Intermediate-High Risk Pulmonary Embolism: The Use of Riociguat and Inferior Vena Cava Filter in a Situation of Recurrent Embolism following Insufficient Anticoagulation and Fibrinolytic Therapy
Pulmonary embolism (PE) is associated with serious morbidity and mortality. In this case report, we describe a hemodynamically stable patient with submassive PE and a large thrombus in the inferior vena cava (IVC) protruding into the right atrium (RA), complicated by severe respiratory failure, elev...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Case Reports in Anesthesiology |
| Online Access: | http://dx.doi.org/10.1155/2020/4219616 |
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| author | Anh Khoi Vo Håkon Reikvam Helga Midtbø Jan Ludvig Wirsching Øyvind Bruserud Øystein Wendelbo |
| author_facet | Anh Khoi Vo Håkon Reikvam Helga Midtbø Jan Ludvig Wirsching Øyvind Bruserud Øystein Wendelbo |
| author_sort | Anh Khoi Vo |
| collection | DOAJ |
| description | Pulmonary embolism (PE) is associated with serious morbidity and mortality. In this case report, we describe a hemodynamically stable patient with submassive PE and a large thrombus in the inferior vena cava (IVC) protruding into the right atrium (RA), complicated by severe respiratory failure, elevated troponin T (TnT), and right ventricular (RV) dysfunction. The patient was stratified as intermediate-high risk of early death. Important issues regarding the initial choice of anticoagulation, rescue thrombolytic therapy, and benefits of adding riociguat to stimulate the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate (NO-sGC-cGMP) pathway to improve the RV function are discussed. Finally, we address appropriate timing and the use of IVC filter in a situation of recurrent PE following anticoagulation and fibrinolytic therapy. |
| format | Article |
| id | doaj-art-c1816d33b7cc428fa63376927a5fdbe7 |
| institution | Kabale University |
| issn | 2090-6382 2090-6390 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Anesthesiology |
| spelling | doaj-art-c1816d33b7cc428fa63376927a5fdbe72025-02-03T01:28:08ZengWileyCase Reports in Anesthesiology2090-63822090-63902020-01-01202010.1155/2020/42196164219616Intermediate-High Risk Pulmonary Embolism: The Use of Riociguat and Inferior Vena Cava Filter in a Situation of Recurrent Embolism following Insufficient Anticoagulation and Fibrinolytic TherapyAnh Khoi Vo0Håkon Reikvam1Helga Midtbø2Jan Ludvig Wirsching3Øyvind Bruserud4Øystein Wendelbo5Department of Medicine, Haukeland University Hospital, Bergen, NorwayDepartment of Medicine, Haukeland University Hospital, Bergen, NorwayDepartment of Heart Disease, Haukeland University Hospital, Bergen, NorwayDepartment of Radiology, Haukeland University Hospital, Bergen, NorwayDepartment of Anaesthesiology and Intensive Care, Haukeland University Hospital, Bergen, NorwayDepartment of Heart Disease, Haukeland University Hospital, Bergen, NorwayPulmonary embolism (PE) is associated with serious morbidity and mortality. In this case report, we describe a hemodynamically stable patient with submassive PE and a large thrombus in the inferior vena cava (IVC) protruding into the right atrium (RA), complicated by severe respiratory failure, elevated troponin T (TnT), and right ventricular (RV) dysfunction. The patient was stratified as intermediate-high risk of early death. Important issues regarding the initial choice of anticoagulation, rescue thrombolytic therapy, and benefits of adding riociguat to stimulate the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate (NO-sGC-cGMP) pathway to improve the RV function are discussed. Finally, we address appropriate timing and the use of IVC filter in a situation of recurrent PE following anticoagulation and fibrinolytic therapy.http://dx.doi.org/10.1155/2020/4219616 |
| spellingShingle | Anh Khoi Vo Håkon Reikvam Helga Midtbø Jan Ludvig Wirsching Øyvind Bruserud Øystein Wendelbo Intermediate-High Risk Pulmonary Embolism: The Use of Riociguat and Inferior Vena Cava Filter in a Situation of Recurrent Embolism following Insufficient Anticoagulation and Fibrinolytic Therapy Case Reports in Anesthesiology |
| title | Intermediate-High Risk Pulmonary Embolism: The Use of Riociguat and Inferior Vena Cava Filter in a Situation of Recurrent Embolism following Insufficient Anticoagulation and Fibrinolytic Therapy |
| title_full | Intermediate-High Risk Pulmonary Embolism: The Use of Riociguat and Inferior Vena Cava Filter in a Situation of Recurrent Embolism following Insufficient Anticoagulation and Fibrinolytic Therapy |
| title_fullStr | Intermediate-High Risk Pulmonary Embolism: The Use of Riociguat and Inferior Vena Cava Filter in a Situation of Recurrent Embolism following Insufficient Anticoagulation and Fibrinolytic Therapy |
| title_full_unstemmed | Intermediate-High Risk Pulmonary Embolism: The Use of Riociguat and Inferior Vena Cava Filter in a Situation of Recurrent Embolism following Insufficient Anticoagulation and Fibrinolytic Therapy |
| title_short | Intermediate-High Risk Pulmonary Embolism: The Use of Riociguat and Inferior Vena Cava Filter in a Situation of Recurrent Embolism following Insufficient Anticoagulation and Fibrinolytic Therapy |
| title_sort | intermediate high risk pulmonary embolism the use of riociguat and inferior vena cava filter in a situation of recurrent embolism following insufficient anticoagulation and fibrinolytic therapy |
| url | http://dx.doi.org/10.1155/2020/4219616 |
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