Clinical assessment of the leg for a suspected deep vein thrombosis
What To Know About Pulmonary Embolism?
A pulmonary embolism is a blockage in the pulmonary artery that supplies blood to the lungs. The blockage, usually caused by a blood clot, impairs oxygenation of the blood and can damage the heart. This means it can be life threatening.
The word "embolism" comes from the Greek émbolos, meaning "stopper" or "plug."
In a pulmonary embolism, the embolus forms in one part of the body and circulates throughout the blood supply. It then blocks the blood flowing through a vessel in another part of the body, namely the lungs. Blood clots often develop in the leg, which is called deep vein thrombosis (DVT).
This article lists the symptoms of pulmonary embolism and outlines its diagnosis and treatment options.
Although the exact number of those affected by pulmonary embolism or DVT is unknown, it may affect as many as 900,000 people in the United States each year.
The National Heart, Lung, and Blood Institute notes that a person may not experience any symptoms of a pulmonary embolism. Others may experience symptoms that develop within seconds to minutes or over days to weeks. The symptoms can also start mild and become more severe.
Common symptoms include:
Less common symptoms include:
Severe symptoms call for immediate emergency medical assistance. More severe cases may result in shock, loss of consciousness, cardiac arrest, and death.
Treatments for a pulmonary embolism aim to:
The main treatment option for pulmonary embolism is anticoagulation.
A doctor will prescribe anticoagulants or blood-thinning medications, such as warfarin, heparin, or direct oral anticoagulants, to stop blood clots from getting bigger and prevent new clots from forming.
They may administer an anticoagulant as soon as they suspect a pulmonary embolism before they have made a definitive diagnosis.
A person will then need to take anticoagulants for approximately 3 months or longer.
For large blood clots causing severe symptoms or complications, a doctor may prescribe an intravenous thrombolytic. However, these carry a high risk of excessive bleeding. Thrombolytics include Activase, Retavase, and Eminase.
In emergencies, a person may require surgery, such as catheter-assisted blood clot removal. A catheter-assisted blood clot removal requires a surgeon inserting a flexible tube to reach the blood clot in the lung. They can then insert a tool to break up the clot or administer medication.
A pulmonary embolism occurs when an embolus, usually a blood clot, blocks the blood flowing through an artery that feeds the lungs.
A blood clot may start in an arm or leg, known as deep vein thrombosis (DVT).
After that, it breaks free and travels through the circulatory system toward the lungs. When the embolus is too large to pass through the small vessels, it forms a blockage.
This blockage stops blood from flowing into a part of the lung. This causes the affected section of the lung to die through lack of oxygen. The blood clot can also cause pressure to build in the right side of the heart, eventually causing heart failure.
Rarely, a pulmonary embolism can result from an embolus that is formed from fat droplets, amniotic fluid, or some other particle that enters the bloodstream.
The risk factors for developing a pulmonary embolism can be genetic or acquired.
Some acquired risk factors include:
To reduce the risk of developing a blood clot or pulmonary embolism, a person can:
A person undergoing surgery should discuss a plan to prevent blood clots with a healthcare professional. They will also advise on how to prevent blood clots during the recovery period.
Those with a high risk of developing pulmonary embolism may require anticoagulant medications.
To reach a diagnosis, the doctor will look at the person's history and consider whether they are likely to have an embolism. They will carry out a physical examination. Doctors may find it challenging to make a diagnosis because other conditions have similar symptoms.
The doctor may perform the following tests:
A doctor may also perform other imaging tests so they can look at the veins and the function of the heart and lungs.
With effective and timely treatment, most people who experience a pulmonary embolism can make a full recovery. However, the condition can carry a high risk of fatality without timely intervention.
A person's outlook can also be affected depending on the underlying condition that caused the blood clot or pulmonary embolism.
A pulmonary embolism is a blockage in the pulmonary artery. The pulmonary artery supplies blood to the lungs. The blockage, which usually occurs due to a blood clot, prevents the oxygen from reaching the lungs.
Anyone experiencing symptoms of a pulmonary embolism should seek urgent medical help. This is because timely treatment and diagnosis can improve a person's outlook. Common symptoms include shortness of breath, rapid breathing, high heart rate, and pain when breathing deeply.
Treatment often involves anticoagulant medications. In severe cases, surgery may be necessary.
APEX-AV Trial Shows Positive Results For Catheter-directed Thrombectomy In Acute Pulmonary Embolism
New data from the Acute Pulmonary Embolism Extraction Trial with the AlphaVac System (APEX-AX) demonstrated that catheter-directed mechanical thrombectomy is safe and effective in patients with acute intermediate-risk pulmonary embolism (PE) with significant improvement in the right ventricle (RV) function and minimal major adverse events. The safety and efficacy results from the prospective trial were presented today as late-breaking science at the Society for Cardiovascular Angiography & Interventions (SCAI) 2024 Scientific Sessions.
Pulmonary embolism (PE), a blood clot that blocks and stops blood flow to an artery in the lung, is common and often life-threatening. PE represents the third-leading cause of cardiovascular mortality with 100,000 to 180,000 deaths per year. Catheter-directed therapies continue to evolve to address the large population of acute PE patients.
The APEX-AV trial is a prospective, single-arm, multicenter investigational device exemption trial in which patients with acute intermediate-risk PE were treated with the AlphaVac F1885 aspiration system. The primary efficacy endpoint was a change in the right ventricle-to-left ventricle (RV/LV) ratio from baseline to 48 hours post-procedure on core lab–adjudicated computed tomography angiography. The primary safety endpoint was a composite of 48 hours post-procedure major adverse events: device-related death, major bleeding, and device-related serious adverse events.
Among the 122 patients treated at 25 U.S. Sites, the average reduction in the RV/LV ratio was 0.45 with a 35.5% mean percentage reduction in the overall clot burden from the baseline at 48 hours post-procedure. Five patients had major adverse events within the 48-hour visit and no death was reported. Lastly, procedural times were short with a mean procedural time of 37.2 ± 17.7 minutes.
Pulmonary emboli can be extremely dangerous and require effective and prompt action. Catheter-directed mechanical thrombectomy using a new aspiration system can achieve excellent thrombus removal with a wonderful safety profile, thus enabling more tools in our armamentarium for the treatment of acute PE."
William Brent Keeling, MD, Associate Professor at the Emory School of Medicine, and lead author of the study
Session details:
Women And Black Patients Less Likely To Receive Catheter-based Treatment For Pulmonary Embolism
New data from the REAL-PE analysis investigated catheter-based pulmonary embolism (PE) treatment, showing women and Black people were less frequently treated with minimally invasive therapy compared to men or non-Black patients. The late-breaking results were presented today at the Society for Cardiovascular Angiography & Interventions (SCAI) 2024 Scientific Sessions.
PE is often caused by blood clots in the legs, otherwise known as deep vein thrombosis, that travel through the veins and into the lungs. PE affects around 900,000 people in the U.S. Each year, with 10–30% dying within one month of diagnosis. Ultrasound-assisted catheter-directed thrombolysis (USCDT), a common invasive treatment option for PE, enables deeper penetration of the clot-busting medication into the clot, restoring normal blood flow faster.
Mechanical thrombectomy (MT), another invasive treatment method has been shown to reduce thrombus burden and pulmonary artery pressure (PAP) and to improve right ventricular (RV) function in patients with high-risk or intermediate-high-risk PE.
REAL-PE analyzed data from patients within the Truveta database diagnosed with PE and treated with USCDT or MT for PE. Patient characteristics including race, ethnicity, age, sex, comorbidities, and prior diagnoses were assessed to investigate their association with the type of treatment used.
Of the more than 430,000 patients diagnosed with PE, about 2,000 patients analyzed were treated with one of the invasive therapies. Women or Black patients were less frequently treated with invasive therapy than men or non-Black patients. Moreover, women more than men and Black people more than white people had higher bleeding rates.
"Although this data demonstrates the value of real-world data in the assessments of new technologies in which randomized data are not always available, there is still work that needs to be done to evaluate the current utilization of advanced therapies for PE in underrepresented patient populations," said Sahil A. Parikh, MD, Associate Professor of Medicine, Columbia University Irving Medical Center, and lead author of the study.
"Evaluating care disparities in real clinical practices is key to addressing the existing barrier and improving patient outcomes."
More information: "Disparities in Pulmonary Embolism Care: Insights from Big Data Analytics," Friday, May 3, 2024; 2:02-2:09 PM PT, Long Beach Convention Center, 104A, First Level
Citation: Women and Black patients less likely to receive catheter-based treatment for pulmonary embolism (2024, May 3) retrieved 6 May 2024 from https://medicalxpress.Com/news/2024-05-women-black-patients-catheter-based.Html
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