Background: Patients with intermediate-high risk pulmonary embolism (PE) who have acute right ventricular dysfunction and myocardial injury without overt hemodynamic compromise may be candidates for thrombolytic therapy (TT). In this study, we aimed to compare the clinical outcomes of low-dose prolonged TT and unfractionated heparin (UFH) in intermediate-high risk PE patients.
Methods: This study enrolled 83 (female: 45 [54.2%], mean age: 70.07±10.7 years) retrospectively evaluated patients with the diagnosis of acute PE who were treated with low-dose and slow-infusion of TT or UFH. The primary outcomes of the study were de-fined as a combination of death from any cause and hemodynamic decompensation, and severe or life-threatening bleeding. Secondary endpoints were recurrent PE, pulmonary hypertension, and moderate bleeding.
Results: The initial management strategy of intermediate-high risk PE was TT in 41 (49.4%) patients and UFH in 42 (50.6%) cases. Low-dose prolonged TT was successful in all patients. While the frequency of hypotension decreased significantly after TT (22 vs. 0%, P<0.001), it did not decrease after UFH (2.4 vs. 7.1%, p=0.625). The proportion of hemodynamic decompensation was significantly lower in the TT group (0 vs. 11.9%, p=0.029). The rate of secondary endpoints was significantly higher in the UFH group (2.4 vs. 19%, P=0.016). Moreover, the prevalence of pulmonary hypertension was significantly higher in UFH group (0 vs. 19%, p=0.003).
Conclusion: Prolonged TT regimen with low dose, slow infusion of tissue plasminogen activator was found to be associated with a lower risk of hemodynamic decompensation and pulmonary hypertension in patients with acute intermediate-high-risk PE compared to UFH.
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http://dx.doi.org/10.14744/tjtes.2023.55236 | DOI Listing |
J Am Coll Surg
January 2025
Department of Surgery, Emory University School of Medicine, Atlanta, GA.
Introduction: Pancreatoduodenectomy (PD) may occasionally be indicated for complete removal of periampullary (duodenal and ampullary) adenomas (PAs). As compared with malignant indications, PD for benign or pre-malignant disease is often associated with increased morbidity. While the Spigelman classification assesses malignancy risk for familial adenomatous polyposis (FAP)-related duodenal adenomas, no malignancy risk score (MRS) exists for non-FAP related PAs.
View Article and Find Full Text PDFAliment Pharmacol Ther
January 2025
School of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Wolfson Wohl Cancer Research Centre, Garscube Estate, Glasgow, UK.
Background: Adherence to post-polypectomy surveillance is poor despite evidence that it is associated with lower risk of future colorectal cancer.
Methods: We evaluated 6,210 bowel screening participants between 2009-2016 in NHS Greater Glasgow and Clyde to assess potential barriers to post-polypectomy surveillance.
Results: Increasing deprivation (Scottish Index of Multiple Deprivation quintile 1 vs 5; OR 1.
Int Urol Nephrol
January 2025
Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy.
Purpose: Intravesical (i) immunotherapy with Bacillus Calmette-Guérin (BCG) is the recommended treatment for patients with intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC) after complete tumor resection. Discontinuation or suspension of this therapy is often due to local side effects. Aim of the study was to evaluate the efficacy and safety of sequential intravesical instillations of combined hyaluronic acid (HA) and chondroitin sulfate (CS) in reducing local BCG toxicity and urinary symptoms.
View Article and Find Full Text PDFPort J Card Thorac Vasc Surg
October 2024
Intensive Care Medicine, Centro Hospitalar e Universitário São João, Porto, Portugal; Faculty of Medicine, Porto University, Portugal.
Background And Objectives: The optimal management of high-risk and intermediate-high-risk Pulmonary Embolism (PE) is a matter of ongoing debate. This paper aims to assess the short and long-term clinical outcomes associated with different treatment approaches for high-risk and intermediate-high-risk PE within an Intensive Care Unit (ICU) and identify potential areas for improvement.
Methods: We conducted a retrospective analysis of patients admitted to an ICU with high and intermediate-high-risk PE between January 2018 and December 2023.
Clin Lymphoma Myeloma Leuk
December 2024
Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; Hematology Center, Peking University People's Hospital, Qingdao, China. Electronic address:
Aim: To describe tyrosine kinase inhibitor (TKI) treatment patterns and analyze co-variates of TKI switch for chronic myeloid leukemia (CML) patients in a center from China.
Methods: A retrospectively study was designed to analyze TKI switching patterns, reasons and associated covariates in patients with CP-CML.
Results: 1766 patients receiving initial imatinib (n = 1374), nilotinib (n = 254), dasatinib (n = 63) and flumatinib (n = 75) therapy were retrospectively interrogated.
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