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Risk stratification in Pulmonary Embolism and Duration of Anticoagulation

Risk stratification in Pulmonary Embolism and Duration of Anticoagulation. Respiratory CONNECT meeting Dr Julius Cairn. Risk stratification in PE. Clinical parameters – shock, JVP, S3 Imaging – CTPA, echo Biomarkers – Troponin , BNP High mortality risk > 15%

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Risk stratification in Pulmonary Embolism and Duration of Anticoagulation

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  1. Risk stratification in Pulmonary Embolism and Duration of Anticoagulation Respiratory CONNECT meeting Dr Julius Cairn

  2. Risk stratification in PE • Clinical parameters – shock, JVP, S3 • Imaging – CTPA, echo • Biomarkers – Troponin, BNP • High mortality risk > 15% • - shock, RV dysfunction, positive biomarkers – thrombolyse • Intermediate risk 3-15% • RV dysfunction and positive biomarkers – iv heparin • Low risk <1% mortality • Early discharge • Above knee DVT – high risk for post-thrombotic syndrome and for PE • Risk stratification should improve outcome and reduce length of stay

  3. Duration of anticoagulation • Number of studies show no benefit of 6 months over 3 months, also ACCP recommendation • Risk of recurrence returns after stopping • 0.7% per year VTE provoked by surgery • 3% per year for all patients • 7.4% per year for unprovoked event • In order to justify lifelong anticoagulation 5% or greater risk • Consider lifelong anticoagulation in idiopathic PE

  4. Improving outcomes from Community Acquired Pneumonia (CAP) Respiratory CONNECT meeting Dr Julius Cairn

  5. Late mortality from CAP • Leading cause of death from infectious disease in western countries – mortality rate 5-15% • On-going risk of mortality in months/years afterwards • >25% of deaths within 30 days are not directly related • Nearly 50% deaths overall related to comorbidties • Evidence of link between acute respiratory infections and increased risk of cardiovascular events • Incidence after CAP : 15 days – 10.7%, 90days 13%, 1 year 33% • Prior statin or ACEi treatment • Influenza/ Pneumococcal vaccination • Further define if cause of CV events and pathogenesis

  6. How differences in medical management of CAP might influence outcome • Menendes et al multicentre trial of 4,137 pts • Adherence to antibiotic guidelines • Shorter length of stay in patients without organ failure • Delivery of the first dose of antibiotic within 6 hours of presentation • Mortality better in the severe sepsis patients • Measurement of oxygenation at presentation • Doesn’t distinguish between preventable/inevitable mortality BUT medical management influence outcome • Challenge – identify bundles of practice that give best outcomes

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