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Subject: search.filters.subject.pulmonary thromboembolism

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    CTPA beyond pulmonary embolism- the pulmonary arterial obstruction index
    (2023-10)
    Pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT) are different manifestations of the same condition, venous thromboembolism (VTE), which is the third most common cardiovascular disease after the ischemic heart and cerebrovascular diseases. Thus, we have to be mindful that acute pulmonary embolism (APE) is a medical emergency and a very serious clinical manifestation of VTE, that occurs due to discharge of emboli in the pulmonary arterial system which leads in subsequent arterial occlusion and an increase in the pulmonary vascular resistance, an increase in the right heart afterload and acute right ventricular failure, which is a life- threatening condition. Taking into account the fact that patients with right heart dysfunction have a high mortality rate, timely diagnosis and prompt management are the basis for the reversibility of the condition. The significantly improved image quality and upgraded diagnostic performance of CT pulmonary angiography are essential in acknowledging this diagnostic modality as the imaging technique of choice in suspected pulmonary embolism. The last decade has shown a dramatic improvement in the CTPA depiction quality of the pulmonary vasculature, and through additional enabling of the PAOI calculation, offers a quantitative value to the severity of APE, as well as detailed assessment of RV function. The objective of this lecture is not only to confirm the importance of CTPA in the prompt diagnosis of APE, but also to help radiologists conduct a detailed assessment of the CTPA’s in patients with APE, and by evaluating the relationship between the pulmonary arterial obstruction index (PAOI) and several CT cardiovascular markers of right heart dysfunction, to determine its prognostic value in the risk stratification of potential RHD. Besides confirming the prognostic value of CTPA in predicting possible complications, we also want to make a meaningful contribution into the decision making of the APE management, in forming an interdisciplinary consensus regarding follow up CTPA protocols in patients with PTE, and through the evaluation of PAOI and PAOI- associated right ventricular dysfunction, to optimize the duration of therapy and avoid unnecessary imaging examinations, i.e., over- diagnosis.
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    Acute Arterial Thrombosis in Anticoagulated Patient for Acute Pulmonary Thromboembolism
    (Nizameddin KOCA, 2023-04-29)
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    Elena Grueva
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    Elma Kandic
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    Oliver Bushljetikj
    Acute limb ischemia is a rare condition in patients with venous thromboembolism (VTE), who already receive anticoagulation treatment. Inflammation is a risk factor for thrombus formation. Patients with active ulcerative colitis, especially at time of exacerbation, are more prone to thromboembolism, both venous and arterial. Risk for thrombosis is 18% higher risk, with also higher risk of bleeding. Up to date, there is no contraindication to any anticoagulant drug in patients with ulcerative colitis. We represent a case of a 73 year - old woman with ulcerative colitis (UC) exacerbation, hospitalized initially for pulmonary thromboembolism, that developed acute arterial thrombosis when switched on novel oral anticoagulant (NOAC).
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    Antiphospholipid Syndrome - A Case Report of Pulmonary Thromboembolism, Followed with Acute Myocardial Infarction in Patient with Systemic Sclerosis
    (ID Design 2012/DOOEL Skopje, 2015-12-15)
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    Chaparoska, Emilija
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    Pocesta, Bekim
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    We are presenting an uncommon case of pulmonary embolism, followed with an acute myocardial infarction, in a patient with progressive systemic sclerosis.
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    Can rivaroxaban be a drug of choice for treating heparin-induced thrombocytopenia in a patient with pulmonary thromboembolism?
    (2017-07)
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    Taravari, Hajber
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    Heparin-induced thrombocytopenia (HIT) is an adverse effect of heparin therapy (1). There are two types of HIT: non-immunomediated (HIT-I) and immunomediated (HIT-II) disorders. HIT-II is characterized by the formation of IgG antibodies against the heparin-PLT factor 4 complex (PF4) (1, 2). Bounded with heparin, this factor creates a neoantigen and stimulates the production of antibodies (2). Activated PLTs, along with the heparin/PF4 antibody complex attached to their surface, undergo aggregation and premature removal from the circulation, leading to thrombocytopenia and additionally to a procoagulant state with high potential for thrombus formation and thromboembolic events (3). The incidence of HIT-II is 0.1%–1% in low-molecular-weight heparins (LMWH) and 3%–5% in un-fractionated heparin (UHF)- treated patients (3). In HIT-II, the PLT count drop can be seen 3–4 days after exposure in patients with pre-existing heparin- PF4 antibodies from a previous exposure to heparin, whereas in those exposed for the first time, the PLT count drops 5–10 days after heparin administration (3). It has been confirmed that new oral anticoagulants (NOACs) offer advantages regarding this side effect (4), and this case report aims to share our first positive experience in relation to the previously mentioned.