This document discusses risk factors for thromboembolism in women, including reproductive factors and diseases that are more common in women. It provides statistics on the incidence of venous thromboembolism and notes that women are at higher risk during pregnancy and postpartum, as well as when using oral contraceptives or undergoing hormone replacement therapy. The document also examines differences in stroke risk factors and outcomes between men and women.
1) Patent foramen ovale (PFO) is a persistent opening between the left and right atria that normally closes shortly after birth. In adults, PFO is present in 10-15% based on transesophageal echocardiography (TEE).
2) PFO is associated with cryptogenic stroke, which accounts for approximately half of all strokes of unknown cause. Larger PFO size and the presence of an atrial septal aneurysm further increase the risk of stroke.
3) Closure of a PFO has been shown to improve migraine headaches, especially those with an aura. The relationship between PFO and migraine is thought to involve paradoxical embolism of thrombi
Anemo 2014 - Infusino - Protocol anticoagulation in urologyanemo_site
1) The document discusses guidelines for bridging anticoagulation therapy for patients on vitamin K antagonists (VKAs) undergoing elective urological procedures.
2) It proposes a new protocol for patients undergoing ThuLEP which stratifies thromboembolic risk and minimizes or avoids bridging with low molecular weight heparin (LMWH).
3) Preliminary results from 5 patients managed under the new protocol found it was safe and allowed for shorter hospitalization without thromboembolic or bleeding complications compared to standard bridging therapy.
This document summarizes a study that evaluated the use of 256 slice MDCT pulmonary angiography (MDCT-PA) to diagnose pulmonary embolism (PE) in 100 unselected patients with clinically suspected PE. The study found that 35% of patients had thromboembolic disease, with 32% having acute PE and 8% having acute deep vein thrombosis (DVT). MDCT-PA allowed direct visualization of thrombi in the pulmonary arteries and veins. The study concludes that MDCT-PA is an effective first-line imaging method for evaluating patients suspected of having a PE due to its non-invasive nature and ability to directly identify thrombotic material.
Beyond amyloidosis a case of cardiac light chain deposition diseasedrucsamal
A 48-year-old man presented with worsening dyspnea and was found to have reduced left ventricular ejection fraction and hypertrophy. Tests ruled out amyloidosis but showed monoclonal free light chains and cardiac light chain deposition. Biopsy demonstrated light chain immunoreactivity in fibrotic areas, confirming light chain deposition disease. Medical management was initiated but the patient deteriorated and died while being evaluated for heart transplantation.
Venous Thromboembolism (VTE): Recent Advances in Reducing the Disease BurdenNBCA
- Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity and mortality worldwide. It is estimated that there are 900,000 cases of VTE per year in the US.
- Recent clinical trials have found that the direct oral anticoagulants rivaroxaban, apixaban, edoxaban and dabigatran are non-inferior to standard therapy for treating VTE and reduce the risk of recurrence, while having a similar or lower risk of bleeding.
- The EINSTEIN DVT and EINSTEIN PE trials found that rivaroxaban was non-infer
1) Patent foramen ovale (PFO) is a persistent opening between the left and right atria that normally closes shortly after birth. In adults, PFO is present in 10-15% based on transesophageal echocardiography (TEE).
2) PFO is associated with cryptogenic stroke, which accounts for approximately half of all strokes of unknown cause. Larger PFO size and the presence of an atrial septal aneurysm further increase the risk of stroke.
3) Closure of a PFO has been shown to improve migraine headaches, especially those with an aura. The relationship between PFO and migraine is thought to involve paradoxical embolism of thrombi
Anemo 2014 - Infusino - Protocol anticoagulation in urologyanemo_site
1) The document discusses guidelines for bridging anticoagulation therapy for patients on vitamin K antagonists (VKAs) undergoing elective urological procedures.
2) It proposes a new protocol for patients undergoing ThuLEP which stratifies thromboembolic risk and minimizes or avoids bridging with low molecular weight heparin (LMWH).
3) Preliminary results from 5 patients managed under the new protocol found it was safe and allowed for shorter hospitalization without thromboembolic or bleeding complications compared to standard bridging therapy.
This document summarizes a study that evaluated the use of 256 slice MDCT pulmonary angiography (MDCT-PA) to diagnose pulmonary embolism (PE) in 100 unselected patients with clinically suspected PE. The study found that 35% of patients had thromboembolic disease, with 32% having acute PE and 8% having acute deep vein thrombosis (DVT). MDCT-PA allowed direct visualization of thrombi in the pulmonary arteries and veins. The study concludes that MDCT-PA is an effective first-line imaging method for evaluating patients suspected of having a PE due to its non-invasive nature and ability to directly identify thrombotic material.
Beyond amyloidosis a case of cardiac light chain deposition diseasedrucsamal
A 48-year-old man presented with worsening dyspnea and was found to have reduced left ventricular ejection fraction and hypertrophy. Tests ruled out amyloidosis but showed monoclonal free light chains and cardiac light chain deposition. Biopsy demonstrated light chain immunoreactivity in fibrotic areas, confirming light chain deposition disease. Medical management was initiated but the patient deteriorated and died while being evaluated for heart transplantation.
Venous Thromboembolism (VTE): Recent Advances in Reducing the Disease BurdenNBCA
- Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity and mortality worldwide. It is estimated that there are 900,000 cases of VTE per year in the US.
- Recent clinical trials have found that the direct oral anticoagulants rivaroxaban, apixaban, edoxaban and dabigatran are non-inferior to standard therapy for treating VTE and reduce the risk of recurrence, while having a similar or lower risk of bleeding.
- The EINSTEIN DVT and EINSTEIN PE trials found that rivaroxaban was non-infer
This document summarizes guidelines for antithrombotic therapy for venous thromboembolism from the 10th edition of the CHEST guidelines. It recommends non-vitamin K antagonist oral anticoagulants over warfarin for VTE treatment and prevention in patients without cancer. For patients with cancer, it recommends low molecular weight heparin over other anticoagulants. It provides dosing and monitoring recommendations for the different anticoagulant options. It also addresses duration of therapy, management of recurrent VTE, and specific situations like subsegmental pulmonary embolism.
VTE and Cancer Healthcare Professional Educationvtesimplified
Cancer patients are at increased risk of developing blood clots (venous thromboembolism or VTE) due to factors such as tumour infiltration of blood vessels, immobility, and cancer treatments. VTE is a leading cause of death in cancer patients and the risk is highest in the first months after diagnosis. Guidelines recommend thromboprophylaxis for hospitalized cancer patients without bleeding risk, but evidence for routine outpatient prophylaxis is limited to certain high risk groups. Risk assessment tools can help identify those at highest risk who may benefit most from prophylaxis.
This document discusses the diagnostic and treatment approaches to venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). It provides details on evaluating patients using Wells criteria and D-dimer testing to determine pre-test probability and decide between imaging with CT pulmonary angiogram or VQ scan. For confirmed VTE, treatment options include warfarin, novel oral anticoagulants (NOACs), inferior vena cava filters or thrombolytics. The document reviews best practices for treating isolated distal DVT, catheter-related thrombosis, and selecting appropriate long-term anticoagulation therapy.
The document provides an agenda and overview for the UPMC VTE 3.0 project. It introduces the team members and their roles. It then discusses the background, scope, and objectives of the project, which aims to analyze patient data from 2012-2014 to determine bleed and clot rates, compare outcomes based on patient characteristics and risk scores, and analyze the effectiveness and safety of different anticoagulation agents. It describes the data collection and criteria for defining and classifying bleeds. Analysis shows a decrease in identified bleed percentage between iterations. Distribution of bleeds and major bleeds is also examined by hospital and medication.
This document discusses thromboprophylaxis in ICU patients. It provides information on:
- The risk of venous thromboembolism (VTE) in hospitalized patients and the potential for prophylaxis to reduce this risk
- Common prophylactic options like enoxaparin, fondaparinux, and unfractionated heparin
- Tools to assess patient risk like the PADUA and IMPROVE scores
- Factors to consider when selecting a prophylactic method, including duration of prophylaxis
The document aims to review best practices for preventing VTE in high-risk hospitalized populations through appropriate thromboprophylaxis.
These are the slides from a presentation I recently gave at work. It demonstrates two fascinating cases [one massive & one submassive PE] & lends itself to a review of the literature assessing the roles and evidence behind thrombolysis for pulmonary embolism.
Covered includes the MAPPET-3, MOPPET & PEITHO trials.
A pulmonary embolism occurs when a blood clot or other material occludes the pulmonary artery or its branches. This most commonly results from a deep vein thrombosis in the lower leg that embolizes to the lung. When a PE occurs, it causes ventilation-perfusion mismatching in the lungs. Diagnosis is difficult due to nonspecific symptoms but evaluation involves a Wells criteria assessment, D-dimer testing, echocardiogram, and CT pulmonary angiogram. Treatment consists of anticoagulation with low molecular weight heparin or novel oral anticoagulants. Fibrinolytic therapy may be used in massive PEs. Prevention focuses on prophylaxis in high risk hospitalized patients.
This document summarizes contemporary management of pulmonary embolism (PE). It discusses that PE is a common cause of death in the US, killing 50,000-200,000 people annually. Massive PE has a much higher mortality than non-massive PE. The document reviews risk factors, diagnostic testing including D-dimer, V/Q scan, CT, and echocardiography. Treatment options discussed include anticoagulation with heparin, thrombolysis for unstable patients or those with RV dysfunction, and percutaneous interventions.
High risk pulmonary embolism , Dr David JimenezFundacion EPIC
Presentación de "High risk pulmonary embolism" por el Dr David Jimenez del Hospital Ramón y Cajal, en el I Curso IVP, Intervencionismo Vascular Pulmonar, organizado por EpicLearning (Fundación EPIC) el 23 de marzo de 2021.
Deep Venous Thrombosis and Pulmonary Embolism : Diagnostic Approach and Curre...Bassel Ericsoussi, MD
This document summarizes guidelines for diagnosing and treating deep vein thrombosis (DVT) and pulmonary embolism (PE). It discusses the clinical presentation and risk factors for PE. Diagnostic tests covered include D-dimer, ventilation-perfusion scanning, ultrasound, and CT angiography. Biomarkers like BNP and troponin are also reviewed. Treatment guidelines and prognostic factors like right ventricular dysfunction are outlined.
This document discusses venous thrombosis and pulmonary embolism. It covers risk factors, pathophysiology, diagnostic evaluation, and treatment options. The main points are:
1. Venous thrombosis and pulmonary embolism are concerns in postoperative and ICU patients. Thrombi often form silently in leg veins and can break off and travel to the lungs.
2. Diagnostic evaluations include D-dimer, ventilation-perfusion scans, echocardiograms, angiograms. Imaging shows defects from clots blocking blood flow.
3. Treatment involves anticoagulation initially with heparin or low molecular weight heparin. Warfarin is used long-term. Thrombolytics or inferior v
1. Pulmonary embolism results from partial or complete obstruction of the pulmonary arteries, which can overload the right ventricle and compromise cardiac output.
2. Risk factors for pulmonary embolism range from strong risks like recent spinal cord injury or hip/knee replacement, to moderate risks such as oral contraceptive use or cancer, to weaker risks including prolonged immobility.
3. Diagnosis involves assessing the pre-test probability using prediction rules, d-dimer testing, and imaging with ultrasound, CT, or V/Q scan depending on the clinical situation. Biomarkers and echocardiography can help evaluate right ventricular function.
Acute pulmonary embolism - risk stratification and managementPrithvi Puwar
what is the guideline recommendation and ideal to be done in management of acute pulmonary embolism. the presentation includes risk stratification, recommendation and approach to investigations (guidelines based) and management options with evidence.
This document summarizes information about acute pulmonary embolism (PE):
- PE occurs when a blood clot blocks a pulmonary artery, has nonspecific symptoms, and diagnosis is often delayed. Treatments are effective but prevention is important.
- Risk factors include older age, surgery, trauma, cancer, oral contraceptives, prior clots, obesity, and hereditary conditions. Asians may have a lower risk due to dietary and genetic factors.
- Diagnosis involves considering symptoms, tests like CT scans and D-dimers, and algorithms for diagnosing with varying levels of suspicion. Treatment involves anticoagulants while preventing future clots.
Vte, identification and management of patients at riskWale Jesudemi
Venous thrombo-embolism (VTE) refers to deep vein thrombosis (DVT) and pulmonary embolism (PE) caused by blood clots. The document discusses risk factors for VTE, signs and symptoms, diagnostic tests including ultrasound and CT scans, and treatment including anticoagulation medications and thrombolytic therapy. It also provides guidelines for assessing VTE risk in patients and implementing preventative measures.
A Complete & Effective Study Of Venous ThromboembolismMedical and Health
VENOUS THROMBOEMBOLISM: CAUSES, SYMPTOMS, DIAGNOSIS & TREATMENT
In this article, we’ll discuss thrombosis, thrombosis vs embolism, thrombosis definition, and thrombosis coronary. Our main headings are venous thromboembolism disease, venous thromboembolism symptoms, venous thromboembolism causes, venous thromboembolism diagnosis and treatment for venous thromboembolism. For complete article, head over to the given link, https://diseases8804.blogspot.com/2021/08/a-complete-effective-study-of-venous.html
This document provides an overview of renal vasculitis (AAV). It begins with the historical landmarks in recognizing and classifying different types of vasculitis. It then discusses ANCA-associated vasculitis in more detail, including the role of ANCA testing in diagnosis and monitoring disease. The clinical manifestations, pathology, treatment including induction and maintenance therapies, and prognosis of AAV are summarized. It also reviews recent insights into the genetics and environmental factors involved in AAV.
1) A study compared the yield of CT pulmonary angiograms (CTPAs) for patients with pulmonary embolism (PE) when clinicians overrode clinical decision support (CDS) guidelines versus adhering to them.
2) The override group had a lower yield of PE detection (4.2% vs 11.2%) and 51.3% lower odds of acute PE compared to the adherent group.
3) Guidelines for PE management include anticoagulation, thrombolysis, catheter-directed thrombolysis, surgical embolectomy, and consideration of inferior vena cava filters depending on the risk level and characteristics of the patient's PE.
Menopause typically occurs around age 51 and is defined as the cessation of menstrual periods for one year. It marks a major decline in estrogen and progesterone levels. Common symptoms include hot flashes, sleep disturbances, mood changes, and vaginal dryness. Long-term risks of estrogen deficiency include osteoporosis, heart disease, and cognitive decline. Historically, hormone replacement therapy (HRT) was widely used to treat menopausal symptoms but large studies in the early 2000s like the Women's Health Initiative found increased risks of breast cancer and heart disease with HRT use. This led to a reevaluation of HRT recommendations focusing on using the lowest effective dose for the shortest duration possible to manage menopausal symptoms
The document discusses cardiovascular risk factors and management. It summarizes that most heart attacks are caused by low-grade coronary artery blockages rupturing and triggering blood clots. Several risk factors can make plaques more vulnerable to rupture, such as inflammation, thin fibrous caps, and lipid-rich cores. Lifestyle changes and statin drugs are effective at reducing cardiovascular risks by lowering cholesterol levels and having additional anti-inflammatory effects. More aggressive lowering of LDL cholesterol is associated with greater reduction in heart attack risk.
This document summarizes guidelines for antithrombotic therapy for venous thromboembolism from the 10th edition of the CHEST guidelines. It recommends non-vitamin K antagonist oral anticoagulants over warfarin for VTE treatment and prevention in patients without cancer. For patients with cancer, it recommends low molecular weight heparin over other anticoagulants. It provides dosing and monitoring recommendations for the different anticoagulant options. It also addresses duration of therapy, management of recurrent VTE, and specific situations like subsegmental pulmonary embolism.
VTE and Cancer Healthcare Professional Educationvtesimplified
Cancer patients are at increased risk of developing blood clots (venous thromboembolism or VTE) due to factors such as tumour infiltration of blood vessels, immobility, and cancer treatments. VTE is a leading cause of death in cancer patients and the risk is highest in the first months after diagnosis. Guidelines recommend thromboprophylaxis for hospitalized cancer patients without bleeding risk, but evidence for routine outpatient prophylaxis is limited to certain high risk groups. Risk assessment tools can help identify those at highest risk who may benefit most from prophylaxis.
This document discusses the diagnostic and treatment approaches to venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). It provides details on evaluating patients using Wells criteria and D-dimer testing to determine pre-test probability and decide between imaging with CT pulmonary angiogram or VQ scan. For confirmed VTE, treatment options include warfarin, novel oral anticoagulants (NOACs), inferior vena cava filters or thrombolytics. The document reviews best practices for treating isolated distal DVT, catheter-related thrombosis, and selecting appropriate long-term anticoagulation therapy.
The document provides an agenda and overview for the UPMC VTE 3.0 project. It introduces the team members and their roles. It then discusses the background, scope, and objectives of the project, which aims to analyze patient data from 2012-2014 to determine bleed and clot rates, compare outcomes based on patient characteristics and risk scores, and analyze the effectiveness and safety of different anticoagulation agents. It describes the data collection and criteria for defining and classifying bleeds. Analysis shows a decrease in identified bleed percentage between iterations. Distribution of bleeds and major bleeds is also examined by hospital and medication.
This document discusses thromboprophylaxis in ICU patients. It provides information on:
- The risk of venous thromboembolism (VTE) in hospitalized patients and the potential for prophylaxis to reduce this risk
- Common prophylactic options like enoxaparin, fondaparinux, and unfractionated heparin
- Tools to assess patient risk like the PADUA and IMPROVE scores
- Factors to consider when selecting a prophylactic method, including duration of prophylaxis
The document aims to review best practices for preventing VTE in high-risk hospitalized populations through appropriate thromboprophylaxis.
These are the slides from a presentation I recently gave at work. It demonstrates two fascinating cases [one massive & one submassive PE] & lends itself to a review of the literature assessing the roles and evidence behind thrombolysis for pulmonary embolism.
Covered includes the MAPPET-3, MOPPET & PEITHO trials.
A pulmonary embolism occurs when a blood clot or other material occludes the pulmonary artery or its branches. This most commonly results from a deep vein thrombosis in the lower leg that embolizes to the lung. When a PE occurs, it causes ventilation-perfusion mismatching in the lungs. Diagnosis is difficult due to nonspecific symptoms but evaluation involves a Wells criteria assessment, D-dimer testing, echocardiogram, and CT pulmonary angiogram. Treatment consists of anticoagulation with low molecular weight heparin or novel oral anticoagulants. Fibrinolytic therapy may be used in massive PEs. Prevention focuses on prophylaxis in high risk hospitalized patients.
This document summarizes contemporary management of pulmonary embolism (PE). It discusses that PE is a common cause of death in the US, killing 50,000-200,000 people annually. Massive PE has a much higher mortality than non-massive PE. The document reviews risk factors, diagnostic testing including D-dimer, V/Q scan, CT, and echocardiography. Treatment options discussed include anticoagulation with heparin, thrombolysis for unstable patients or those with RV dysfunction, and percutaneous interventions.
High risk pulmonary embolism , Dr David JimenezFundacion EPIC
Presentación de "High risk pulmonary embolism" por el Dr David Jimenez del Hospital Ramón y Cajal, en el I Curso IVP, Intervencionismo Vascular Pulmonar, organizado por EpicLearning (Fundación EPIC) el 23 de marzo de 2021.
Deep Venous Thrombosis and Pulmonary Embolism : Diagnostic Approach and Curre...Bassel Ericsoussi, MD
This document summarizes guidelines for diagnosing and treating deep vein thrombosis (DVT) and pulmonary embolism (PE). It discusses the clinical presentation and risk factors for PE. Diagnostic tests covered include D-dimer, ventilation-perfusion scanning, ultrasound, and CT angiography. Biomarkers like BNP and troponin are also reviewed. Treatment guidelines and prognostic factors like right ventricular dysfunction are outlined.
This document discusses venous thrombosis and pulmonary embolism. It covers risk factors, pathophysiology, diagnostic evaluation, and treatment options. The main points are:
1. Venous thrombosis and pulmonary embolism are concerns in postoperative and ICU patients. Thrombi often form silently in leg veins and can break off and travel to the lungs.
2. Diagnostic evaluations include D-dimer, ventilation-perfusion scans, echocardiograms, angiograms. Imaging shows defects from clots blocking blood flow.
3. Treatment involves anticoagulation initially with heparin or low molecular weight heparin. Warfarin is used long-term. Thrombolytics or inferior v
1. Pulmonary embolism results from partial or complete obstruction of the pulmonary arteries, which can overload the right ventricle and compromise cardiac output.
2. Risk factors for pulmonary embolism range from strong risks like recent spinal cord injury or hip/knee replacement, to moderate risks such as oral contraceptive use or cancer, to weaker risks including prolonged immobility.
3. Diagnosis involves assessing the pre-test probability using prediction rules, d-dimer testing, and imaging with ultrasound, CT, or V/Q scan depending on the clinical situation. Biomarkers and echocardiography can help evaluate right ventricular function.
Acute pulmonary embolism - risk stratification and managementPrithvi Puwar
what is the guideline recommendation and ideal to be done in management of acute pulmonary embolism. the presentation includes risk stratification, recommendation and approach to investigations (guidelines based) and management options with evidence.
This document summarizes information about acute pulmonary embolism (PE):
- PE occurs when a blood clot blocks a pulmonary artery, has nonspecific symptoms, and diagnosis is often delayed. Treatments are effective but prevention is important.
- Risk factors include older age, surgery, trauma, cancer, oral contraceptives, prior clots, obesity, and hereditary conditions. Asians may have a lower risk due to dietary and genetic factors.
- Diagnosis involves considering symptoms, tests like CT scans and D-dimers, and algorithms for diagnosing with varying levels of suspicion. Treatment involves anticoagulants while preventing future clots.
Vte, identification and management of patients at riskWale Jesudemi
Venous thrombo-embolism (VTE) refers to deep vein thrombosis (DVT) and pulmonary embolism (PE) caused by blood clots. The document discusses risk factors for VTE, signs and symptoms, diagnostic tests including ultrasound and CT scans, and treatment including anticoagulation medications and thrombolytic therapy. It also provides guidelines for assessing VTE risk in patients and implementing preventative measures.
A Complete & Effective Study Of Venous ThromboembolismMedical and Health
VENOUS THROMBOEMBOLISM: CAUSES, SYMPTOMS, DIAGNOSIS & TREATMENT
In this article, we’ll discuss thrombosis, thrombosis vs embolism, thrombosis definition, and thrombosis coronary. Our main headings are venous thromboembolism disease, venous thromboembolism symptoms, venous thromboembolism causes, venous thromboembolism diagnosis and treatment for venous thromboembolism. For complete article, head over to the given link, https://diseases8804.blogspot.com/2021/08/a-complete-effective-study-of-venous.html
This document provides an overview of renal vasculitis (AAV). It begins with the historical landmarks in recognizing and classifying different types of vasculitis. It then discusses ANCA-associated vasculitis in more detail, including the role of ANCA testing in diagnosis and monitoring disease. The clinical manifestations, pathology, treatment including induction and maintenance therapies, and prognosis of AAV are summarized. It also reviews recent insights into the genetics and environmental factors involved in AAV.
1) A study compared the yield of CT pulmonary angiograms (CTPAs) for patients with pulmonary embolism (PE) when clinicians overrode clinical decision support (CDS) guidelines versus adhering to them.
2) The override group had a lower yield of PE detection (4.2% vs 11.2%) and 51.3% lower odds of acute PE compared to the adherent group.
3) Guidelines for PE management include anticoagulation, thrombolysis, catheter-directed thrombolysis, surgical embolectomy, and consideration of inferior vena cava filters depending on the risk level and characteristics of the patient's PE.
Menopause typically occurs around age 51 and is defined as the cessation of menstrual periods for one year. It marks a major decline in estrogen and progesterone levels. Common symptoms include hot flashes, sleep disturbances, mood changes, and vaginal dryness. Long-term risks of estrogen deficiency include osteoporosis, heart disease, and cognitive decline. Historically, hormone replacement therapy (HRT) was widely used to treat menopausal symptoms but large studies in the early 2000s like the Women's Health Initiative found increased risks of breast cancer and heart disease with HRT use. This led to a reevaluation of HRT recommendations focusing on using the lowest effective dose for the shortest duration possible to manage menopausal symptoms
The document discusses cardiovascular risk factors and management. It summarizes that most heart attacks are caused by low-grade coronary artery blockages rupturing and triggering blood clots. Several risk factors can make plaques more vulnerable to rupture, such as inflammation, thin fibrous caps, and lipid-rich cores. Lifestyle changes and statin drugs are effective at reducing cardiovascular risks by lowering cholesterol levels and having additional anti-inflammatory effects. More aggressive lowering of LDL cholesterol is associated with greater reduction in heart attack risk.
This document summarizes research on biochemical and imaging markers for cardiovascular disease. It includes 3 sections:
1. It discusses several major risk factors for cardiovascular events and how biomarkers like CRP, fibrinogen, and homocysteine can provide additional predictive value beyond traditional risk factors.
2. It reviews studies on emerging biomarkers for inflammation, thrombosis, and oxidative stress, and their association with future cardiovascular outcomes in prospective studies.
3. It presents data on imaging markers like carotid intimal thickness, echocardiography, and electron beam computed tomography and their ability to track disease severity and response to treatment.
The document concludes by discussing features of an ideal cardiovascular biomarker and potential surrogate markers of endothelial function
Jennifer Tremmel - Sex Differences In Cardiovascular DiseaseClayman Institute
This document discusses sex differences in cardiovascular disease. It summarizes that historically, heart disease studies primarily enrolled men. Women represent about half of cardiovascular disease patients but were underrepresented in clinical trials. Risk factors like diabetes and obesity confer greater relative risk of cardiovascular events in women than men. Symptom presentation of heart disease can differ between sexes, with women more likely to experience atypical symptoms. Guidelines recommend against menopausal hormone therapy for primary or secondary prevention of cardiovascular disease in women.
This document discusses risk factors for stroke and summarizes data from multiple studies on 5-year and 10-year risks of all stroke and ischemic stroke. Key findings include:
- Hypertension, smoking, age, diabetes and atrial fibrillation are important risk factors for increased stroke risk.
- The 5-year and 10-year risks of all stroke and ischemic stroke varied across different cohorts but were generally around 3% and 7-11% respectively.
- Risk factors like age, smoking, pre-existing cardiovascular disease and atrial fibrillation were associated with higher 10-year risks of stroke in most cohorts studied.
This document summarizes key points from a task force report on identifying and treating asymptomatic patients vulnerable to heart attack. It introduces a new paradigm focused on outcomes studies, measuring disease activity, and identifying the vulnerable plaque and patient. The report was chaired by Morteza Naghavi and had writing contributions from experts in cardiovascular imaging, risk assessment, and prevention. It aims to advance the field beyond traditional risk factor assessment alone.
This document provides information on screening criteria and recommendations for various preventative measures. It begins with definitions of universal, selective, and indicated prevention approaches. It then lists criteria for good screening tests, including sensitivity, specificity, predictive value, simplicity, cost, safety, acceptability, and labeling. The document discusses screening recommendations from the U.S. Preventive Services Task Force for conditions like aspirin, diabetes, dyslipidemia, abdominal aortic aneurysm, and others. It provides both recommended screening (grade A or B) and those that are discouraged (grade D).
1) Armand Trousseau was the first to associate thrombosis and malignancy in the 19th century and suggest screening cancer patients for thrombosis.
2) Cancer patients have a highly elevated risk of developing venous thromboembolism (VTE), which can occur in up to 20% and is a common cause of death.
3) The presence of VTE at cancer diagnosis is associated with worse prognosis and survival rates. Tissue factor expression by tumor cells contributes to increased coagulation and thrombosis.
Menopausal Harmone Therapy & Indian Gynaecologists Dr Sharda Jain Lifecare Centre
This document discusses menopause and menopausal hormone therapy (MHT). It provides information on:
1) The average age of menopause for Indian women is 46.2 years. Premature menopause, which occurs before age 40, increases risks for cardiovascular disease, diabetes, and metabolic syndrome.
2) Lessons learned from the WHI study show that the risks of MHT depend on factors like age of starting treatment, type of estrogen and progestogen used, and whether the uterus is present. Not all progestogens have the same safety profile.
3) The choice of progestogen is important as some, like medroxyprogesterone acetate (MPA), may
Palpitations In The Young Patients: Another False Alarm?ahvc0858
This document discusses palpitations in young adults. It begins by introducing the speakers and describing the services provided at AHVC, including general cardiology, interventional procedures, and electrophysiology. It then discusses common causes of palpitations like supraventricular tachycardia, outlines four case studies of patients presenting with palpitations, and debunks myths about palpitations always being benign or due to anxiety. The document emphasizes that arrhythmias in young patients should be properly evaluated.
Ohio State's 2016 ASH Review - BEST OF ASH 2015 MULTIPLE MYELOMA AND PLASMA C...OSUCCC - James
This randomized clinical trial compared autologous stem cell transplantation (ASCT) versus continued therapy without transplantation in newly diagnosed multiple myeloma patients. 389 patients received induction with lenalidomide-dexamethasone (Rd) or cyclophosphamide-lenalidomide-dexamethasone (CRD). Patients were then randomized to receive ASCT or continued Rd or CRD therapy. The primary endpoint was progression-free survival (PFS). Results showed ASCT improved PFS compared to continued therapy without transplantation. However, overall survival was not significantly different between the two groups, suggesting continued therapy without ASCT may be sufficient for some patients.
Syndrome metabolique et maladies vasculaires s novosfa_angeiologie
This document summarizes a presentation on detecting preclinical atherosclerosis and evaluating cardiovascular risk. It discusses the metabolic syndrome and its association with future cardiovascular events. The summary is:
1) The presentation discusses preclinical atherosclerosis, metabolic syndrome, and their ability to predict future cardiovascular events over long-term follow-up of patients.
2) Metabolic syndrome was found to double the risk of cardiovascular events over 20 years of follow-up compared to healthy patients.
3) Preclinical atherosclerosis detected by carotid ultrasound also independently predicted cardiovascular outcomes, with higher rates of events in patients showing thickening of carotid arteries.
1) Women admitted for acute myocardial infarction have 40-100% higher 30-day mortality than men, though this difference is reduced after adjusting for age and comorbidities.
2) When patients are matched based on clinical characteristics, the differences in treatments received and mortality between men and women are reduced, but women still receive less invasive procedures and reperfusion.
3) When patients are matched on both characteristics and treatments, men and women have similar in-hospital and 30-day mortality, suggesting increased use of invasive treatments could reduce the gender gap in outcomes.
1. The document discusses Valentin Fuster's disclosure information and level of involvement as chair of BG Medicine. It then covers several topics related to atrial fibrillation (AF) and antithrombotic treatment including Virchow's triad, different disease compartments, bleeding risks, and new directions in treatment.
2. Several studies and trials are summarized related to anticoagulation therapy for AF, risks of bleeding, outcomes for different antithrombotic regimens, and prevalence and management of AF in clinical practice based on various surveys.
3. The document provides an overview of Valentin Fuster's disclosure statement and then reviews the literature on antithrombotic treatment and
Hypertension: New Concepts, Guidelines, and Clinical Management Hypertensio...MedicineAndFamily
This document summarizes guidelines for diagnosing and treating hypertension. It discusses the prevalence of hypertension and cardiovascular disease in the US population. It reviews risk factors for hypertension and cardiovascular events. It also summarizes findings from clinical trials demonstrating the benefits of treating hypertension, including reduced risks of stroke, heart failure, and myocardial infarction. Thiazide diuretics are recommended as first-line treatment based on their effectiveness and lower costs.
1) Hypertension is a significant risk factor for cardiovascular and renal diseases. It affects over 26% of the US adult population and control rates remain suboptimal.
2) Recent guidelines classify blood pressure into normal, prehypertensive, and hypertensive stages based on systolic and diastolic levels with goals of treating to lower risk levels.
3) Clinical trials demonstrate that treating hypertension reduces risks of stroke, heart attack, heart failure, and kidney disease and can prevent over a third of cardiovascular events.
Metabolic syndrome (MetS) predicts cardiovascular and cerebrovascular events over 20 years of follow-up. A study of 529 asymptomatic patients with MetS at baseline found they experienced 199 cardiovascular adverse events, compared to 120 events for 278 healthy controls, with an odds ratio of 2.3. Multivariate analysis identified MetS, BMI, C-reactive protein levels, and preclinical atherosclerosis as independent predictors of cardiovascular events over the 20 year period. Subclinical atherosclerosis was more prevalent in patients with MetS compared to controls. MetS significantly increased the risk of total cardiovascular, cerebrovascular, myocardial infarction and angina events over the long term follow-up period.
Women face greater risks from coronary artery disease than men. CAD is a leading cause of death in women worldwide. While women tend to develop CAD approximately 10 years later than men, they are more likely than men to die within a year of a heart attack. Women often experience different symptoms than men and are less likely to receive timely diagnosis and treatment. Risk factors like diabetes, smoking, and autoimmune diseases confer greater relative risks for CAD in women. There remains a need for greater awareness of heart disease in women and more tailored screening and management strategies.
This document summarizes research on the health risks and benefits of combined oral contraceptives (COCs). It finds that while COCs modestly increase the risk of conditions like venous thromboembolism, the risk depends on estrogen dose and progestin generation, and the benefits of COCs in reducing other health conditions are significant. Specifically:
1) COCs are associated with a small increased risk of conditions like venous thromboembolism, but the risk varies by estrogen dose and is higher for third-generation progestins than second-generation.
2) However, studies adjusting for confounding factors found no difference in risk between second and third-generation pills.
3) The health
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2. Tromboembolismo: di
che cosa stiamo
parlando?
• Nel sistema venoso
– Trombosi venosa profonda
• con o senza embolia polmonare
• Nel sistema arterioso
– Embolia cerebrale
– Embolia periferica
4. Precisiamo: Sesso o Genere?
definizione OMS
• Sesso: classificazione di maschio o femmina in relazione
alle funzioni riproduttive, si basa sulle caratteristiche
biologiche che definiscono uomo o donna
• Genere : comprende comportamenti, attività e attributi
che una società considera specifici per l’uomo e per la donna,
e il modo di vedersi come maschio o femmina anche in
relazione al proprio ruolo sociale
5.
6. Rudolf Virchow 1821-1902
• Rallentamento del
flusso
• Lesione endoteliale
• Alterazioni della
coagulazione
7.
8. Tromboembolismo venoso (TEV)
entità del problema
• Nord America e Europa incidenza annua
– TVP 160/100.000
– EP sintomatica non fatale 20/100.000
– EP fatale (autopsia) 50/100.000
– S. Postflebitica con ulcere (prev.)75/100.000
13. Sex Difference in Risk of Second but Not of First
Venous Thrombosis
Paradox Explained
Rachel E.J. Circulation. 2014;129:51-56
When female reproductive risk factors are taken into account, the risk of a first
venous thrombosis is twice as high in men as in women.
ORaggiustato*conIC95%
*aggiustato per IMC e fumo
8
6
4
2
0
OR=1
14.
15.
16. 0.0 0.5 1.0
USA
Danimarca
Inghilterra
Francia
Cina
Differenze di genere per le malattie autoimmuni
Prevalenza relativa fra i sessi del Lupus Eritematoso Sistemico
Femmine Maschi
S.T. Ngo et al. / Frontiers in Neuroendocrinology 35 (2014) 347–369
17. Fattori associati alla trombofilia
con meccanismo noto
Perdita di funzione Aumento di funzione
Antitrombina III Fattore V di Leiden
Proteina C Protrombina G20210A
Proteina S Aumento fattore VIII
18.
19.
20.
21. ASSOCIAZIONE FRA DIFETTI TROMBOFILICI
E CONTRACCETTIVI ORALI
0
5
10
15
20
25
30
35
CO
FV LEIDEN
--
--
+
--
--
+
+
+
RischioRelativo
(Vandenbroucke et al, Lancet 1996)
22. Screening for Factor V Leiden Mutation
• Not cost effective
• Adverse
psychological and
insurance effects
8000 Screened
400 FVL
1 DVT
More than 500,000 women would need to
be screened to prevent 1 death from PE
23. THROMBOPHILIA
AND VENOUS THROMBOEMBOLISM
International Consensus Statement
Guidelines According to Scientific Evidence
• TEV non provocato (spontaneo)
• TEV età<50 fattore predisponente transitorio
• TEV in corso di CO, terapia estrogenica sostitutiva , gravidanza
• TEV ricorrente
• Tromboflebile superficiale ricorrente in assenza di cancro e vene varicose
• TV in sede insolita (arti superiori, mesenteriche, seni cerebrali)
• Necrosi cutanea indotta da warfarin
• Parerenti asintomatici di trombofilici sintomatici
• 2 aborti consecutivi o 3 non consecutivi o una morte fetale
• Grave pre-eclampsia
• TEV in bambini
Int Angiol 2005;24:1-26
24. Martinelli, I. et al. Nat. Rev. Cardiol. 11, 140–156 (2014); published online 14 January 2014; doi:10.1038/nrcardio.2013.211
25. Martinelli, I. et al. Nat. Rev. Cardiol. 11, 140–156 (2014); published online 14 January 2014; doi:10.1038/nrcardio.2013.211
26. USA 1960: la FDA approva la
commercializzazione di Enovid®
con
indicazione contraccettiva.
EUROPA 1961 Anovlar®
F.M. Primiero, 2012F.M. Primiero, 2012
150 mcg di mestranolo
9,85 mg di noretinodrel
norethindrone acetate 4 mg +
ethinyl estradiol 50 µg
27.
28. Generazioni di contraccettivi orali
combinati
I generazione II generazione III generazione IV generazione
Norethisterone
o Norethindrone
(e.g. Loestrin®
)
Levonorgestrel
(e.g. Microgynon®
)
Desogestrel
(Mercilon®
, Marvelon®
)
Drospirenone
(Yasmin®
)
29. Rischio di trombosi in rapporto al
Progestinico
(30-40 μg di Etinil Estradiolo)
Progestinico Rapporto fra tassi di
incidenza rispetto a
levonorgestrel
Levonorgestrel (II g) 1,00
Noretisterone (I g) 0,98
Norgestimate 1,19
Drospirenone (IV g) 1,64
Desogestrel (III g) 1,82
Gestodene (III g) 1,86
Ciproterone acetato 1,88
BMJ 2009;339:b2890
30. Likelihood of developing a blood clot
(number of women with a blood clot
per 10,000 women-years).
http://www.fda.gov/Drugs/DrugSafety/ucm299305
31. This guideline focuses on the risk factors unique to women, such as
•reproductive factors,
and those that are more common in women, including
•migraine with aura,
•obesity,
•metabolic syndrome, and
•atrial fibrillation.
http://stroke.ahajournals.org/content/early/2014/02/06/01.str.0000442009.06663.48
35. Prevalence of Risk Factors
Women are older at stroke onset1-7
and more likely to have:
Atrial fibrillation4,5,8,9
Hypertension2,3,5,9
Dementia2
Congestive heart failure3
1. Appelros et al. Stroke 2009, 40:1082-1090
2. Eriksson M et al. Stroke. 2009;40:909-914
3. Niewada M et al. Neuroepi. 2005;24:123–128.
4. Silva GS et al. Cerebrov Dis 2010;30:470–475
1. Petrea RE et al. Stroke 2009;40;1032-1037
2. Kapral MK et al. Stroke 2005;36;809-814
3. Gargano JW et al. Stroke 2008;39;24-29
4. Reid JM et al. Stroke 2008;39;1090-1095
5. Di Carlo A et al. Stroke 2003;34;1114-1119
36. Effects of Stroke Risk Factors: Sex Related
Women with DM have greater stroke risk compared to men with DM1
MetS: doubles stroke risk in women but not in men2
Migraines: 2-fold increased risk of stroke in women
Even higher in women >45 years and those on OCP3
Atrial fibrillation
Women with AF have a two-fold greater risk of stroke than men
with AF4
1. Almdal et al. Arch Int Med. 2004;164:1422–26.
2. Boden-Albala et al. Stroke. 2008;39:30–35.
3. Etminan M et al. BMJ 2005;330;63.
4. Wang TJ et al. JAMA 2003;290;1049-1056
37. Gender differences in the risk of stroke and peripheral
embolism in AF: the ATRIA study
RR = 1.6 (1.3-1.9)
RR = 1.6 (1.0-2.3)
RR = 1.8 (1.4-2.3)
AnnualThromboembolismRate(%)
Fang MC, et al. Circulation 2005;112:1687-91
41. Outcomes at 6 months
• 676 consecutive admissions to teaching hospital
• Female sex: independent predictor of poor outcome at 6
mo: 1.57, 95% CI 1.03–2.36, p=0.04
Silva GS et al. Cerebrovasc Dis 2010;30:470–475
42. Perché l’ictus cardioembolico ha una
prognosi severa?
• Più grave all’inizio
• Assenza di circoli di compenso e lesioni
multiple
• Alto rischio di recidiva
• Alto rischio di trasformazione emorragica
43. CHADS2 -> CHA2DS2VASc
CHA2DS2-VASc
Risk
Score
CHF or LVEF <
40%
1
Hypertension 1
Age > 75 2
Diabetes 1
Stroke/TIA/
Thromboembolism
2
Vascular
Disease
1
Age 65 - 74 1
Female 1
CHADS2 Risk Score
CHF 1
Hypertension 1
Age > 75 1
Diabetes 1
Stroke or TIA 2
From ESC AF Guidelines
http://www.escardio.org/guidelines-surveys/esc-
guidelines/GuidelinesDocuments/guidelines-afib-FT.pdf
44. • Oral anticoagulation in women aged ≤65
years with AF alone (no other risk
factors; women with CHADS2=0 or
CHA2DS2-VASc=1) is not recommended
(Class III; Level of Evidence B).
Antiplatelet therapy is a reasonable
therapeutic option for selected low-risk
women (Class IIa; Level of Evidence B).
• New oral anticoagulants are a useful
alternative to warfarin for the prevention of
stroke and systemic thromboembolism in
women with paroxysmal or permanent AF and
prespecified risk factors (according to
CHA2DS2-VASc) who do not have a prosthetic
heart valve or hemodynamically significant
valve disease, severe renal failure (creatinine
clearance 15 mL/min), lower weight (<50 kg),
or advanced liver disease (impaired baseline
clotting function) (Class I; Level of Evidence A).
45. Gravidanza e ictus
• 34 ictus per 100.000 parti
– (III trim e post partum)
• vs 21 ictus per 100.000
• Stasi,
• Edema
• Ipercoagulabilità
– Resistenza alla PC
– Bassi livelli di Proteina S
– Aumento del fibrinogeno
46. Pregnancy Complications and the
Long-term Risk of Stroke
• An expanding body of research has
shown that complications of pregnancy
– preeclampsia,
– gestational diabetes,
– pregnancy-induced hypertension
• are associated with higher risk for future
CVD and stroke beyond the childbearing
years than among women without these
disorders
VTE causing deep vein thrombosis (DVT) or
pulmonary embolism (PE) is a major international
health problem. At one extreme, PE can be fatal.
In North America and Europe, the annual incidence
is approximately 160 per 100 000 for DVT,
20 per 100 000 for symptomatic non fatal PE and
50 per 100 000 for fatal autopsy-detected PE.7-11
Often, overlooked is the fact that DVT can lead to
post-thrombotic deep venous reflux or obstruction
causing leg skin changes and ulceration, which
adversely impacts on quality of life and escalates
health care costs. The prevalence of venous ulceration
is at least 300 per 100 000 and approximately
25% are due to DVT.12, 13 The annual cost resulting
from venous ulceration has been estimated to
be £ 400 to 600 million for the UK 14, 15 and more
than $ 1 billion for the US.16, 17
VTE should be an appealing target for maximum
prophylaxis, but it has been difficult to
Age-specific incidence rates of venous thromboembolism in siblings.
More than 500,000 women would need to be screened to prevent 1 death from PE
The first case of thrombosis associated with HC occurred in 1961 when a nurse taking a high-dose estrogen OCP developed a pulmonary embolism. Myocardial infarction and stroke were reported in OCP users during the following years and were associated with older women who smoke and use HC. These early reports seemed to suggest that the thrombotic potential of the OCP was related to its relatively high estrogen content of 50 µg or more.
Evitare COC di III e IV generazione in caso di trombofilia ereditaria o acquisita
Tenere conto dell’età e del fumo
Tenere conto che la gravidanza indesiderata si associano a rischio tromboembolico elevato
Flow and Intracardiac Thromboembolism
Rheological factors may be important in pathogenesis of
atrial thrombosis, which occurs in low-shear areas in dilated
fibrillating atria. Such areas are visualised by &quot;spontaneous
echo contrast&quot; at echocardiography, which is associated
with increased risk of thromboembolic stroke as well as
increased circulating markers of haemostatic activation
[18]. Valvular thrombosis is favoured by high shear stresses
through the valve, followed by areas of flow separation;
while left ventricular mural thrombus occurs after myocardial
infarction on damaged endothelium in areas of reduced
contractility with flow separation [19].
Flow and Intracardiac Thromboembolism
Rheological factors may be important in pathogenesis of
atrial thrombosis, which occurs in low-shear areas in dilated
fibrillating atria. Such areas are visualised by &quot;spontaneous
echo contrast&quot; at echocardiography, which is associated
with increased risk of thromboembolic stroke as well as
increased circulating markers of haemostatic activation
[18]. Valvular thrombosis is favoured by high shear stresses
through the valve, followed by areas of flow separation;
while left ventricular mural thrombus occurs after myocardial
infarction on damaged endothelium in areas of reduced
contractility with flow separation [19].
Female sex is an independent predictor of stroke in patients
with AF.379–383 This has been incorporated into other risk stratification
tools used in the decision making for anticoagulation
prophylaxis.380
The CHA2DS2-VASc score can be considered an extension
of the CHADS2 with extra points added for female sex
(1 point), previous MI, peripheral arterial disease or aortic
plaque (1 point), and age 65 to 74 years (1 point) or ≥75 years (2
points). The American College of Cardiology/AHA/European
Society of Cardiology guidelines included similar risk stratification
strategies as CHADS2, with the inclusion of left ventricular
ejection fraction &lt;35% in the high-risk category. The
CHA2DS2-VASc score has been recommended recently by the
European Society of Cardiology for risk classification.368,384–387