Next up for #CHEST2021 is "Controversies for Diagnosis and Management of Acute Pulmonary Embolism"! 1/
Dr. Bhavin Dalal (@Bhavinddalal) will speak on "Patient with intermediate risk PE should go for thrombolysis: True/False". #CHEST2021 2/
Risk stratification of PEs #CHEST2021 3/
The PEITHO trial looks at submissive PEs and Heparin alone or with TPA. No difference in mortality, but a higher risk of bleeding with TPA, #CHEST2021 4/
The meta-analysis does not support the use of TPA in general. #CHEST2021 5/
A higher sPESI at 48 hours is associated with higher mortality. #CHEST2021 6/
Thrombolysis should be considered for patients with PTE who deteriorate. #CHEST2021 7/
This meta-analysis showed a benefit of thrombolysis in intermediate risk PE, but a NNT of 59. #CHEST2021 8/
The Fasullo trial was the only one in the meta-analysis that has significant findings, and their study had a higher mortality rate. #CHEST2021 9/
Patients with proximal DVTs have higher mortality rates. #CHEST2021 10/
Patient selection is key. #CHEST2021 11/
These are the 5 Ds to consider in patient selection for thrombolysis. #CHEST2021 12/
Dr. Parth Rali (@ParthRali) will speak on "Patients with intermediate or high-risk PE should go for catheter-directed therapies: True/False". #CHEST2021 13/
PE classifications #CHEST2021 14/
ESC PE classification breaks down the intermediate-risk PEs in to low- and high-risk. #CHEST2021 15/
Prevalence of submassive PEs #CHEST2021 16/
Submassive PE mortality #CHEST2021 17/
Current risk stratification tools are not ideal. #CHEST2021 18/
Additional risk stratification markers #CHEST2021 19/
There are several available catheter-directed therapies including suction thrombectomies, ultrasound-accelerated thrombolysis (EKOS), and catheter-directed pharmaco-mechanical thrombolysis. #CHEST2021 20/
Logistical and practical questions for catheter-directed therapies #CHEST2021 21/
What are your goals and expectations for catheter-directed therapies? #CHEST2021 22/
Conclusions #CHEST2021 23/
Dr. Victor Test (@redraiderpulmcc) will talk on "Patients with high-risk PE should undergo IVC filter: True/False". (Slide issue for beginning of this presentation but I caught what I could type.) #CHEST2021 24/
There is a mortality benefit to filters in patients who are unstable. #CHEST2021 25/
Lower OR of death from PE with IVF filter placement. #CHEST2021 26/
This study showed a lower risk of PE-related death with IVC filter. #CHEST2021 27/
Filter placement in the first 48 hours with an unstable PE had a decreased mortality. #CHEST2021 28/
The best treatment is prevention. Let's focus on preventing rather than responding to the life-threatening embolism. 29/
Dr. Vijay Balasubramanian will talk on "Patients presented with syncope should undergo CTPA protocol: True/False". #CHEST2021 30/
VTE-PE Epidemiology. Rates are increasing, but mortality is decreasing. #CHEST2021 31/
CTA is the gold standard for PE diagnosis. #CHEST2021 32/
Fatal pulmonary embolisms are often a missed diagnosis. #CHEST2021 33/
This study illustrated the overuse of CTPE. #CHEST2021 34/
Syncope definition and causes #CHEST2021 35/
Causes of syncope #CHEST2021 36/
How common is PE as the cause for syncope? #CHEST2021 37/
How common is syncope as a manifestation of PE? #CHEST2021 38/
Pathomechanisms of syncope in PE #CHEST2021 39/
Cardiac syncope is associated with a lower survival. #CHEST2021 40/
This study found a large prevalence of PE in patients with syncope. #CHEST2021 41/
This study also evaluated the prevalence of PE but only found it in 1.4% of patients with syncope. #CHEST2021 42/
How do we reconcile these different findings? #CHEST2021 43/
This article concluded that the reality probably lies somewhere in between. #CHEST2021 44/
So does everyone with syncope need a CTPA? Only if other factors raise their pre-test probability. #CHEST2021 45/45
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