrics, Division of Hematology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. · Department of Haematology, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK. · Department of Pediatric Haematology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, the Netherlands. · Division of Hematology/Oncology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada. · Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Johns Hopkins Medicine Pediatric Thrombosis Program, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA. · Johns Hopkins Children's Center, Baltimore, MD, USA. · All Children's Research Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA. ·J Thromb Haemost · Pubmed #29027741.

ABSTRACT: -- No abstract --

14 Guideline [A statement the Polish Cardiac Society Working Group on Pulmonary Circulation on screening for CTEPH patients after acute pulmonary embolism]. 2017

Ciurzyński, Michał / Kurzyna, Marcin / Kopeć, Grzegorz / Błaszczak, Piotr / Chrzanowski, Łukasz / Kamiński, Karol / Mizia-Stec, Katarzyna / Mularek-Kubzdela, Tatiana / Mroczek, Ewa / Biederman, Andrzej / Pruszczyk, Piotr / Torbicki, Adam. ·Klinika Chorób Wewnętrznych i Kardiologii z Centrum Diagnostyki i Leczenia Żylnej Choroby Zakrzepowo Zatorowej, Warszawski Uniwersytet Medyczny, Warszawa, Polska. michal.ciurzynski@wum.edu.pl. ·Kardiol Pol · Pubmed #28628189.

ABSTRACT: Both pharmacological and invasive treatment of chronic thromboembolic pulmonary hypertension (CTEPH) is now available in Poland and the awareness of the disease among physicians is growing. Thus, the Polish Cardiac Society's Working Group on Pulmonary Circulation in cooperation with independent experts in this field, have launched the statement on algorithm to guide a CTEPH diagnosis in patients with previous acute pulmonary embolism (APE). In Poland, every year this disease affects about 250 patients. CTEPH should be suspected in individuals after APE with dyspnea, despite at least 3 months period of effective anticoagulation, particularly when specified risk factors are present. Echocardiography is a main screening tool. The authors suggest that a diagnostic process of patients with significant clinical suspicion of CTEPH and right ventricle overload in echocardiography should be performed in reference centres. The document contains a list of Polish centres diagnosing patients with suspected CTEPH. Pulmonary scintigraphy is a safe and highly sensitive screening test for CTEPH. Multi-detector computed tomography with precise detection of thromboembolic residues in pulmonary circulation is important for planning of pulmonary endarterectomy. Right heart catheterisation definitely confirms the presence of pulmonary hypertension and direct pulmonary angiography allows for identification of lesions suitable for thromboendarterectomy or pulmonary balloon angioplasty. In this document a diagnostic algorithm in patients with suspected CTEPH is also proposed. With individualised sequential diagnostic strategy each patient can be finally qualified for a particular mode of therapy by dedicated CTEPH Heart Team. Moreover the document contains short information for the primary care physician about the management of patients after APE.

15 Guideline ACR Appropriateness Criteria 2017

Anonymous3740905 / Kirsch, Jacobo / Brown, Richard K J / Henry, Travis S / Javidan-Nejad, Cylen / Jokerst, Clinton / Julsrud, Paul R / Kanne, Jeffrey P / Kramer, Christopher M / Leipsic, Jonathon A / Panchal, Kalpesh K / Ravenel, James G / Shah, Amar B / Mohammed, Tan-Lucien / Woodard, Pamela K / Abbara, Suhny. ·Principal Author, Cleveland Clinic, Weston, Florida. Electronic address: kirschj@gmail.com. · University Hospital, Ann Arbor, Michigan. · University of California San Francisco, San Francisco, California. · Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri. · Banner University Medical Center, Tucson, Arizona. · Mayo Clinic, Rochester, Minnesota. · University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. · University of Virginia Health System, Charlottesville, Virginia; American College of Cardiology. · St. Paul's Hospital, Vancouver, British Columbia, Canada. · University of Cincinnati Hospital, Cincinnati, Ohio. · Medical University of South Carolina, Charleston, South Carolina. · Westchester Medical Center, Valhalla, New York. · Specialty Chair, University of Florida College of Medicine, Gainesville, Florida. · Specialty Chair, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri. · Panel Chair, UT Southwestern Medical Center, Dallas, Texas. ·J Am Coll Radiol · Pubmed #28473076.

ABSTRACT: Pulmonary embolism (PE) remains a common and important clinical condition that cannot be accurately diagnosed on the basis of signs, symptoms, and history alone. The diagnosis of PE has been facilitated by technical advancements and multidetector CT pulmonary angiography, which is the major diagnostic modality currently used. Ventilation and perfusion scans remain largely accurate and useful in certain settings. Lower-extremity ultrasound can substitute by demonstrating deep vein thrombosis; however, if negative, further studies to exclude PE are indicated. In all cases, correlation with the clinical status, particularly with risk factors, improves not only the accuracy of diagnostic imaging but also overall utilization. Other diagnostic tests have limited roles. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

16 Guideline Clinical Pharmacogenetic Testing and Application: Laboratory Medicine Clinical Practice Guidelines. 2017

Kim, Sollip / Yun, Yeo Min / Chae, Hyo Jin / Cho, Hyun Jung / Ji, Misuk / Kim, In Suk / Wee, Kyung A / Lee, Woochang / Song, Sang Hoon / Woo, Hye In / Lee, Soo Youn / Chun, Sail. ·Department of Laboratory Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea. · Department of Laboratory Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea. · Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. · Department of Laboratory Medicine, Konyang University Hospital, College of Medicine, Konyang University, Daejeon, Korea. · Department of Laboratory Medicine, Veterans Health Service Medical Center, Seoul, Korea. · Department of Laboratory Medicine, School of Medicine, Pusan National University, Busan, Korea. · Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea. · Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea. · Department of Laboratory Medicine, Seoul National University Hospital and College of Medicine, Seoul, Korea. · Department of Laboratory Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea. · Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. suddenbz@skku.edu. · Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea. sailchun@amc.seoul.kr. ·Ann Lab Med · Pubmed #28029011.

ABSTRACT: Pharmacogenetic testing for clinical applications is steadily increasing. Correct and adequate use of pharmacogenetic tests is important to reduce unnecessary medical costs and adverse patient outcomes. This document contains recommended pharmacogenetic testing guidelines for clinical application, interpretation, and result reporting through a literature review and evidence-based expert opinions for the clinical pharmacogenetic testing covered by public medical insurance in Korea. This document aims to improve the utility of pharmacogenetic testing in routine clinical settings.

17 Guideline Combined hormonal contraception and the risk of venous thromboembolism: a guideline. 2017

Anonymous330886 / Anonymous340886. ·American Society for Reproductive Medicine, Birmingham, Alabama. ·Fertil Steril · Pubmed #27793376.

ABSTRACT: While venous thromboembolism (VTE) is rare in young women of reproductive age, combined oral contraceptives increase the risk of VTE. In the patient in whom combined hormonal contraception is appropriate, it is reasonable to use any currently available preparation.

18 Guideline [ANMCO Position paper: Recommendations for the follow-up of patients with pulmonary thromboembolism]. 2016

D'Agostino, Carlo / Zonzin, Pietro / Enea, Iolanda / Gulizia, Michele Massimo / Ageno, Walter / Agostoni, Piergiuseppe / Azzarito, Michele / Becattini, Cecilia / Bongarzoni, Amedeo / Bux, Francesca / Casazza, Franco / Corrieri, Nicoletta / D'Alto, Michele / D'Amato, Nicola / D'Armini, Andrea Maria / De Natale, Maria Grazia / Di Minno, Giovanni / Favretto, Giuseppe / Filippi, Lucia / Grazioli, Valentina / Palareti, Gualtiero / Pesavento, Raffaele / Roncon, Loris / Scelsi, Laura / Tufano, Antonella. ·U.O.C. Cardiologia Ospedaliera, Azienda Ospedaliero-Universitaria Policlinico, Bari. · U.O.C. Cardiologia, Presidio Ospedaliero, Rovigo. · U.O.C. Medicina d'Urgenza, A.O.R.N. S. Anna e S. Sebastiano, Caserta. · U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania. · Dipartimento di Medicina Clinica e Sperimentale, Università dell'Insubria, Varese. · Centro Cardiologico Monzino, IRCCS, Milano. · Servizio di Cardiologia, Ospedale San Carlo di Nancy, Roma. · Medicina Interna e Vascolare, Azienda Ospedaliera di Perugia, Perugia. · U.O.C. Cardiologia, Ospedale San Carlo Borromeo, Milano. · U.O.C. Cardiologia-UTIC, Ospedale Di Venere ASL, Bari. · Fondazione Moscati, Buccinasco (MI). · Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi, Milano. · U.O.C. Cardiologia-SUN, A.O.R.N. dei Colli-A.O. Monaldi, Napoli. · Chirurgia Cardio-Toracica, Università degli Studi, Fondazione IRCSS Policlinico San Matteo, Pavia. · Centro per le Coagulopatie, Università degli Studi "Federico II", Napoli. · U.O. Cardiologia Riabilitativa e Preventiva, Ospedale Riabilitativo Alta Specializzazione, Motta di Livenza (TV). · Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Università degli Studi, Padova. · Divisione di Angiologia e Malattie della Coagulazione, Policlinico S. Orsola-Malpighi, Università degli Studi, Bologna. · U.O.C. Cardiologia, Ospedale S. Maria della Misericordia, Rovigo. · S.C. Cardiologia, Fondazione IRCSS Policlinico San Matteo, Pavia. ·G Ital Cardiol (Rome) · Pubmed #27869893.

ABSTRACT: Venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism, is the third most common cause of cardiovascular death. The management of the acute phase of VTE is well described in several papers and guidelines, whereas the management of the follow-up of the patients affected from VTE is less defined. This position paper of the Italian Association of Hospital Cardiologists (ANMCO) tries to fill the gap using currently available evidence and the opinion of the experts to suggest the most useful way to manage patients in the chronic phase.The clinical and laboratory tests acquired during the acute phase of the disease drives the decision of the following period. Acquired or congenital thrombophilic factors may be identified to explain an apparently not provoked VTE. In some patients, a not yet clinically evident cancer could be the trigger of VTE and this could lead to a different strategy. The main target of the post-acute management is to prevent relapse of the disease and to identify those patients who could worsen or develop chronic thromboembolic pulmonary hypertension. The knowledge of the etiopathogenetic ground is important to address the therapeutic approach, choosing the best antithrombotic strategy and deciding how long therapy should last. During the follow-up period, prognostic stratification should be updated on the basis of new evidences eventually acquired.Treatment of VTE is mainly based on oral or parenteral anticoagulation. Oral direct inhibitors of coagulation represent an interesting new therapy for the acute and extended period of treatment.

19 Guideline [ANMCO position paper: Use of new oral anticoagulants for the treatment and prevention of pulmonary thromboembolism]. 2016

Enea, Iolanda / Roncon, Loris / Gulizia, Michele Massimo / Azzarito, Michele / Becattini, Cecilia / Bongarzoni, Amedeo / Casazza, Franco / Cuccia, Claudio / D'Agostino, Carlo / Rugolotto, Matteo / Vatrano, Marco / Vinci, Eugenio / Fenaroli, Paride / Formigli, Dario / Silvestri, Paolo / Nardi, Federico / Vedovati, Maria Cristina / Scherillo, Marino. ·U.O.C. Medicina d'Urgenza, A.O.R.N. S. Anna e S. Sebastiano, Caserta. · U.O.C. Cardiologia, Ospedale S. Maria della Misericordia, Rovigo. · U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania. · Servizio di Cardiologia, Ospedale San Carlo di Nancy, Roma. · Medicina Interna e Vascolare, Azienda Ospedaliera di Perugia, Perugia. · U.O.C. Cardiologia, Ospedale San Carlo Borromeo, Milano. · Fondazione Moscati, Buccinasco (MI). · U.O. Cardiologia, Istituto Ospedaliero Fondazione Poliambulanza, Brescia. · U.O.C. Cardiologia Ospedaliera, Azienda Ospedaliero-Universitaria Policlinico, Bari. · U.O.C. Cardiologia, Ospedale Ca' Foncello, Treviso. · UTIC-Emodinamica e Cardiologia Interventistica, Ospedale Civile Pugliese, Catanzaro. · U.O.C. Cardiologia-UTIC, Ospedale Umberto I, Siracusa. · U.O. Nefrologia e Dialisi, IRCCS Fondazione Salvatore Maugeri, Università degli Studi, Pavia. · Cardiologia Interventistica-UTIC, A.O. G. Rummo, Benevento. · S.O.C. Cardiologia, Ospedale Castelli, Verbania. · Medicina Interna e Vascolare, Ospedale S. Maria della Misericordia, Università degli Studi, Perugia. ·G Ital Cardiol (Rome) · Pubmed #27869892.

ABSTRACT: The new oral anticoagulants (NOACs) have radically changed the approach to the treatment and prevention of thromboembolic pulmonary embolism. The authors of this position paper face, in succession, issues concerning NOACs, including 1) their mechanism of action, pharmacodynamics and pharmacokinetics; 2) the use in the acute phase with the "double drug single dose" approach or with "single drug double dose"; 3) the use in the extended phase with demonstrated efficacy and with low incidence of bleeding events; 4) the encouraging use of NOACs in particular subgroups of patients such as those with cancer, the ones under- or overweight, with renal insufficiency (creatinine clearance >30 ml/min), the elderly (>75 years); 5) they propose a possible laboratory clinical pathway for follow-up; 6) carry out an examination on the main drug interactions, their potential bleeding risk, and the way to deal with some bleeding complications. The authors conclude that the use of NOACs both in the acute phase and in the extended phase is equally effective to conventional therapy and associated with fewer major bleeding events, which make their use in patients at higher risk of recurrences safer.

20 Guideline [Clinical guidelines for the diagnosis and treatment of chronic thromboembolic pulmonary hypertension (Part 2)]. 2016

Chazova, I E / Martynyuk, T V. ·A.L. Myasnikov Institute of Clinical Cardiology, Russian Cardiology Research and Production Complex, Ministry of Health of the Russian Federation, Moscow, Russia. ·Ter Arkh · Pubmed #27801422.

ABSTRACT: The paper gives current approaches to treating chronic thromboembolic pulmonary hypertension (CTEPH) from the document «Federal Guidelines for the Diagnosis and Treatment of CTEPH» approved at the Third Russian Congress on Pulmonary Hypertension on December 11, 2015. The guidelines had been elaborated to optimize the treatment of patients with CTEPH on the basis of an analysis of the data of the present-day registries and multicenter randomized clinical trials, national and international guidelines and consensus documents, and documents published in recent years. CTEPH is a unique form of pulmonary hypertension since it is potentially curable by surgical treatment. The paper presents indications for and contraindications to pulmonary thromboendartectomy; preparation for surgery; operating room facilities; the specific features of postoperative management and possible complications; and long-term RESULTS: In terms of therapy, in addition to non-pharmacological measures, the authors discuss maintenance and specific treatment options for CTEPH, balloon pulmonary angioplasty, and lung/heart-lung transplantation. In conclusion they propose a management algorithm in patients with CTEPH and requirements for its problem to the center of experts.

21 Guideline [Clinical guidelines for the diagnosis and treatment of chronic thromboembolic pulmonary hypertension (Part 1)]. 2016

Chazova, I E / Martynyuk, T V. ·A.L. Myasnikov Institute of Clinical Cardiology, Russian Cardiology Research and Production Complex, Ministry of Health of the Russian Federation, Moscow, Russia. ·Ter Arkh · Pubmed #27735920.

ABSTRACT: Chronic thromboembolic pulmonary hypertension (CTEPH) is precapillary pulmonary hypertension, in which chronic obstruction of large and middle branches of pulmonary arteries (PAs) and secondary changes in the lung microcirculatory bed result in a progressive increase in pulmonary vascular resistance and PA pressure with the development of severe right cardiac dysfunction and heart failure. CTEPH is a unique form of pulmonary hypertension since it is potentially curable by surgical treatment. The diagnostic criteria for CTEPH are a mean PA pressure of ≥25 mm Hg, as evidenced by right heart catheterization; a PA wedge pressure of ≤15 mm Hg; a pulmonary vascular resistance of >2 Wood units; the presence of chronic/organized thrombi/emboli in the elastic PAs (pulmonary trunk, lobular, segmental, subsegmental PAs); effective anticoagulant therapy at therapeutic dosages over at least 3 months. Up to now, our country has had no guidelines for the diagnosis and treatment of this rare severe disease that, when appropriately untreated, has an extremely poor prognosis. The main task in the preparation of this document was to generalize and analyze the data of current registries, multicenter randomized clinical trials, national and international guidelines, and consensus documents recently published on this problem in order to optimize a diagnostic process and treatment in this category of patients. Part 1 gives a definition of CTEPH, its place in the clinical classification, epidemiology and prognosis, risk factors, pathogenesis and morphology, diagnostic approaches and determination of operability in patients, and specific features of differential diagnosis.

22 Guideline [Update on Current Care Guideline: Venous thromboembolism (VTE): deep venous thrombosis and pulmonary embolism]. 2016

Anonymous2080868. · ·Duodecim · Pubmed #27188093.

ABSTRACT: Key recommendations in management of VTE include prompt and systematic diagnostics based on clinical probability, D-dimer testing and imaging studies, and individualized antithrombotic treatment. Outpatient management is encouraged for patients with favourable prognosis. Interventions such as thrombolysis, venous stenting and inferior vena cava filters are limited to specific subgroups of patients. The duration of anticoagulation is tailored by balancing the risks of VTE recurrence and bleeding. Without contraindications, the minimal duration of anticoagulation is 3 months. The selection between warfarin, direct oral anticoagulants (apixaban, dabigatran, rivaroxaban) and low molecular weight heparin is based on individual patient characteristics and suitability of each drug.

23 Guideline Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients-Part II: Cardiac Ultrasonography. 2016

Levitov, Alexander / Frankel, Heidi L / Blaivas, Michael / Kirkpatrick, Andrew W / Su, Erik / Evans, David / Summerfield, Douglas T / Slonim, Anthony / Breitkreutz, Raoul / Price, Susanna / McLaughlin, Matthew / Marik, Paul E / Elbarbary, Mahmoud. ·1Division of Pulmonary and Critical Care Medicine Eastern Virginia Medical School, Norfolk, VA. 2Los Angeles, CA. 3Department of Emergency Medicine, St Francis Hospital, University of South Carolina School of Medicine, Columbus, GA. 4Foothills Medical Centre and the University of Calgary, Calgary, AB, Canada. 5Department of Anesthesiology and Critical Care Medicine The Johns Hopkins University School of Medicine, Baltimore, MD. 6Emergency Ultrasound, Department of Emergency Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA. 7Aerospace and Critical Care Medicine, Mayo Clinic, Rochester, MN. 8Renown Health Reno, Nevada. 9Department of Anesthesiology, University Hospital of the Sarrland, Homburg-Saar, Germany. 10Clinics of Anesthesiology, Intensive Care and Pain Therapy, Hospital of the Goethe University, Frankfurt, Germany. 11Royal Brompton Hospital, London, United Kingdom. 12Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA. 13King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia. 14Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. ·Crit Care Med · Pubmed #27182849.

ABSTRACT: OBJECTIVE: To establish evidence-based guidelines for the use of bedside cardiac ultrasound, echocardiography, in the ICU and equivalent care sites. METHODS: Grading of Recommendations, Assessment, Development and Evaluation system was used to rank the "levels" of quality of evidence into high (A), moderate (B), or low (C) and to determine the "strength" of recommendations as either strong (strength class 1) or conditional/weak (strength class 2), thus generating six "grades" of recommendations (1A-1B-1C-2A-2B-2C). Grading of Recommendations, Assessment, Development and Evaluation was used for all questions with clinically relevant outcomes. RAND Appropriateness Method, incorporating the modified Delphi technique, was used in formulating recommendations related to terminology or definitions or in those based purely on expert consensus. The process was conducted by teleconference and electronic-based discussion, following clear rules for establishing consensus and agreement/disagreement. Individual panel members provided full disclosure and were judged to be free of any commercial bias. RESULTS: Forty-five statements were considered. Among these statements, six did not achieve agreement based on RAND appropriateness method rules (majority of at least 70%). Fifteen statements were approved as conditional recommendations (strength class 2). The rest (24 statements) were approved as strong recommendations (strength class 1). Each recommendation was also linked to its level of quality of evidence and the required level of echo expertise of the intensivist. Key recommendations, listed by category, included the use of cardiac ultrasonography to assess preload responsiveness in mechanically ventilated (1B) patients, left ventricular (LV) systolic (1C) and diastolic (2C) function, acute cor pulmonale (ACP) (1C), pulmonary hypertension (1B), symptomatic pulmonary embolism (PE) (1C), right ventricular (RV) infarct (1C), the efficacy of fluid resuscitation (1C) and inotropic therapy (2C), presence of RV dysfunction (2C) in septic shock, the reason for cardiac arrest to assist in cardiopulmonary resuscitation (1B-2C depending on rhythm), status in acute coronary syndromes (ACS) (1C), the presence of pericardial effusion (1C), cardiac tamponade (1B), valvular dysfunction (1C), endocarditis in native (2C) or mechanical valves (1B), great vessel disease and injury (2C), penetrating chest trauma (1C) and for use of contrast (1B-2C depending on indication). Finally, several recommendations were made regarding the use of bedside cardiac ultrasound in pediatric patients ranging from 1B for preload responsiveness to no recommendation for RV dysfunction. CONCLUSIONS: There was strong agreement among a large cohort of international experts regarding several class 1 recommendations for the use of bedside cardiac ultrasound, echocardiography, in the ICU. Evidence-based recommendations regarding the appropriate use of this technology are a step toward improving patient outcomes in relevant patients and guiding appropriate integration of ultrasound into critical care practice.

24 Guideline Treatment of pregnancy-associated venous thromboembolism - position paper from the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH). 2016

Linnemann, Birgit / Scholz, Ute / Rott, Hannelore / Halimeh, Susan / Zotz, Rainer / Gerhardt, Andrea / Toth, Bettina / Bauersachs, Rupert / Anonymous1750864. ·1 Medical Practice of Angiology and Haemostaseology, Praxis am Grüneburgweg, Frankfurt/Main, Germany. · 2 Zentrum für Blutgerinnungsstörungen, MVZ Labor Dr. Reising-Ackermann und Kollegen, Leipzig, Germany. · 3 Gerinnungszentrum Rhein Ruhr, Duisburg, Germany. · 4 Centrum für Blutgerinnungsstörungen und Transfusionsmedizin, Düsseldorf, Germany. · 5 Blutgerinnung Ulm, Germany. · 6 Gynäkologische Endokrinologie und Fertilitätsstörungen, Ruprecht-Karls-Universität Heidelberg, Germany. · 7 Klinikum Darmstadt, Klinik für Gefäßmedizin - Angiologie, Darmstadt, Germany. · 8 Centrum für Thrombose und Hämostase, Johannes-Gutenberg-Universität, Mainz, Germany. ·Vasa · Pubmed #27058796.

ABSTRACT: Venous thromboembolism (VTE) is a major cause of maternal morbidity during pregnancy and the postpartum period. However, because there is a lack of adequate study data, management strategies for pregnancy-associated VTE must be deduced from observational stu-dies and extrapolated from recommendations for non-pregnant patients. In this review, the members of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH) have summarised the evidence that is currently available in the literature to provide a practical approach for treating pregnancy-associated VTE. Because heparins do not cross the placenta, weight-adjusted therapeutic-dose low molecular weight heparin (LMWH) is the anticoagulant treatment of choice in cases of acute VTE during pregnancy. No differences between once and twice daily LMWH dosing regimens have been reported, but twice daily dosing seems to be advisable, at least peripartally. It remains unclear whether determining dose adjustments according to factor Xa activities during pregnancy provides any benefit. Management of delivery deserves attention and mainly depends on the time interval between the diagnosis of VTE and the expected delivery date. In particular, if VTE manifests at term, delivery should be attended by an experienced multidisciplinary team. In lactating women, an overlapping switch from LMWH to warfarin is possible. Anticoagulation should be continued for at least 6 weeks postpartum or for a minimum period of 3 months. Although recommendations are provided for the treatment of pregnancy-associated VTE, there is an urgent need for well-designed prospective studies that compare different management strategies and define the optimal duration and intensity of anticoagulant treatment.

25 Guideline Diagnosis of pregnancy-associated venous thromboembolism - position paper of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH). 2016

Linnemann, Birgit / Bauersachs, Rupert / Rott, Hannelore / Halimeh, Susan / Zotz, Rainer / Gerhardt, Andrea / Boddenberg-Pätzold, Barbara / Toth, Bettina / Scholz, Ute / Anonymous1740864. ·1 Medical Practice of Angiology and Haemostaseology, Praxis am Grüneburgweg, Frankfurt/Main, Germany. · 2 Klinikum Darmstadt, Klinik für Gefäßmedizin - Angiologie, Darmstadt, Germany. · 9 Centrum für Thrombose und Hämostase (CTH), Johannes-Gutenberg-Universität, Mainz, Germany. · 3 Gerinnungszentrum Rhein Ruhr, Duisburg, Germany. · 4 Centrum für Blutgerinnungsstörungen und Transfusionsmedizin, Düsseldorf, Germany. · 5 Blutgerinnung Ulm, Germany. · 6 Nuramed, Gemeinschaftspraxis für Radiologie und Nuklearmedizin, Köln, Germany. · 7 Gynäkologische Endokrinologie und Fertilitätsstörungen, Ruprecht-Karls-Universität Heidelberg. · 8 Zentrum für Blutgerinnungsstörungen, MVZ Labor Dr. Reising-Ackermann und Kollegen, Leipzig, Germany. ·Vasa · Pubmed #27058795.

ABSTRACT: Pregnancy and the postpartum period are associated with an increased risk of venous thromboembolism (VTE). Over the past decade, new diagnostic algorithms have been established, combining clinical probability, laboratory testing and imaging studies for the diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) in the non-pregnant population. However, there is no such generally accepted algorithm for the diagnosis of pregnancy-associated VTE. Studies establishing clinical prediction rules have excluded pregnant women, and prediction scores currently in use have not been prospectively validated in pregnancy or during the postpartum period. D-dimers physiologically increase throughout pregnancy and peak at delivery, so a negative D-dimer test result, based on the reference values of non-pregnant subjects, becomes unlikely in the second and third trimesters. Imaging studies therefore play a major role in confirming suspected DVT or PE in pregnant women. Major concerns have been raised against radiologic imaging because of foetal radiation exposure, and doubts about the diagnostic value of ultrasound techniques in attempting to exclude isolated iliac vein thrombosis grow stronger as pregnancy progresses. As members of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH), we summarise evidence from the available literature and aim to establish a more uniform strategy for diagnosing pregnancy-associated VTE.

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