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Journal articles on the topic 'Control Embolism'
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1
JONES, H. G., and R. A. SUTHERLAND. "Stomatal control of xylem embolism." Plant, Cell and Environment 14, no. 6 (August 1991): 607–12. http://dx.doi.org/10.1111/j.1365-3040.1991.tb01532.x.
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Broder, Sarah, and Peter Paré. "Diagnosis and Management of Pulmonary Embolism in Pregnancy." Canadian Respiratory Journal 3, no. 3 (1996): 187–91. http://dx.doi.org/10.1155/1996/674564.
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Pulmonary embolism in pregnancy is a significant and under-recognized problem. In British Columbia, where there are 46,000 pregnancies per year, it is estimated that there are approximately 160 pulmonary embolisms per year and one maternal death every two years secondary to pulmonary embolism. A complete assessment for suspected pulmonary embolus can be performed without putting the fetus at significant risk from radiation exposure. An algorithm is provided for the workup of pulmonary embolus during pregnancy. Heparin is the drug of choice for anticoagulating pregnant women, initially managing the situation with intravenous heparin and then switching to the subcutaneous route given in a bid or tid regimen, aiming to keep the activated partial thromboplastin time 1.5 to 2 times the control. The risks to both the fetus and the mother from anticoagulation during pregnancy are reviewed.
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Kalemci, Serdar, Arife Zeybek, Serap Cilaker Mıcılı, Aydın Sarıhan, Meryem Çalışır, Abdullah Şimşek, Fatih Akın, Alperen İhtiyar, and Osman Yılmaz. "The Protective Effect of The Interleukin 1 Receptor Antagonist on Chronic Thromboembolic Pulmonary Hypertension Model." Postępy Higieny i Medycyny Doświadczalnej 73 (December 31, 2019): 944–50. http://dx.doi.org/10.5604/01.3001.0013.7878.
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Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the main reasons of severe pulmonary hypertension and has significantly higher morbidity and mortality rates. The pathogenesis of the disease is characterized by the incomplete resolution of acute embolisms. The elevated inflammatory conditions after the acute embolism are one of the critical factors. Therefore, we aimed to investigate whether or not anakinra is an option for treating CTEPH in an animal model. We studied twenty-one rats in this study They were randomly divided into three groups containing seven animals: the control group: saline-treated control; the embolism group: CTEPH + normal saline; the anakinra group: CTEPH + anakinra. We have observed that the layers of the segmental arteries and the alveolar were normal in the control group. In the cardiac tissue it was observed that muscular tissues and connective tissue were normal in the right ventricle. In embolism group, we detected a widening of the alveolar septum, a surrounding the alveolar infiltrates and a thickening of the segmental arteries in the muscular layer and a hypertrophy in the right ventricle tissues. We have determined that the lung and cardiac tissue specimens in the anakinra group are similar to control group. We have showed that anakinra was useful option for the CTEPH model in rats. Anakinra may be considered as protective effect and the regression of the increased inflammation in CTEPH. The effectiveness of anakinra will continue to be subject to the further experimental and clinical studies.
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Kulesh, A. A., D. A. Demin, and O. I. Vinogradov. "Cryptogenic stroke. Part 1: Aorto-arterial embolism." Meditsinskiy sovet = Medical Council, no. 4 (April 20, 2021): 78–87. http://dx.doi.org/10.21518/2079-701x-2021-4-78-87.
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The article discusses the concept of embolic stroke from an unspecified source and the role of aorto-arterial embolism in its development. Potential causes of embolic cryptogenic stroke such as aortic atheromatosis, non-stenotic atherosclerosis of the cervical arteries, carotid web and intracranial atherosclerosis are discussed in detail. The discussion of each cause covers epidemiology, pathogenesis, and current approaches to diagnosis and secondary prevention. The diagnostic search is presented in the form of an algorithm. To identify aorto-arterial sources of embolism and to determine their clinical significance, a comprehensive examination including CT angiography with targeted assessment of the aortic arch, transesophageal echocardiography, MRI of the arterial wall and transcranial Doppler is required. When mechanical thrombectomy is performed, histological examination of the thromboembolus is advisable. Given that atherosclerosis is usually systemic, the search for a possible cause of aorto-arterial embolism should be a diagnostic priority in patients with cryptogenic stroke and other arterial (coronary, lower extremity) lesions. With regard to secondary prevention of cryptogenic stroke in the presence of potential sources of aorto-arterial embolism, the principle ‘the more embologenic the source, the more aggressive the prevention’ applies. The arsenal of secondary prevention includes strategies such as strict control of vascular risk factors, achieving target blood pressure, short- and medium-term dual antiplatelet therapy, and intensive hypolipidemic therapy. Surgical prophylaxis is warranted for stroke against a carotid background, the efficacy of which in non-stenotic atherosclerosis requires early evaluation in randomised trials. Each potential cause of cryptogenic stroke considered is illustrated by a clinical example.
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Kamalov, I. A., I. R. Agliullin, and M. G. Tukhbatullin. "Optimization of proper diagnosis of thromboses associated with high risk of embolism in patients with neoplasms." Kazan medical journal 94, no. 2 (April 15, 2013): 202–7. http://dx.doi.org/10.17816/kmj1589.
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Aim. To optimize a proper diagnosis of thromboses associated with high risk of embolism and pulmonary embolism prevention in patients with neoplasms. Methods. Ultrasonography of veins of lower extremities, iliac veins and the distal part of inferior vena cava was performed in patients with and without neoplasms in a prospective study to detect thromboses associated with high risk of embolism and thrombophlebitis. Ultrasonography was performed once in control group subjects, and before and during specialized antineoplastic treatment (surgical, chemotherapy, radiotherapy) in patients of the main group, the results were compared. A detection of a new thrombus in previously intact venous segment of inferior vena cava system was assessed as a high risk for pulmonary embolism. Results. Thromboses associated with high risk of embolism and thrombophlebitis were found in 6 patients of control group, in 5 patients of the main group before and in 27 patients of the main group while at specialized antineoplastic treatment. Specific measures for pulmonary embolism prevention were taken immediately in all of the cases according to ultrasonography results after the detection of thromboses associated with high risk of embolism. No fatal cases of pulmonary embolism were registered both in main (before and while at treatment) and control groups. Conclusion. Ultrasonography of veins of lower extremities, iliac veins and the distal part of inferior vena cava in patients with neoplasms before the start of specialized antineoplastic treatment allows to optimize the choice of prevention measures for pulmonary embolism and thus significantly decreases mortality from pulmonary embolism.
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Qiao, Zhihong, Ningyang Jia, and Qian He. "Does preoperative transarterial embolization decrease blood loss during spine tumor surgery?" Interventional Neuroradiology 21, no. 1 (February 2015): 129–35. http://dx.doi.org/10.15274/inr-2014-10091.
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This paper aimed to evaluate the effect of preoperative transarterial embolization (TAE) on estimated blood loss (EBL) during surgical excision of the vertebral tumors. Three hundred and forty-eight patients with spinal tumors were retrospectively analyzed. The preoperative TAE group consisted of 190 patients and the control group consisted of 158 patients. Gelatin sponge particles mixed withy contrast agent were used in the TAE group to embolize the tumor-feeding artery. The factors evaluated included: the time interval between embolism and surgery; the number of vertebrae involved by the tumor; pathological type of tumor; surgical approach; extent of excision and instrumental fixation. The time interval (P = 0.4669)between embolism and surgery had no significant correlation with EBL during surgery. The pathological diagnosis of vertebral tumor such as plasma cell myeloma, giant cell tumor, chondrosarcoma, hemangioma and metastasis had no significant correlation with EBL between the TAE group and control group during surgery, while the EBL of chordoma in the TAE group was significantly higher than that in the control group (p = 0.0254). The number of vertebrae involved (p = 0.4669, 0.6804, 0.6677), posterior approach (p = 0.3015), anterior approach (p = 0.2446), partial excision (p = 0.1911) and instrumental fixation (p = 0.1789) had no significant correlation with EBL during surgery between the TAE group and the control group. This study showed that preoperative TAE of the spinal tumor had no significant effect on intra-operative blood loss during surgical excision of the spinal tumor. In view of the risk of embolism, this method should be carefully considered.
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García Suquia, Angela, Alberto Alonso-Fernández, Mónica de la Peña, David Romero, Javier Piérola, Miguel Carrera, Antonia Barceló, et al. "High D-dimer levels after stopping anticoagulants in pulmonary embolism with sleep apnoea." European Respiratory Journal 46, no. 6 (July 23, 2015): 1691–700. http://dx.doi.org/10.1183/13993003.02041-2014.
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Obstructive sleep apnoea is a risk factor for pulmonary embolism. Elevated D-dimer levels and other biomarkers are associated with recurrent pulmonary embolism. The objectives were to compare the frequency of elevated D-dimer levels (>500 ng·mL−1) and further coagulation biomarkers after oral anticoagulation withdrawal in pulmonary embolism patients, with and without obstructive sleep apnoea, including two control groups without pulmonary embolism.We performed home respiratory polygraphy. We also measured basic biochemical profile and haemogram, and coagulation biomarkers (D-dimer, prothrombin fragment 1+2, thrombin-antithrombin complex, plasminogen activator inhibitor 1, and soluble P-selectin).64 (74.4%) of the pulmonary embolism cases and 41 (46.11%) of the controls without pulmonary embolism had obstructive sleep apnoea. Plasmatic D-dimer was higher in PE patients with OSA than in those without obstructive sleep apnoea. D-dimer levels were significantly correlated with apnoea–hypopnoea index, and nocturnal hypoxia. There were more patients with high D-dimer after stopping anticoagulants in those with pulmonary embolism and obstructive sleep apnoea compared with PE without obstructive sleep apnoea (35.4% versus 19.0%, p=0.003). Apnoea–hypopnoea index was independently associated with high D-dimer.Pulmonary embolism patients with obstructive sleep apnoea had higher rates of elevated D-dimer levels after anticoagulation discontinuation for pulmonary embolism than in patients without obstructive sleep apnoea and, therefore, higher procoagulant state that might increase the risk of pulmonary embolism recurrence.
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Koć, Marcin, Maciej Kostrubiec, Waldemar Elikowski, Nicolas Meneveau, Mareike Lankeit, Stefano Grifoni, Agnieszka Kuch-Wocial, et al. "Outcome of patients with right heart thrombi: the Right Heart Thrombi European Registry." European Respiratory Journal 47, no. 3 (January 21, 2016): 869–75. http://dx.doi.org/10.1183/13993003.00819-2015.
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Our aim was the assessment of the prognostic significance of right heart thrombi (RiHT) and their characteristics in pulmonary embolism in relation to established prognostic factors.138 patients (69 females) aged (mean±sd) 62±19 years with RiHT were included into a multicenter registry. A control group of 276 patients without RiHT was created by propensity scoring from a cohort of 963 contemporary patients. The primary end-point was 30-day pulmonary embolism-related mortality; the secondary end-point included 30-day all-cause mortality. In RiHT patients, pulmonary embolism mortality was higher in 31 patients with systolic blood pressure <90 mmHg than in 107 normotensives (42% versus 12%, p=0.0002) and was higher in the 83 normotensives with right ventricular dysfunction (RVD) than in the 24 normotensives without RVD (16% versus 0%, p=0.038). In multivariable analysis the simplified Pulmonary Embolism Severity Index predicted mortality (hazard ratio 2.43, 95% CI 1.58–3.73; p<0.0001), while RiHT characteristics did not. Patients with RiHT had higher pulmonary embolism mortality than controls (19% versus 8%, p=0.003), especially normotensive patients with RVD (16% versus 7%, p=0.02).30-day mortality in patients with RiHT is related to haemodynamic consequences of pulmonary embolism and not to RiHT characteristics. However, patients with RiHT and pulmonary embolism resulting in RVD seem to have worse prognosis than propensity score-matched controls.
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Branger, Annette B., and David M. Eckmann. "Accelerated Arteriolar Gas Embolism Reabsorption by an Exogenous Surfactant." Anesthesiology 96, no. 4 (April 1, 2002): 971–79. http://dx.doi.org/10.1097/00000542-200204000-00027.
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Background Cerebrovascular gas embolism can cause profound neurologic dysfunction, and there are few treatments. The authors tested the hypothesis that an exogenous surfactant can be delivered into the bloodstream to alter the air-blood interfacial mechanics of an intravascular gas embolism and produce bubble conformations, which favor more rapid bubble absorption. Methods Microbubbles of air were injected into the rat cremaster microcirculation after intravascular administration of either saline (control, n = 5) or Dow Corning Antifoam 1510US (surfactant, n = 5). Embolism dimensions and dynamics were directly observed after entrapment using intravital microscopy. Results To achieve embolization, the surfactant group required twice as many injections as did controls (3.2 +/- 1.3 vs. 1.6 +/- 0.9; P < 0.05). There was no difference in the initial lodging configuration between groups. After bubble entrapment, there was significantly more local vasoconstriction in the surfactant group (24.2% average decrease in diameter) than in controls (3.4%; P < 0.05). This was accompanied by a 92.7% bubble elongation in the surfactant group versus 8.2% in controls (P < 0.05). Embolism shape change was coupled with surfactant-enhanced breakup into multiple smaller bubbles, which reabsorbed nearly 30% more rapidly than did parent bubbles in the control group (P < 0.05). Conclusions Intravascular exogenous surfactant did not affect initial bubble conformation but dramatically increased bubble breakup and rate of reabsorption. This was evidenced by both the large shape change after entrapment and enhancement of bubble breakup in the surfactant group. These dynamic surfactant-induced changes increase the total embolism surface area and markedly accelerate bubble reabsorption.
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Martinelli, Ida, Marco Cattaneo, Daniela Panzeri, and Pier Mannuccio Mannucci. "Low Prevalence of Factor V:Q506 in 41 Patients with Isolated Pulmonary Embolism." Thrombosis and Haemostasis 77, no. 03 (1997): 440–43. http://dx.doi.org/10.1055/s-0038-1655985.
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SummaryIn 70-80% of cases, pulmonary embolism is the consequence of lower extremity deep vein thrombosis. It has been demonstrated that the most common coagulation defect predisposing to venous thrombosis, resistance to activated protein C (APC), is not associated with an increased risk for pulmonary embolism, but the evidence was based on a functional assay to diagnose APC resistance and no information about concomitant deep vein thrombosis was provided. The aim of our study was to evaluate the prevalence of factor V:Q506, the gene mutation responsible for APC resistance, in patients with symptomatic non-fatal pulmonary embolism, whether or not associated with deep vein thrombosis. Patients with uncomplicated deep vein thrombosis and healthy controls were investigated as comparison groups. The overall prevalence of factor V:Q506 in 106 patients with pulmonary embolism was 12.3%, lower than that found in 106 patients with deep vein thrombosis (22.6%, OR 0.5, 95% Cl 0.2-1.0) but significantly higher than that found in 212 healthy subjects taken as controls (2.8%, OR 4.8,95% Cl 1.8-13.0). In the 41 patients with isolated pulmonary embolism, i.e., without the presence of deep vein thrombosis, the prevalence was 4.9%, similar to that in controls (OR 1.8,95% Cl 0.3-9.6), while in the remaining 65 patients with pulmonary embolism associated with deep vein thrombosis the prevalence was significantly higher (16.9%, OR 5.5, 95% Cl 2.0-15.8). In conclusion, the prevalence of factor V:Q506 is high in patients with pulmonary embolism associated with deep vein thrombosis, whereas in patients with isolated pulmonary embolism it is similar to that found in control subjects. This intriguing finding is of difficult interpretation and needs confirmation by further studies.
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Çevik, İbrahim, Hüseyin Narcı, Güllü Akbaydoğan Dündar, Cüneyt Ayrık, and Seyran B. Babuş. "Is there a diagnostic value for the platelet indices patients in pulmonary embolism?" Hong Kong Journal of Emergency Medicine 25, no. 2 (December 20, 2017): 91–94. http://dx.doi.org/10.1177/1024907917743489.
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Background: Pulmonary embolism is a common disease with a high mortality risk. It has recently been reported that platelet indices may be diagnostic in pulmonary embolism. Objective: In this study, we aimed to determine the diagnostic value of platelet indices in acute pulmonary embolism. Methods: The study group was composed of 61 patients diagnosed with pulmonary embolism and a control group of 67 subjects without pulmonary embolism. Patient age, sex, leukocyte and platelet number, hemoglobin concentration (Hb), mean platelet volume, platelet distribution width, red blood cell distribution width, C-reactive protein, D-Dimer, and troponin I levels were retrospectively analyzed and compared between the two groups. Results: There was no significant difference between age and platelet number of pulmonary embolism and control group. In pulmonary embolism group, platelet distribution width level was significantly high (p = 0.002), whereas mean platelet volume level was significantly lower (p = 0.038). Receiver operating characteristic curve analysis revealed that a mean platelet volume cut-off of 9 fL had a sensitivity of 35%, a specificity of 89.55%, and area under the curve of 0.589 for pulmonary embolism, while a platelet distribution width cut-off of 12.8 fL had a sensitivity of 61%, a specificity of 71.64%, and area under the curve of 0.661. Platelet distribution width and D-dimer levels had a significant positive correlation with each other, whereas there was no significant correlation between mean platelet volume and D-dimer. Conclusion: Platelet distribution width values of the pulmonary embolism group were higher than those of control group. Although the area under the curve of platelet distribution width is slightly better than for platelet number or mean platelet volume, it does not seem that this parameter has better diagnostic accuracy than the other two.
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Pevnev, A. A., A. Yu Yakovlev, M. S. Belous, D. V. Ryabikov, and V. I. Zagrekov. "Predictive signs of fat embolism syndrome. Case-control study." Annals of Critical Care, no. 1 (2021): 143–49. http://dx.doi.org/10.21320/1818-474x-2021-1-143-149.
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Thomson, Duncan, Georgios Kourounis, Rebecca Trenear, Claudia-Martina Messow, Petr Hrobar, Alistair Mackay, and Chris Isles. "ECG in suspected pulmonary embolism." Postgraduate Medical Journal 95, no. 1119 (January 2019): 12–17. http://dx.doi.org/10.1136/postgradmedj-2018-136178.
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ObjectiveTo establish the diagnostic value of prespecified ECG changes in suspected pulmonary embolism (PE).MethodsRetrospective case–control study in a district general hospital setting. We identified 189 consecutive patients with suspected PE whose CT pulmonary angiogram (CTPA) was positive for a first PE and for whom an ECG taken at the time of presentation was available. We matched these for age±3 years with 189 controls with suspected PE whose CTPA was negative. We considered those with large (n=76) and small (n=113) clot load separately. We scored each ECG for the presence or absence of eight features that have been reported to occur more commonly in PE.Results20%–25% of patients with PE, including those with large clot load, had normal ECGs. The most common ECG abnormality in patients with PE was sinus tachycardia (28%). S1Q3T3 (3.7%), P pulmonale (0.5%) and right axis deviation (4.2%) were infrequent findings. Right bundle branch block (9.0%), atrial dysrhythmias (10.1%) and clockwise rotation (20.1%) occurred more frequently but were also common in controls. Right ventricular (RV) strain pattern was significantly more commonly in patients than controls, 11.1% vs 2.6% (sensitivity 11.1%, specificity 97.4%; OR 4.58, 95% CI 1.63 to 15.91; p=0.002), particularly in those with large clot load, 17.1% vs 2.6% (sensitivity 17.1%, specificity 97.4%; OR 7.55, 95% CI 1.62 to 71.58; p=0.005).ConclusionAn ECG showing RV strain in a breathless patient is highly suggestive of PE. Many of the other ECG changes that have been described in PE occur too infrequently to be of predictive value.
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Khasanov, R. Sh, and I. A. Kamalov. "Pulmonary embolism prevention in out-patients with malignancies during the first year of follow-up." Kazan medical journal 96, no. 1 (February 15, 2015): 13–16. http://dx.doi.org/10.17750/kmj2015-013.
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Aim. To decrease the one-year mortality rate in out-patients with malignancies undergoing periodic health examination.Methods. The study included 270 patients, who were examined and followed up. The main group included 140 patients, who monthly underwent ultrasonography of inferior vena cava branches during the first year of follow-up. The control group included 130 patients, in whom ultrasonography of inferior vena cava branches was performed only if clinical manifestations of venous thrombosis were registered.Results. Venous thrombosis was diagnosed in 35 patients of the main group, including 21 cases of venous thrombosis at very high risk for embolism. In control group, ultrasonography of inferior vena cava branches was performed in 13 patients who developed clinical manifestations of venous thromboembolic events, in whom 6 patients were diagnosed with deep vein thrombosis of the lower limbs, in 3 patients venous thrombosis was assessed as at very high risk for embolism. In 24 patients (21 in the main group and 3 in the control group), targeted measures to prevent pulmonary embolism were administered, including cava filter implantation, vein ligation above the venous thrombosis at very high risk for embolism site, and crossectomy. The rest of the patients were administered conservative prevention of thromboembolism. In the main group, no deaths associated with pulmonary embolism were registered. In the control group, 19 patients died due to developing pulmonary embolism.Conclusion. Preventive measures for pulmonary embolism, selected according to the results of timely ultrasound diagnosis of venous thrombosis, may reduce the one-year mortality rate in patients with cancer.
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Tympa, Aliki, Kassiani Theodoraki, Athanassia Tsaroucha, Nikolaos Arkadopoulos, Ioannis Vassiliou, and Vassilios Smyrniotis. "Anesthetic Considerations in Hepatectomies under Hepatic Vascular Control." HPB Surgery 2012 (May 28, 2012): 1–12. http://dx.doi.org/10.1155/2012/720754.
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Background. Hazards of liver surgery have been attenuated by the evolution in methods of hepatic vascular control and the anesthetic management. In this paper, the anesthetic considerations during hepatic vascular occlusion techniques were reviewed. Methods. A Medline literature search using the terms “anesthetic,” “anesthesia,” “liver,” “hepatectomy,” “inflow,” “outflow occlusion,” “Pringle,” “hemodynamic,” “air embolism,” “blood loss,” “transfusion,” “ischemia-reperfusion,” “preconditioning,” was performed. Results. Task-orientated anesthetic management, according to the performed method of hepatic vascular occlusion, ameliorates the surgical outcome and improves the morbidity and mortality rates, following liver surgery. Conclusions. Hepatic vascular occlusion techniques share common anesthetic considerations in terms of preoperative assessment, monitoring, induction, and maintenance of anesthesia. On the other hand, the hemodynamic management, the prevention of vascular air embolism, blood transfusion, and liver injury are plausible when the anesthetic plan is scheduled according to the method of hepatic vascular occlusion performed.
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von Wunster, S., P. D’Oria, L. Colonna, and G. Patelli. "Ulipristal Acetate Efficacy in a Patient with Symptomatic Fibroid and Concomitant Pulmonary Embolism." Case Reports in Medicine 2020 (February 22, 2020): 1–4. http://dx.doi.org/10.1155/2020/3249268.
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Ulipristal acetate (UPA) is an effective drug for the treatment of symptomatic uterine fibroids. The drug is highly effective in controlling bleeding control and in the recovery of anemia. Here, we report the case of a woman with severe menorrhagia due to a uterine fibroid and with concomitant pulmonary embolism, a serious life-threatening condition. UPA was shown to be effective in reducing fibroid volume and controlling symptoms, without worsening the underlying embolic disease. No adverse events were observed, and the patient has completely recovered.
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Badr, Omaima Ibrahim, Hassan Alwafi, Wael Aly Elrefaey, Abdallah Y. Naser, Mohammed Shabrawishi, Zahra Alsairafi, and Fatemah M. Alsaleh. "Incidence and Outcomes of Pulmonary Embolism among Hospitalized COVID-19 Patients." International Journal of Environmental Research and Public Health 18, no. 14 (July 18, 2021): 7645. http://dx.doi.org/10.3390/ijerph18147645.
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Objectives: Patients with COVID-19 may be at high risk for thrombotic complications due to excess inflammatory response and stasis of blood flow. This study aims to assess the incidence of pulmonary embolism among hospitalized patients with COVID-19, risk factors, and the impact on survival. Methods: A retrospective case-control study was conducted at Al-Noor Specialist Hospital in Saudi Arabia between 15 March 2020 and 15 June 2020. Patients with confirmed COVID-19 diagnosis by a real-time polymerase chain reaction (PCR) and confirmed diagnosis of pulmonary embolism by Computed Tomography pulmonary angiogram (CTPA) formed the case group. Patients with confirmed COVID-19 diagnosis by a real-time polymerase chain reaction (PCR) and without confirmed diagnose of pulmonary embolism formed the control group. Logistic regression analysis was used to identify predictors of pulmonary embolism and survival. Results: A total of 159 patients participated were included in the study, of which 51 were the cases (patients with pulmonary embolism) and 108 patients formed the control group (patients without pulmonary embolism). The incidence of PE among those hospitalized was around 32%. Smoking history, low level of oxygen saturation, and higher D-dimer values were important risk factors that were associated with a higher risk of developing PE (p < 0.05). Higher respiratory rate was associated with higher odds of death, and decreased the possibility of survival among hospitalized patients with PE. Conclusions: Pulmonary embolism is common among hospitalized patients with COVID-19. Preventive measures should be considered for hospitalized patients with smoking history, low level of oxygen saturation, high D-dimer values, and high respiratory rate.
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Karalezli, Aysegul, Ebru Sengül Parlak, Asiye Kanbay, Aysegul Senturk, and H. Canan Hasanoglu. "Homocysteine and Serum-Lipid Levels in Pulmonary Embolism." Clinical and Applied Thrombosis/Hemostasis 17, no. 6 (February 8, 2011): E186—E189. http://dx.doi.org/10.1177/1076029610395570.
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Pulmonary embolism (PE) is a fatal disease that arises from genetic and environmental factors. There is little evidence for low high-density lipoprotein cholesterol (HDL-C) with hyperhomocysteinemia to lead to PE. Therefore, we evaluated homocysteine levels and lipid profile in PE patients and to display risk for PE. Forty six patients with proven PE and 46 healthy controls were included in the study. Homocysteine and serum lipid levels were calculated and compared in both groups. There were no significant differences between two groups in terms of total cholesterol, triglyceride, and low-density lipoprotein cholesterol. In PE group, HDL-C levels were found significantly lower in comparison to the control group ( P = .004). Mean homocysteine levels were significantly higher in PE group than in the control group ( P = .001). High-density lipoprotein cholesterol levels were significantly low in which homocysteine levels were high in the PE group. We thought that low HDL-C level with hyperhomocysteinemia is susceptible to PE.
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GANDARA, E., G. BOSE, P. ERKENS, M. RODGERS, M. CARRIER, and P. WELLS. "Outcomes of saddle pulmonary embolism: a nested case-control study." Journal of Thrombosis and Haemostasis 9, no. 4 (April 2011): 867–69. http://dx.doi.org/10.1111/j.1538-7836.2011.04189.x.
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NOVELLI, E. M., C. HUYNH, M. T. GLADWIN, C. G. MOORE, and M. V. RAGNI. "Pulmonary embolism in sickle cell disease: a case-control study." Journal of Thrombosis and Haemostasis 10, no. 5 (May 2012): 760–66. http://dx.doi.org/10.1111/j.1538-7836.2012.04697.x.
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Huynh, Cindy, Enrico M. Novelli, Charity G. Moore, and Margaret V. Ragni. "Pulmonary Embolism in Sickle Cell Disease: A Case-Control Study." Blood 114, no. 22 (November 20, 2009): 3998. http://dx.doi.org/10.1182/blood.v114.22.3998.3998.
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Abstract Abstract 3998 Poster Board III-934 Introduction Pulmonary embolism (PE) is a leading cause of morbidity and mortality in the U.S. We and others previously have shown that PE is increasingly detected with increasing use of spiral computerized tomography (CT), at lower severity of illness, suggesting earlier PE diagnosis. Although thrombosis is increased in those with sickle cell trait (Austin, Blood 2007), data are lacking on the prevalence and predictors of PE among individuals with sickle cell disease (SCD), in whom thrombosis may be driven by hemolysis-associated endothelial dysfunction and platelet aggregation. Methods We performed a case-control study to compare demographics, co-morbidity, severity of illness, and mortality in SCD cases with PE and SCD controls without PE, by analyzing statewide discharge data (2001-2006) from the Pennsylvania Health Care Cost Containment Council (PHC4). For this analysis “SCD” included ICD-9 codes for HbSS, HbS/C, HbS/thal, and HbS trait. Clinical and laboratory data were obtained on local SCD cases and controls from the Medical Archival Record System (MARS) at the University of Pittsburgh, using the same ICD-9 codes. Cases were matched by age within 5 years, race, gender, year of admission, and (for PHC4 data only) hospital system. Results The prevalence of PE among SCD admissions, 2001-2006, was 119/ 20,847 (0.57%), increasing over the period by 41.2%, from 0.51% to 0.72%. By comparison, among non-SCD admissions, the prevalence of PE was 66,440/1,416,109 (4.7%), with a similar rate of increase, 54.0%, from 3.78% to 5.82% over the same period. As compared to controls without PE, SCD PE cases had a longer length of stay, 9 vs. 5 days (p=0.0006), greater severity of illness, two highest scores 11.1% vs. 0%, (p=0.0002), and a higher in-hospital mortality rate, 8.7% vs. 0% (p=0.0011). In the local sample (n=14 cases, n=28 controls), the majority of cases were evaluated by spiral CT scans (92.8%). Co-morbidity rates were no greater in cases than controls, including pneumonia (p=0.227), heart failure (p=0.461), coronary symptoms (p=0.464), or stroke (p=0.183). Risk factors for thrombosis were also similar between groups, including estrogen use (p=0.461), obesity (p= 0.763), hyperlipidemia (p=0.106), hypertension (p=0.146), diabetes (p=0.276), smoking (p=0.069), HIV (p=1.000), and HCV (p=0.667). A similar proportion of cases and controls were in crisis, 35.7% each (p=0.888), and there were no differences in the proportion with HbSS, 35.7% vs. 46.4% (p=0.212), HbS/C, 14.3% vs. 0% (p=0.106), HbS/thal, 0% vs. 3.6% (p=0.667), and sickle trait, 50.0% each (p=1.000). Among cases, the degree of anemia (p=0.276), reticulocytosis (p=0.261), WBC (p=0.257) and platelet count (p=0.254) were similar to that of controls. There was no difference between groups in the proportion receiving hydroxyurea (p=0.167), iron chelation therapy (p=1.000), or red cell transfusions (p=0.262). Conclusions Rates of PE are increasing in hospitalized SCD patients in Pennsylvania, with greater severity of illness and higher mortality than in SCD patients without PE. The clinical and laboratory parameters, including severity of hemolysis measured, do not appear to be predictive of PE. Thus, prospective studies are needed to evaluate risk for PE by other markers of disease severity, including tests of platelet activation, tissue factor activity, and hemostatic activation, e.g. thrombospondin, von Willebrand factor, and ADAMTS13. Disclosures: No relevant conflicts of interest to declare.
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Bose, Gauruv, Esteban Gandara, Marc Carrier, Petra MG Erkens, Marc Rodger, and Philip Wells. "Outcome of Saddle Pulmonary Embolism: A Nested Case-Control Study." Blood 116, no. 21 (November 19, 2010): 1102. http://dx.doi.org/10.1182/blood.v116.21.1102.1102.
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Abstract Abstract 1102 Introduction: The management of saddle pulmonary embolism (PE) is controversial. Evidence about outcomes and management strategies is scarce in the literature due to the small prevalence of saddle PE. Historically it has been recommended that this group of patients should be treated aggressively. Purpose: To determine the prevalence and outcomes of patients diagnosed with saddle PE. Methods: Retrospective cohort study of consecutive patients with saddle PE diagnosed at the Ottawa Hospital between January 2007 and December 2008. Patients were included if a thrombus was present on computed tomographic pulmonary angiography (CTPA) in the main pulmonary arteries spanning the bifurcation of the main pulmonary trunk. These cases were each matched with two non-saddle controls with proximal PE (thromboemboli in the main pulmonary arteries) based on age, sex, systolic blood pressure greater than or less than 90 mmHg, and the presence or absence of cancer. Demographics, prognostic factors, treatment, and outcomes were collected. Patients were followed over a 30 day period following the diagnosis. RESULTS: A total of 32 (5%) of 724 patients with PE had a saddle event. Baseline characteristics are depicted in Table 1. Differences between the saddle case group and non-saddle control group include the presence of right ventricular dilation (59% of saddle cases vs. 22% of controls, p-value: 0.0007) and in the proportion of patients managed as outpatients (7% of saddle cases vs. 33% of controls, p-value: 0.02). At 30 days no differences were found in patients with saddle PE or proximal PE for all cause mortality (6% vs. 10%; OR: 0.64; 95% CI: 0.08–3.2), PE related mortality (0% vs. 6%; OR: 0.52; 95% CI: 0.01–6.1), major bleeding (3% vs. 5%; OR: 0.65; 95% CI: 0.02–6.4), or recurrent venous thromboembolism (6% vs. 10%; OR: 0.64; 95% CI: 0.08–3.2). Conclusions: Patients with saddle PE do not have a worse 30-day prognosis than patients with proximal PE matched by age, sex, systolic blood pressure, and presence of cancer. Disclosures: No relevant conflicts of interest to declare.
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Kosovalı, Deniz, Meral Uyar, Osman Elbek, Nazan Bayram, İlker Özsaraç, Esra Yarar, and Ayten Filiz. "Obstructive sleep apnea is prevalent in patients with pulmonary embolism." Clinical & Investigative Medicine 36, no. 6 (December 1, 2013): 277. http://dx.doi.org/10.25011/cim.v36i6.20624.
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Purpose: Obstructive sleep apnea (OSA) syndrome causes systemic consequences due to hypoxia and endothelial dysfunction. The purpose of this study was to investigate whether OSA is more common in subjects with pulmonary embolism (PE). Methods: This prospective study was conducted between November 2009 and December 2010 in the Department of Pulmonary Medicine of Gaziantep University. Twenty-eight patients with PE were included in the study group along with forty-five subjects with OSA as the control group. The control group was selected from among subjects who were referred to the sleep clinic. Full night polysomnography was performed for each subject. Results: Mean apnea-hypopnea index (AHI) was found to be higher in the PE group compared with the control group (p=0.010). Severe OSA was detected in 21.4% of the PE group but in no controls (p=0.015). Sleep stage 2 was longer in control group whereas stage 1 and rapid eye movement (REM) sleep was longer in the PE group. Snoring and excessive daytime sleepiness were more common in the control group compared with the study group. AHI severity and thrombus localization were not significantly different between the groups (p=0.350). Conclusion: Our study findings suggest that OSA is more prevalent and severe in subjects with PE compared with control subjects. The clinical significance of less prevalent excessive daytime sleepiness and snoring in subjects with PE should be evaluated in further studies.
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Ehrhart, I. C., and W. F. Hofman. "Segmental vascular pressures in lung embolism." Journal of Applied Physiology 74, no. 5 (May 1, 1993): 2502–8. http://dx.doi.org/10.1152/jappl.1993.74.5.2502.
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Average microvascular filtration pressure and vascular permeability measures were obtained in 100-microns glass bead-embolized dog lung lobes randomly assigned to groups in which isolated perfusion was designed to produce weight gain (edema groups) or no weight gain (isogravimetric groups). The solvent drag reflection coefficient (sigma), an index of vascular permeability, was obtained during edema formation, whereas isogravimetric capillary pressure was obtained during isogravimetry. Vascular permeability increased in response to embolism, because sigma was 0.53 +/- 0.03 vs. 0.80 +/- 0.05 (P < 0.005) in embolized and control lobes, respectively. Vascular occlusion methods indicated the greatest resistance increase in response to embolism in the vascular segment represented by Pao--Pdo (arterial occlusion pressure--double occlusion pressure). Because papaverine vasodilation reduced total vascular resistance (RT; P < 0.05) by decreasing Pao (P < 0.01) without altering Pdo, the RT increase in response to embolism was likely due to both vasoconstriction and obstruction. Because Pdo approximated capillary pressure at isogravimetry, Pdo appears to estimate average filtration pressure in both embolized (n = 6) and control lungs (n = 6). Arterial pressure was 56.2 +/- 13.6 vs. 17.6 +/- 1.5 cmH2O (P < 0.01) in embolized (n = 5) and control lobes (n = 6), respectively, whereas Pdo values of 16.1 +/- 1.5 vs. 12.4 +/- 0.8 (P < 0.05) suggested relatively little increase in filtration pressure in response to embolism. If the beads obstructed 100-microns vessels, the vascular segment represented by Pao--Pdo, the major site of vasoconstriction as well as mechanical obstruction, likely includes 100-microns arteries.
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Yel, Mustafa, Hülya Dalgiç, Güngör Taştekin, Mehmet Arazi, and Abdurrahman Kutlu. "EFFECTS OF APROTININ ON PULMONARY FUNCTIONS IN EXPERIMENTAL FAT EMBOLISM: CHANGES IN ARTERIAL BLOOD GAS LEVELS AND SCINTIGRAPHIC FINDINGS." Journal of Musculoskeletal Research 04, no. 03 (September 2000): 189–98. http://dx.doi.org/10.1142/s0218957700000197.
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Purpose: To assess the effects of aprotinin on the formation and resolution of fat embolism of the lungs. Methods: The changes in arterial blood gas levels and perfusion scintigraphy were studied by forming experimental standardized fat embolism in rabbits with autogenous fat obtained from their femur medullas. Two groups, each consisting of 14 albino rabbits, were used in this study. Group 1, which received intravenous saline solution, was the control group. Group 2, which received aprotinin, was referred to as the aprotinin group. Autogenous femoral medullary content was used for embolization procedures. Arterial blood gas levels were recorded 72 hours before and 1, 24, 72 hours and 10 days following the embolization procedure. Pulmonary perfusion scintigraphies were performed 72 hours before the embolization procedure and on the first and 72nd hours, and the 10th day. Results: Fat embolism was achieved in all rabbits. Seven rabbits in the control group and one rabbit in the aprotinin group died within an hour after the embolization procedure. According to blood gas levels and perfusion scintigraphic findings, the aprotinin group significantly had less pulmonary fat embolism and recovered faster than the control group, especially during the first 24 hours. There was no significant difference in regression of pulmonary dysfunction between the two groups. Conclusion: The correlation between the blood gas levels and scintigraphic findings suggested that the administration of aprotinin for prophylactic purposes had favorable effects on the development of pulmonary gas exchange disturbance and perfusion defect in fat embolism.
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Tomic, Branko, Maja Gvozdenov, Iva Pruner, Mirjana Kovac, Nebojsa Antonijevic, Dragica Radojkovic, and Valentina Djordjevic. "The frequencies of FV Leiden and FII G20210A mutations in patients with different clinical manifestations of venous thromboembolism: Experience from large Serbian cohort." Genetika 48, no. 2 (2016): 609–16. http://dx.doi.org/10.2298/gensr1602609t.
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Venous thromboembolism is a multifactorial disorder with two manifestations: deep-vein thrombosis and pulmonary embolism. Pulmonary embolism is usually considered as the complication of deep-vein thrombosis, but there are reported cases of isolated pulmonary embolism. FV Leiden and FII G20210A mutations are most common genetic risk factors for the venous thromboembolism. Several studies reported "FV Leiden paradox": lower prevalence of FV Leiden mutation among patients with isolated pulmonary embolism than among those with deep-vein thrombosis. The aim of this study was to determine FV Leiden and FII G20210A mutations frequency in thrombophilic patients in Serbian population. We tested prevalence of these mutations carriers in 1427 individuals divided in three groups of patients (with deep-vein thrombosis, deep-vein thrombosis/ pulmonary embolism and isolated pulmonary embolism) and control group. All subjects were tested for these mutations using PCR-RFLP analysis. Detected frequency of FV Leiden heterozygous carriers in patients with isolated pulmonary embolism was 6.9% (for FII G20210A 11.6%), while in other two groups of patients with deep-vein thrombosis and deep vein thrombosis/pulmonary embolism, frequency was 18.6% (for FII G20210A mutation were 11.6% and 8.3%, respectively). Our results showed that FV Leiden mutation is less frequent in patients with isolated pulmonary embolism than in patients with deep-vein thrombosis or deep-vein thrombosis accompanied with pulmonary embolism, confirming "FV Leiden paradox". On the other hand, detected frequency of FII G20210A mutation carriers was similar in all three groups of patients.
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Kamalov, I. A., I. R. Agliullin, M. G. Tukhbatullin, and I. R. Safin. "Required frequency of ultrasonography for detection of thrombosis with high risk for embolism in patients with malignancies." Kazan medical journal 94, no. 3 (June 15, 2013): 335–39. http://dx.doi.org/10.17816/kmj2180.
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Aim. To determine the optimal terms for detection of thrombosis with high risk for embolism in patients with malignancies receiving specialized treatment. Methods. 117 patients (50 males, 67 females - the main group) with malignancies were randomly picked out (using the random numbers tables) underwent daily ultrasonography of inferior vena cava tributaries for detection of thrombosis with high risk for embolism. Ultrasonography of inferior vena cava distal part, both common iliac veins and veins of lower extremities was done in patients while on surgical treatment, chemotherapy or radiotherapy. The control group consisted of 130 patients (58 males, 72 females) with malignancies in whom ultrasonography was performed only if clinical signs of venous thrombosis were present. Results. Ultrasonic features of venous blood flow decrease (spontaneous contrast phenomenon) in veins of lower extremities were found in 27 out of 117 main group patients on the second day. On the third day features of saphenous veins thrombosis were found in 13 patients. On the fourth day, 4 patients were diagnosed with iliofemoral thrombosis. 5 more patients developed ultrasonic features of venous blood flow decrease (spontaneous contrast phenomenon) on the fourth and fifth day. Signs of thrombosis progression and floating thrombus were found in 6 patients on the 6th and 7th day. No fatal cases of pulmonary embolism were registered in the main group. 10 patients of the control group had clinical signs of inferior vena cava tributaries and underwent distal part of inferior vena cava, both common iliac veins and veins of lower extremities ultrasonography while on specialized treatment. 5 cases of pulmonary embolism were reported in the rest of the control group patients (120 patients). Conclusion. Inferior vena cava tributaries thrombosis with high risk for embolism in patients with malignancies can be reliably detected by repeating ultrasonography every 3-4 days; Reliable diagnosis of thrombosis with high risk for embolism by means of ultrasonography during the post-surgical period allows to prevent pulmonary embolism in a timely and targeted manner.
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Poli, Daniela, Emilia Antonucci, Emanuele Cecchi, Irene Betti, Lelia Valdrè, Cristina Mugnaini, Bruno Alterini, et al. "Thrombophilic mutations in high-risk atrial fibrillation patients: high prevalence of prothrombin gene G20210A polymorphism and lack of correlation with thromboembolism." Thrombosis and Haemostasis 90, no. 12 (2003): 1158–62. http://dx.doi.org/10.1160/th03-04-0240.
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SummaryAtrial fibrillation (AF) is a common arrhythmia that results in a high risk of cerebral and peripheral embolism. Factor V Leiden and factor II G20210A variant are two leading conditions for venous thrombosis. The aim of our study was to find out whether these two common prothrombotic mutations play a role in the occurrence of embolic events in AF patients. We investigated 336 non-valvular AF patients and 336 healthy control subjects. Factor II G20210A variant was found in 24/336 patients (7.14%) and in 11/336 of control subjects (3.3%). At a multivariate analysis, factor II G20210A variant was independently associated to AF (OR 2.4 95% CI 1.1-5.2; p<0.05). No significant difference was observed in the prevalence of factor V Leiden in the two groups investigated [6/304 (2.0%) in patients vs 13/336 (3.9%) in controls (p=0.24)]. AF patients were separately analyzed in relation to the occurrence or absence of a cerebral or peripheral embolic event (200 with and 136 without embolic event). The prevalence of the two mutations among AF patients with and without an embolic event was similar [factor II G20210A polymorphism (7% and 7.3% respectively) and factor V Leiden (1.2% and 2.9%, respectively)]. No differences were found in relation to the type of embolic event. Our results suggest a possible relationship between the presence of prothrombin gene variant and AF per se.
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WILMSHURST, P. T., M. J. PEARSON, K. P. WALSH, W. L. MORRISON, and P. BRYSON. "Relationship between right-to-left shunts and cutaneous decompression illness." Clinical Science 100, no. 5 (April 6, 2001): 539–42. http://dx.doi.org/10.1042/cs1000539.
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The presence of a large right-to-left shunt is associated with neurological decompression illness after non-provocative dives, as a result of paradoxical gas embolism. A small number of observations suggest that cutaneous decompression illness is also associated with a right-to-left shunt, although an embolic aetiology of a diffuse rash is more difficult to explain. We performed a retrospective case–control comparison of the prevalence and sizes of right-to-left shunts determined by contrast echocardiography performed blind to history in 60 divers and one caisson worker with a history of cutaneous decompression illness, and 123 historical control divers. We found that 47 (77.0%) of the 61 cases with cutaneous decompression illness had a shunt, compared with 34 (27.6%) of 123 control divers (P< 0.001). The size of the shunts in the divers with cutaneous decompression illness was significantly greater than in the controls. Thus 30 (49.2%) of the 61 cases with cutaneous decompression illness had a large shunt at rest, compared with six (4.9%) of the 123 controls (P< 0.001). During closure procedures in 17 divers who had cutaneous decompression illness, the mean diameter of the foramen ovale was 10.9 mm. Cutaneous decompression illness occurred after dives that were provocative or deep in subjects without shunts, but after shallower and non-provocative dives in those with shunts. The latter individuals are at increased risk of neurological decompression illness. We conclude that cutaneous decompression illness has two pathophysiological mechanisms. It is usually associated with a large right-to-left shunt, when the mechanism is likely to be paradoxical gas embolism with peripheral amplification when bubble emboli invade tissues supersaturated with nitrogen. Cutaneous decompression illness can also occur in individuals without a shunt. In these subjects, the mechanism might be bubble emboli passing through an ‘overloaded’ lung filter or autochthonous bubble formation.
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Bell, Melanie, Peter Herbison, Charlotte Paul, David Skegg, and Lianne Parkin. "Air travel and fatal pulmonary embolism." Thrombosis and Haemostasis 95, no. 05 (2006): 807–14. http://dx.doi.org/10.1160/th05-12-0813.
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SummaryAlthough long-distance air travel is commonly regarded as a risk factor for venous thromboembolism, the risk of clinically important events has not been well defined. We estimated the absolute risk of dying from pulmonary embolism following longdistance air travel in a national population-based descriptive study of 121 men and women who were aged 15–59 years (the age range in which the majority of international arrivals are found) and whose underlying cause of death was certified as codes 415.1, 451, or 453 of the International Classification of Diseases (ninth revision). Eleven cases had undertaken longdistance air travel in the four weeks before the onset of the fatal episode. The estimated risks of fatal pulmonary embolism following a flight of at least three hours’ duration were 0.5 (95% CI 0.2–1.2) and 0.6 (95% CI 0.2–1.4) per million arrivals for overseas visitors and New Zealand residents, respectively. For air travel of more than eight hours’ duration, the risk in New Zealand residents was 1.3 (95% CI 0.4–3.0) per million arrivals. We also conducteda case-control study based on those cases who were normally resident in New Zealand and registered on the electoral roll (n=99). For each case, four controls matched for sex, age, and electorate, were randomly selected from the electoral roll. In the key analysis (based on 88 cases and 334 controls), the adjusted odds ratio for travellers who had flown for more than eight hours was 7.9 (95% CI 1.1–55.1) compared with those who did not undertake a long-distance flight. Longdistance air travellers have a higher risk of dying from pulmonary embolism than non-travellers, but the absolute risk in people aged 15–59 years appears to be very small.
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Gul, Evrim, Yeliz Gul, Ersin Yıldırım, Mustafa Safa Pepele, Mustafa Yıldız, Mehmet Nuri Bozdemir, Mehmet Ruhi Onur, et al. "The Diagnostic Role of Adiponectin in Pulmonary Embolism." BioMed Research International 2016 (2016): 1–4. http://dx.doi.org/10.1155/2016/6121056.
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Background and Aims. Pulmonary thromboembolism (PTE) is a frequent disease with difficult diagnosis and high mortality. Misdiagnosis occurs in 2/3 patients and mortality rates reach up to 30%. The aim of our study was to investigate the role of adiponectin used in emergency service in diagnosis of PTE.Materials and Methods. 95 patients with suspected PTE included in the study. Plasma adiponectin and D-dimer levels were measured and chest X-ray and multidetector row computed tomography scan obtained. Diagnosis was supported by vascular filling defect on tomography. Control group consisted of patients with suspected PTE and normal chest computed tomography findings.Results. Mean D-dimer level was4241.66±1082.98 ng/mL in patients and2211.21±1765.53 ng/mL in the control group (p≤0.05). Mean adiponectin level was5.46±4.39 μg/mL in patients and7.68±4.67 μg/mL in the control group (p≤0.05). Wells and Geneva scores were higher in patients compared to the control group.Conclusions. As a result, we conclude that lower adiponectin levels have an important role in the diagnosis of PTE.
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Naimov, A. M., and A. A. Razzokov. "The diagnostics of fat embolism syndrome at multitrauma." Health care of Tajikistan, no. 2 (July 28, 2021): 75–80. http://dx.doi.org/10.52888/0514-2515-2021-349-2-75-80.
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Aim. To improve diagnostics of fat embolism syndrome in patients with multitrauma.Material and methods. The study included 250 patients with multitrauma at the age of 18 to 60 years that received treatment during 2014-2010. There were 174 (69.6%) men and 76 (30.4%) women. The patients were divided into two groups. The main group included 128 (51, 2%) patients with multitrauma, in whom the diagnosis, prevention, and treatment of fat embolism syndrome were carried out using improved approaches. The control group of 122 (48, 8%) patients with multitrauma received a diagnosis, prevention, and treatment of fat embolism syndrome using traditional approaches.Results and methods. Comprehensive analysis of data with the formalization and standardization of data by comparing the frequency of symptoms in the group of patients with and without fat embolism syndrome helped to reveal integral criteria for the diagnosis of various clinical manifestations of this symptom-complex were identified. Based on the data obtained, a highly effective method for the diagnosis of fat embolism syndrome has been developed. In the main group, differentiated treatment of patients using the developed approaches contributed to an increase in the proportion of positive results (43.7%) and a decrease in unsatisfactory results (8.6%) and mortality (8.6%). In the control group, satisfactory (36.0%) and unsatisfactory results (15.6%), as well as lethal outcomes (16.4%), prevailed.Conclusion. The use of improved approaches in the diagnosis and treatment of fat embolism syndrome and the construction of treatment tactics on this basis are among the effective ways to improve the results of multitrauma.
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Bal, Laurence, Stéphane Ederhy, Emanuele Di Angelantonio, Florence Toti, Fatiha Zobairi, Ghislaine Dufaitre, Catherine Meuleman, et al. "Circulating procoagulant microparticles in acute pulmonary embolism: A case–control study." International Journal of Cardiology 145, no. 2 (November 2010): 321–22. http://dx.doi.org/10.1016/j.ijcard.2009.11.048.
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孙, 广红. "Research Progress of Prevention and Control of Deep Vein Thrombosis Embolism." Hans Journal of Surgery 06, no. 02 (2017): 13–20. http://dx.doi.org/10.12677/hjs.2017.62003.
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Martin, D. O. "Managing chronic atrial fibrillation: strategies to control symptoms and prevent embolism." Cleveland Clinic Journal of Medicine 70, Suppl_3 (July 1, 2003): S30. http://dx.doi.org/10.3949/ccjm.70.suppl_3.s30.
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Meißner, Lisa, Peter Schürmann, Thilo Dörk, Lars Hagemeier, and Michael Klintschar. "Genetic association study of fatal pulmonary embolism." International Journal of Legal Medicine 135, no. 1 (October 30, 2020): 143–51. http://dx.doi.org/10.1007/s00414-020-02441-7.
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AbstractPulmonary embolism (PE) is a complex multi-factorial disease and represents one manifestation of venous thromboembolism (VTE). Most commonly PE constitutes a complication of VTE’s other clinical presentation deep vein thrombosis (DVT). The majority of studies concerning risk factors do not distinguish between PE and DVT. The risk factors are often estimated to be alike, but the prevalence and the risk associated with the major genetic factor Factor V Leiden differ between the two disease states. We have investigated the association of 22 SNPs with PE in 185 PE case and 375 healthy control subjects. At p = 0.05, eight SNPs presented with nominally significant evidence of association (EOA), although no significantly different genotype distributions remained between cases and controls after Bonferroni correction. Three of these variants (rs1800790, rs3813948, rs6025) showed EOA in the main analysis, and five variants (rs169713, rs1801131, rs4524, rs5985 and rs8176592) demonstrated EOAs in subgroups. Genomic variation modulating Factor V, Factor XIII, Beta fibrinogen (FGB), TFPI or HIVEP1 should be worth to be followed in subsequent studies. The findings of this study support the view that PE represents a complex disease with many factors contributing relatively small effects. Larger sample sizes will be required to reliably detect these small effects.
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Peters, Siert TA, Marieke J. Witvliet, Anke Vennegoor, Birkitt ten Tusscher, Bauke Boden, and Frank W. Bloemers. "The fat embolism syndrome as a cause of paraplegia." SAGE Open Medical Case Reports 6 (January 1, 2018): 2050313X1878931. http://dx.doi.org/10.1177/2050313x18789318.
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The fat embolism syndrome is a well-known complication in trauma patients. We describe a rare case of traumatic fat embolism that leads to paraplegia. A 19-year-old male motorcycle accident victim was presented to our hospital. After stabilization and trauma survey, he was diagnosed with bilateral femur fractures, a spleen laceration and a tear in the inferior vena cava, for which damage control surgery was performed. Post-operatively, the patient became paraplegic and developed a fluctuating consciousness, respiratory distress and petechiae. Fat embolism syndrome was considered as the most plausible cause of the paraplegia. The fat embolism syndrome is seen in approximately 1% of trauma patients, mostly those with bilateral fractures of the femur. Prevention of the syndrome depends on early stabilization of fractures. However, even with optimal care, this syndrome can still occur and may have dramatic consequences, as we demonstrate in this case.
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Burrowes, K. S., A. R. Clark, A. Marcinkowski, M. L. Wilsher, D. G. Milne, and M. H. Tawhai. "Pulmonary embolism: predicting disease severity." Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences 369, no. 1954 (November 13, 2011): 4255–77. http://dx.doi.org/10.1098/rsta.2011.0129.
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Pulmonary embolism (PE) is the most common cause of acute pulmonary hypertension, yet it is commonly undiagnosed, with risk of death if not recognized promptly and managed accordingly. Patients typically present with hypoxemia and hypocapnia, although the presentation varies greatly, being confounded by co-mordidities such as pre-existing cardio-respiratory disease. Previous studies have demonstrated variable patient outcomes in spite of similar extent and distribution of pulmonary vascular occlusion, but the pathophysiological determinants of outcome remain unclear. Computational models enable exact control over many of the compounding factors leading to functional outcomes and therefore provide a useful tool to understand and assess these mechanisms. We review the current state of pulmonary blood flow models. We present a pilot study within 10 patients presenting with acute PE, where patient-derived vascular occlusions are imposed onto an existing model of the pulmonary circulation enabling predictions of resultant haemodynamics after embolus occlusion. Results show that mechanical obstruction alone is not sufficient to cause pulmonary arterial hypertension, even when up to 65 per cent of lung tissue is occluded. Blood flow is found to preferentially redistribute to the gravitationally non-dependent regions. The presence of an additional downstream occlusion is found to significantly increase pressures.
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Biere-Rafi, Sara, Victor Gerdes, Barbara Hutten, Alessandro Squizzato, Walter Ageno, Patrick Souverein, Anthonius de Boer, Harry Roger Buller, and Pieter Kamphuisen. "Statin Treatment Reduces the Incidence of Recurrent Pulmonary Embolism: a Population Based Case-Control Study." Blood 116, no. 21 (November 19, 2010): 808. http://dx.doi.org/10.1182/blood.v116.21.808.808.
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Abstract Abstract 808 Background: Recurrence of pulmonary embolism (PE) has a high incidence of 5–10% and is associated with increased mortality. Long-term anticoagulant treatment is however associated with an increased bleeding risk. It is therefore essential to investigate other treatment strategies to reduce the long-term recurrence of PE. Statins seem to reduce a first episode of thrombosis, but whether they also have an effect on recurrent pulmonary embolism (PE) is unknown. Methods: A case-control study was conducted using data from the PHARMO Record Linkage System, a Dutch population-based registry of pharmacy records linked with hospital discharge records. Cases were patients hospitalized with a primary diagnosis of PE between 1998 and 2006. Four controls without a history of PE were matched to each case for age, gender and geographic region. Results: The study population consisted of 4.495 PE cases and 16.802 controls. The median age of the study population was 60 years (range 18–96) and 57% was female. Overall, 9% of both cases and controls used statins (odds ratio (OR) 0.95; 95% confidence interval (CI) 0.84–1.07); only rosuvastatin use reduced PE (OR 0.47; 95% CI 0.24–0.92). During a median follow-up period of 4.1 years (range 2.2–6.6), 396 (11%) patients had a recurrent PE. Statin treatment strongly reduced the incidence of recurrent PE (HR 0.57; 95% CI 0.42–0.79), which persisted after adjustment for vitamin K antagonists, duration of statin use, type of VTE or cardiovascular history. Conclusions: Statin treatment seems to be highly effective in the reduction of recurrent pulmonary embolism. Considering the low rate of side effects, statins may be an interesting option for long-term secondary prevention in patients with PE. Disclosures: No relevant conflicts of interest to declare.
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van Langevelde, Kirsten, Linda E. Flinterman, Astrid van Hylckama Vlieg, Frits R. Rosendaal, and Suzanne C. Cannegieter. "Broadening the factor V Leiden paradox: pulmonary embolism and deep-vein thrombosis as 2 sides of the spectrum." Blood 120, no. 5 (August 2, 2012): 933–46. http://dx.doi.org/10.1182/blood-2012-02-407551.
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AbstractRisk factors for deep-vein thrombosis have been shown not to be always the same as for pulmonary embolism. A well-known example is the factor V Leiden (FVL) paradox: the FVL mutation poses a clearly higher risk for deep-vein thrombosis (DVT) than for pulmonary embolism. We aimed to expand this paradox and therefore present risk estimates for several established risk factors for DVT and pulmonary embolism separately. When such separate risk estimates could not be retrieved from the literature, we calculated these risks in our own data, a large population-based case-control study on venous thrombosis (the MEGA study). Our results showed that the FVL paradox can be broadened (ie, the risk factors oral contraceptive use, pregnancy, puerperium, minor leg injuries, and obesity have an effect comparable with FVL). Furthermore, we found that pulmonary conditions, such as chronic obstructive pulmonary disease, pneumonia, and sickle cell disease, were risk factors with an opposite effect: a higher risk of pulmonary embolism, but little or no effect on DVT. These findings suggest that pulmonary embolism and DVT may not always have the same etiology, and encourage unraveling this phenomenon in further studies.
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Williamson, J. A., R. K. Webb, W. J. Russell, and W. B. Runciman. "Air Embolism—An Analysis of 2000 Incident Reports." Anaesthesia and Intensive Care 21, no. 5 (October 1993): 638–41. http://dx.doi.org/10.1177/0310057x9302100524.
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There were 19 cases of air embolism (1%) among the first 2000 incidents reported to the Australian Incident Monitoring Study. No embolism-induced fatalities were reported. Serious acute systemic effects occurred in 14 incidents; one circulatory arrest required electrical counter-shock. The surgical field was the entry route for the air in 63% of the incidents; 47% of the cases occurred during head and neck surgery. Capnography was the most successful first detector (26%) and it confirmed the diagnosis in another 26%. Invasive blood pressure monitoring, the electrocardiograph and the pulse oximeter played a useful role in detecting and/or confirming air embolism. Doppler monitoring was not reported in this series. A successful first response for management included head-down posture, manual ventilation, 100% oxygen and control of the air entry site. Cerebral arterial gas embolism may induce vascular endothelial damage and possible delayed neurological sequelae; hyperbaric oxygen therapy should be considered.
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Knight, Patricia R., J. Roger Harris, and Jody K. Fanelli. "Root Severance at Harvest Increases Embolism and Decreases Sap Flow of Field-grown Acer rubrum L." HortScience 35, no. 5 (August 2000): 833–36. http://dx.doi.org/10.21273/hortsci.35.5.833.
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Root severance during field harvesting alters the water status of a tree, resulting in water stress and reduced post-transplant growth. Two experiments, using Acer rubrum L. (red maple), determined the influence of root severance at harvest on sap flow and xylem embolism. Trees 1.5–1.8 m tall (4 years old) were utilized in the first experiment, and trees 1.2–1.5 m tall (2 years old) were utilized in the second. Sap flow sensors were installed on the 4-year-old trees prior to root severance and remained on the trees until 1 week after harvest. Within 1 day after root severance sap flow was reduced and remained lower than nontransplanted (control) trees for the remainder of the experiment. Leaf stomatal conductance (Cs) of transplanted trees 1 week after root severance was lower than that of control trees, but leaf water potentials (ψ) were similar. In the second experiment, sap flow was reduced relative to control trees within 2 h after root severance. Although Cs was reduced 4 hours after root severance, ψ was not. Embolism increased within 24 hours of root severance. These results indicate that root severance quickly induces increased levels of embolism, which is associated with reduced sap flow.
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Sporns, Peter B., Uta Hanning, Wolfram Schwindt, Aglae Velasco, Boris Buerke, Christian Cnyrim, Jens Minnerup, Walter Heindel, Astrid Jeibmann, and Thomas Niederstadt. "Ischemic Stroke: Histological Thrombus Composition and Pre-Interventional CT Attenuation Are Associated with Intervention Time and Rate of Secondary Embolism." Cerebrovascular Diseases 44, no. 5-6 (2017): 344–50. http://dx.doi.org/10.1159/000481578.
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Background and Purpose: The introduction of stent retrievers has made the complete extraction and histological analysis of human thrombi possible. A number of large randomized trials have proven the efficacy of thrombectomy for ischemic stroke; however, thrombus composition could have an impact on the efficacy and risk of the intervention. We therefore investigated the impact of histologic thrombus features on interventional outcome and procedure-related embolisms. For a pre-interventional estimation of histologic features and outcome parameters, we assessed the pre-interventional CT attenuation of the thrombi. Methods: We prospectively included all consecutive patients with occlusion of the middle cerebral artery who underwent thrombectomy between December 2013 and February 2016 at our university medical center. Samples were histologically analyzed (H&E, Elastica van Gieson, Prussian blue); additionally, immunohistochemistry for CD3, CD20, and CD68/KiM1P was performed. Main thrombus components (fibrin, erythrocytes, and white blood cells) were determined and compared to intervention time, frequency of secondary embolisms, as well as additional clinical and interventional parameters. Additionally, we assessed the pre-interventional CT attenuation of the thrombi in relation to the unaffected side (rHU) and their association with histologic features. Results: One hundred eighty patients were included; of these, in 168 patients (93.4%), complete recanalization was achieved and 27 patients (15%) showed secondary embolism in the control angiogram. We observed a significant association of high amounts of fibrin (p < 0.001), low percentage of red blood cells (p < 0.001), and lower rHU (p < 0.001) with secondary embolism. Higher rHU values were significantly associated with higher amounts of fibrin (p ≤ 0.001) and low percentage of red blood cells (p ≤ 0.001). Additionally, high amounts of fibrin were associated with longer intervention times (p ≤ 0.001), whereas thrombi with high amounts of erythrocytes correlated with shorter intervention times (p ≤ 0.001). ROC analysis revealed reliable prediction of secondary embolisms for low rHU (AUC = 0.746; p ≤ 0.0001), low amounts of RBC (AUC = 0.764; p ≤ 0.0001), and high amounts of fibrin (AUC = 0.773; p ≤ 0.0001). Conclusions: Fibrin-rich thrombi with low erythrocyte percentage are significantly associated with longer intervention times. Embolisms in the thrombectomy process occur more often in thrombi with a small fraction of red blood cells and a low CT-density, suggesting a higher fragility of these thrombi.
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Michael, Philips G., Georgios Antoniades, Anca Staicu, and Shahid Seedat. "Pulmonary Glue Embolism: An unusual complication following endoscopic sclerotherapy for gastric varices." Sultan Qaboos University Medical Journal [SQUMJ] 18, no. 2 (September 9, 2018): 231. http://dx.doi.org/10.18295/squmj.2018.18.02.020.
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A pulmonary glue embolism is an unusual but potentially life-threatening complication following the treatment of variceal bleeding, especially in patients with large varices requiring large volumes of sclerosant. Other contributory factors include the rate of injection and ratio of the constituent components of the sclerosant (i.e. n-butylcyanoacrylate and lipiodol). This condition may be associated with a delayed onset of respiratory compromise. Therefore, a high degree of clinical suspicion is essential in patients with unexplained cardiorespiratory decline during or following endoscopic sclerotherapy. We report a 65-year-old man who was admitted to the Hull Royal Infirmary, Hull, UK, in 2017 with haematemesis and melaena. He subsequently developed acute respiratory distress syndrome secondary to a glue embolism following emergency sclerotherapy for bleeding gastric varices. The aetiology of the embolism was likely a combination of the large size of the gastric varices and the large volume of cyanoacrylate needed. After an endoscopy, the patient underwent transjugular intrahepatic portosystemic shunting twice to control the bleeding, after which he recovered satisfactorily.Keywords: Gastric Varices; Pulmonary Embolism; Sclerotherapy; N-butyl-cyanoacrylate; Lipiodol; Case Report; United Kingdom.
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Grandi, L., R. A. Grandi, C. D. Tomasi, J. L. Da Rocha, V. Cardoso, and F. Dal-Pizzol. "Acute and chronic consequences of polidocanol foam injection in the lung in experimental animals." Phlebology: The Journal of Venous Disease 28, no. 8 (May 6, 2013): 441–44. http://dx.doi.org/10.1258/phleb.2012.012120.
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Objective To assess the presence of pulmonary embolism and inflammation after polidocanol foam injection into the peripheral veins of rabbits. Method The animals were treated with polidocanol foam (1 or 3 mg/kg) or vehicle. Early (15 minutes) and late (30 days) animals were evaluated by perfusional lung scintigraphy and histopathological examination. Results In the control group no alterations were found. After polidocanol foam injection it was observed that an important reduction of pulmonary perfusion in the early periods, was mainly in the left lung ( P < 0.001), with consequent embolism in the histological evaluation. In late periods it was observed that the presence of thrombus was with fibrin in small veins, compatible with chronic thrombus and the presence of chronic pulmonary inflammation. Conclusions The injection of polidocanol foam in experimental animals can induce venous embolism and chronic inflammatory infiltration.
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Suzuki, Akira, Stephen C. Armstead, and David M. Eckmann. "Surfactant Reduction in Embolism Bubble Adhesion and Endothelial Damage." Anesthesiology 101, no. 1 (July 1, 2004): 97–103. http://dx.doi.org/10.1097/00000542-200407000-00016.
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Background Surfactants may reduce the adhesion force holding bubbles to the vessel wall in gas embolism. The authors measured bubble adhesion force using excised microvessels. They assessed endothelial damage by measuring vessel reactivity and with microscopy. Methods Microbubbles injected into arterioles resided for 5, 10, or 30 min, with intact or damaged endothelium. Perfusion was with rat serum alone (control) or with 1% Perftoran (OJSC SPC Perftoran, Moscow, Russia) or 1% Pluronic F-127 (Molecular Probes, Eugene, OR) added. Pressure across the bubble, bubble length, and bubble diameter were measured, and adhesion force per unit surface area, K = deltaPD/4 l, was calculated. Vessel reactivity was assessed using topical application of phenylephrine and acetylcholine. Results With the endothelium intact, K was higher in controls than with Perftoran at 10 and 30 min or Pluronic F-127 at 10 min (P < 0.05). With surfactant added after air perfusion to damage the endothelium, K was lower (P < 0.05) at all times for both Perftoran and Pluronic F-127. With surfactant in the perfusate before air perfusion, K was lower at 10 and 30 min for Perftoran and at 10 min for Pluronic F-127 than for controls (P < 0.05). Phenylephrine-induced vasoconstriction was identical among groups. Acetylcholine-induced vasodilatation was the same among groups with an intact endothelium but was found to be lower in controls after air perfusion that followed surfactant exposure than in either surfactant group (P < 0.05). Conclusions Surfactants reduced bubble adhesion force and preserved basic endothelial structure and vasodilatory function despite attempts to damage the endothelium. Surfactants seem to protect the endothelium from mechanically induced injury in addition to decreasing bubble adhesion forces.
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Galyavich, A. S., and A. Yu Rafikov. "Evaluation of the right ventricular ejection fraction according to multislice computed tomography in patients with pulmonary embolism." Kazan medical journal 96, no. 6 (December 15, 2015): 901–5. http://dx.doi.org/10.17750/kmj2015-901.
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Aim. Evaluation of the global systolic function of the right ventricle according to multislice computed tomography in patients with pulmonary embolism.
Methods. 37 people aged 31 to 75 years (20 women and 17 men, mean age 55±12 years) were examined. The study group included 15 patients without clinical or instrumental signs of congenital heart disease and myocardial infarction of the left and right ventricles, with signs of pulmonary embolism according to multislice computed tomography. The control group included 22 patients. Tomographic analysis of end-diastolic volume, ejection fraction of the left and right ventricles was performed during noninvasive multislice computed tomography - coronary angiography, angiopulmonography. The study was conducted on a 64-helical computed tomography Aquillon 64 (Toshiba, Japan).
Results. Analyzing group medians in patients with pulmonary embolism there was a decrease of the right ventricular ejection fraction and end-diastolic volume of the left ventricle (р
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Trifilò, Patrizia, Andrea Nardini, Fabio Raimondo, Maria A. Lo Gullo, and Sebastiano Salleo. "Ion-mediated compensation for drought-induced loss of xylem hydraulic conductivity in field-growing plants of Laurus nobilis." Functional Plant Biology 38, no. 7 (2011): 606. http://dx.doi.org/10.1071/fp10233.
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Xylem cavitation is a common occurrence in drought-stressed plants. Cavitation-induced embolism reduces xylem hydraulic conductivity (kxylem) and may lead to stomatal closure and reduction of photosynthetic rates. Recent studies have suggested that plants may compensate for kxylem loss through ion-mediated enhancement of the residual water transport capacity of functioning conduits. To test this hypothesis, field-grown laurel (Laurus nobilis L.) plants were subjected to mild drought stress by suspending irrigation. Drought treatment induced a significant increase in xylem embolism compared with control (well watered) plants. Xylem sap potassium concentration ([K+]) increased during the day both in control and water stressed plants. Midday values of sap [K+] were significantly higher in water stressed plants. The recorded increase in sap potassium concentration induced significant enhancement of residual kxylem when solutions with different [K+] were perfused through excised stems sampled in the field and measured in the laboratory. In planta measurements of stem hydraulic conductance revealed no change between water stressed plants and controls. Our data suggest that ion-mediated enhancement of residual kxylem buffered the actual loss of hydraulic conductance suffered by plants during the warmest hours of the day as well as under mild drought stress conditions.
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Mitić, Javorka, Nataša Đurđević, Jelena Janković, Radomir Vešović, Dejan Tabaković, Marko Baralić, Elena Jordanova, and Radmila Janković. "Syncope as a dominant symptom of pulmonary embolism." Halo 194 26, no. 3 (2020): 149–52. http://dx.doi.org/10.5937/halo26-28740.
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Introduction/aim Clinical signs and symptoms of pulmonary embolism (PE) are non-specific, which is why it is commonly not diagnosed on time or sometimes not diagnosed at all. We are presenting a case of pulmonary embolism manifesting with syncope as a dominant symptom. Case report A 74-year-old female patient was hospitalized at the Clinic for Pulmonary Diseases with PE manifested with syncope. At admission, she was afebrile, tachypneic, with normal cardiac function and normal blood tension. Upon auscultation, breathing was muffled with late inspiration crackles above the base of the left lung. There were no other significant findings. The chest X-ray recorded at admission showed a non-homogenous shadow towards the base of the left lung and minimal pleural effusion. The ECG and echocardiography findings were normal. Partial respiratory insufficiency was verified by the acid-base balance analysis. Inflammatory markers were significantly elevated, with erythrocyte sedimentation rate of 30mm/h, fibrinogen of 8.62g/l and D-dimer of 18.6mg/l. Anticardiolipin IgG and IgM antibodies were negative, as well as beta-2 GPI IgG and IgM antibodies. An MDCT lung angiography was performed because of the elevated values of D-dimer and tachypnea, which showed multiple emboli of various sizes in the distal part of the right pulmonary artery and all lobar branches, as well as an embolus in the lobar branch for the lower lobe of the left lung. After a neurology consult, a head CT was ordered because the patient had suffered from loss of consciousness, but there were no pathological densities in the brain. Colour Doppler Ultrasonography of the blood vessels in the lower extremities showed organized thrombosis of the left femoral vein. A vascular surgeon was consulted and he prescribed anticoagulant therapy and an elastic compressive stocking, with control Colour Doppler Ultrasonography to be performed in six months. Conclusion Although syncope is an easily detectable symptom, it is still an unregulated crossroad of many an internal and neurological disease.
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Klok, Frederikus A., Inge C. M. Mos, Lisette Broek, Jouke T. Tamsma, Frits R. Rosendaal, Albert de Roos, and Menno V. Huisman. "Risk of arterial cardiovascular events in patients after pulmonary embolism." Blood 114, no. 8 (August 20, 2009): 1484–88. http://dx.doi.org/10.1182/blood-2009-05-220491.
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Abstract Studies have reported inconsistent evidence for an association between venous thrombosis and arterial cardiovascular events. We further studied the association between both diseases by comparing the occurrence of cardiovascular events in patients diagnosed with acute pulmonary embolism (PE) contrasted to patients with comparable baseline risk characteristics (patients in whom PE was clinically suspected but ruled out). Included were 259 patients with provoked PE, 95 patients with unprovoked PE, and 334 control patients without PE. Patients diagnosed with PE were treated with vitamin K antagonists for 6 months. Median follow-up was 4.2 years. Sixty-three arterial cardiovascular events were registered (incidence, 5.1/100 patient-years). Adjusted hazard ratio was not different between patients with all-cause PE and control patients (1.39, 95% confidence interval [CI], 0.83-2.3) but increased for patients with unprovoked PE versus both patients with provoked PE and control patients without PE (2.18; 95% CI, 1.1-4.5; and 2.62; 95% CI, 1.4-4.9, respectively). This effect was confirmed after redefining the study start date to the moment the vitamin K antagonists were discontinued. Our study underlines the association between unprovoked venous thrombosis and arterial cardiovascular events; however, risk differences between patients with provoked PE and patients in whom PE was clinically suspected but ruled out could not be demonstrated.