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The diagnostic yield for computed tomography pulmonary angiography in patients with anticoagulation

World Journal of Emergency Medicine 2024年第4期15卷 251-255页

作者： Payush Chatta brian diep.jakrin kewcharoen Daniel Rossie Cory Toomasian Purvi Parwani Dmitry Abramov Department of Medicine Division of CardiologyLoma Linda University Medical CenterLoma LindaCA 92374USA Department of Medicine Loma Linda University Medical CenterLoma LindaCA 92374USA Department of Emergency Medicine Loma Linda University Medical CenterLoma LindaCA 92374USA

BACKGROUND:Patients who present to the emergency department(ED)for suspected pulmonary embolism(PE)are often on active oral anticoagulation(AC).However,the diagnostic yield of computed tomography pulmonary angiography(CTPA)in screening for PE in patients who present on AC has not been well *** aim to investigate the diagnostic yield of CTPA in diagnosing PE depending on AC ***:We reviewed and analyzed the electronic medical records of patients who underwent CTPA for PE at a university hospital ED from June 1,2019,to March 25,*** outcome was the incidence of PE on CTPA depending on baseline AC status and indication for ***:Of 2,846 patients,242 were on AC for a history of venous thromboembolism(VTE),210 were on AC for other indications,and 2,394 were not on *** incidence of PE on CTPA was significantly lower in patients on AC for other indications(5.7%)when compared to patients on AC for prior VTE(24.3%)and patients not on AC at presentation(9.8%)(P<0.001).In multivariable analysis among the whole cohort,AC was associated with a positive CTPA(odds ratio[OR]0.26,95%confidence interval[CI]:0.15-0.45,P<0.001).CONCLUSION:The incidence of PE among patients undergoing CTPA in the ED is lower in patients previously on AC for indications other than VTE when compared to those not on AC or those on AC for history of *** status and indication for AC may affect pre-test probability of a positive CTPA,and AC status therefore warrants consideration as part of future diagnostic algorithms among patients with suspected PE.

关键词： Pulmonary embolism Computed tomography pulmonary angiography Emergency department Anticoagulation

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Association of frailty with all-cause mortality and bleeding among elderly patients with acute myocardial infarction: a systematic review and meta-analysis

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Journal of Geriatric Cardiology 2020年第5期17卷 270-278,I0005页

作者： Prapaipan Putthapiban Wasawat Vutthikraivit Pattara Rattanawong Weera Sukhumthammarat Napatt Kanjanahattakij jakrin kewcharoen Aman Amanullah Department of Internal Medicine Einstein Medical CenterPhiladelphiaPAUSA Department of Internal Medicine Texas Tech University Health Sciences CenterLubbockTxUSA University of Hawaii Internal Medicine Residency Program HonoluluHIUSA Institute of Heart and Vascular Health Einstein Medical CenterPhiladelphiaPAUSA

Background Frailty is a multidimensional syndrome that reflects the physiological reserve of *** is related to unfavorable outcomes in various cardiovascular *** conducted a systematic review and meta-analysis of the association of frailty with all-cause mortality and bleeding after acute myocardial infarction(AMI)in the *** We comprehensively searched the databases of MEDLINE and EMBASE from inception to March *** studies that reported mortality and bleeding in AMI patients who were evaluated and classified by frailty status were *** from each study were combined using the random-effects,generic inverse variance method of Der Simonian and Laird to calculate hazard ratio(HR),and 95%confidence interval(CI).Results Twenty-one studies from 2011 to 2019 were included in this meta-analysis involving 143,301 subjects(mean age 75.33-year-old,60.0%male).Frailty status was evaluated using different methods such as Fried Frailty *** was statistically associated with increased early mortality in nine studies(pooled HR=2.07,95%CI:1.67-2.56,P<0.001,I^2=41.2%)and late mortality in 11 studies(pooled HR=2.30,95%CI:1.70-3.11,P<0.001,I^2=65.8%).Moreover,frailty was also statistically associated with higher bleeding in 7 studies(pooled HR=1.34,95%CI:1.12-1.59,P<0.001,I^2=4.7%).Conclusion Frailty is strongly and independently associated with bleeding,early and late mortality in elderly with *** assessment should be considered as an additional risk factor and used to guide toward personalized treatment strategies.

关键词： Acute myocardial infarction Bleeding Frailty Mortality

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