Venous%20thromboembolism%20-%20management Treatment

Treatment

Invasive Procedures

In patients with cardiac arrest or refractory circulatory collapse, extracorporeal membrane oxygenation (ECMO) may be considered in combination with a catheter-directed treatment or surgical embolectomy

Catheter Extraction

Catheter extraction involves the suction extraction of PE under fluoroscopy with ECG monitoring
This approach should be reserved for highly compromised patients who cannot receive thrombolytic therapy or whose status is so critical that it does not allow time to infuse thrombolytic therapy

Pulmonary Embolectomy

Performed in emergency situations when more conservative measures have failed
Should be reserved for the following patients:
- Massive PE (preferably angiographically documented)
- Hemodynamic instability despite Heparin and resuscitation
- High-risk PE or hemodynamically deteriorating patients with failure of thrombolytic therapy or contraindication to its use

Thrombectomy

Percutaneous Venous Thrombectomy

Patients with acute DVT should not be treated with percutaneous thrombectomy alone

Surgical Venous Thrombectomy

Reduces acute symptoms and post-thrombotic morbidity in patients with acute iliofemoral DVT
These patients have extensive venous thrombosis and have contraindications for anticoagulation and thrombolytic therapy

Vena Caval Interruption

Inferior Vena Caval (IVC) Filters

Should be considered in DVT/PE patients with contraindication or complication of anticoagulant therapy and in patients with large, free-floating iliocaval thrombus or with a PE that developed during anticoagulation therapy
- May consider removing the IVC filter if anticoagulation has been established and is no longer contraindicated
May also be considered in patients who suffer from recurrent VTE despite adequate anticoagulant therapy and patients with chronic recurrent embolism with pulmonary hypertension
May be indicated after surgical embolectomy or pulmonary thromboendarterectomy
Preferable in patients with proximal DVT with active hemorrhage, platelet count <50,000 x 10⁹/L, or previous intracerebral hemorrhage
Should not be used routinely in patients with DVT who are also being treated with anticoagulants

HK in CKD: Do diet, HD frequency matter?

Elvira Manzano, 28 Jun 2020

Hyperkalaemia (HK) occurrence and recurrence are frequent in advanced CKD*, creating a perfect storm for cardiovascular events and death, says Professor Juan-Jesus Carrero from the Karolinska Institute, Solna, Sweden, at ERA-EDTA 2020. Given these risks, acutely elevated potassium (K+) should merit clinical attention.

Trimetazidine new formulation redefining angina control in daily practice

12 Mar 2021

Chronic coronary syndrome (CCS) remains a leading cause of death and disability worldwide. The dual goals of CCS management is to prevent future cardiac events, such as myocardial infarction and death, and to reduce ischaemia and relieve angina symptoms, says Prof Peter Yan, consultant cardiologist and medical director, Peter Yan Cardiology Clinic, Gleneagles Medical Centre, Singapore, during a Servier-sponsored virtual symposium.

Dapagliflozin DELIVERs across full HF spectrum regardless of LVEF

Elvira Manzano, 04 Oct 2022

The selective, oral sodium–glucose cotransporter 2 (SGLT2) inhibitor dapagliflozin reduces the risk of cardiovascular (CV) death or worsening heart failure (HF) in patients with HF and mildly reduced or preserved ejection fraction (HFmrEF or HFpEF) in the phase III DELIVER* trial, touted as the largest and most inclusive thus far in this patient group.