Recent Advances in Pulmonary Embolism and Thrombosis

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (20 April 2024) | Viewed by 8051

Special Issue Editors


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Guest Editor
Ospedale di Bentivoglio, Via Marconi, 35, 40010 Bentivoglio, BO, Italy
Interests: critical care medicine; intensive care medicine; emergency treatment; embolism and thrombosis

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Guest Editor
Department of Internal Medicine, Ospedale Maggiore "Carlo Alberto Pizzardi", L.go Bartolo Nigrisoli, 2, 40133 Bologna, BO, Italy
Interests: hemostasis and thrombosis

Special Issue Information

Dear Colleagues,

Pulmonary embolism (PE) and thrombosis are serious conditions that involve the formation of blood clots in the lungs or other parts of the body. Anticoagulant therapy remains the mainstay of treatment for PE and thrombosis. In cases where anticoagulation alone is insufficient or contraindicated, interventional procedures, such as catheter-directed thrombolysis or surgical embolectomy, may be considered. These procedures aim to remove or dissolve clots, restoring blood flow and preventing further complications.

Despite the advances in the diagnosis and treatment of pulmonary embolism and thrombosis that have been made over recent years, challenges remain in the management of PE and thrombosis. These include prevention, treatment, and management for patients with pulmonary embolism and thrombosis; continued research and innovation in this field will further enhance our understanding and management of these conditions, ultimately leading to better outcomes for patients. This Special Issue aims to report the latest research on pulmonary embolism and thrombosis. We would like to cordially invite you to submit your manuscripts for review and publication in the Journal of Clinical Medicine, to improve clinical outcomes as well as ensure optimal short- and long-term management.

Dr. Andrea Boccatonda
Dr. Mauro Silingardi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Keywords

  • pulmonary embolism
  • embolism and thrombosis
  • thrombus aspiration for pulmonary embolism
  • deep vein throm-bosis
  • venous thromboembolism

Published Papers (4 papers)

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Research

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12 pages, 852 KiB  
Article
De Ritis Ratio to Predict Clinical Outcomes of Intermediate- and High-Risk Pulmonary Embolisms
by Koray Durak, Katharina Nubbemeyer, Rashad Zayat, Jan Spillner, Slavena Dineva, Sebastian Kalverkamp and Alexander Kersten
J. Clin. Med. 2024, 13(7), 2104; https://doi.org/10.3390/jcm13072104 - 4 Apr 2024
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Abstract
Background: Abnormal liver function tests can identify severe cardiopulmonary failure. The aspartate transaminase/alanine transaminase (AST/ALT) ratio, or the De Ritis ratio, is commonly used to evaluate acute liver damage. However, its prognostic value in pulmonary embolism (PE) is unknown. Methods: Two [...] Read more.
Background: Abnormal liver function tests can identify severe cardiopulmonary failure. The aspartate transaminase/alanine transaminase (AST/ALT) ratio, or the De Ritis ratio, is commonly used to evaluate acute liver damage. However, its prognostic value in pulmonary embolism (PE) is unknown. Methods: Two cohorts, including patients with intermediate- and high-risk PEs, were established: one with an abnormal baseline AST/ALT ratio (>1) and another with a normal baseline AST/ALT ratio (<1). The primary outcome was a 60-day mortality. Secondary outcomes included peak N-terminal pro-brain-natriuretic-peptide (NT-proBNP) levels, complications, and the need for critical care treatment. To assess the effect of abnormal AST/ALT ratios, inverse probability weighted (IPW) analyses were performed. Results: In total, 230 patients were included in the analysis, and 52 (23%) had an abnormal AST/ALT ratio. After the IPW correction, patients with an abnormal AST/ALT ratio had a significantly higher mortality rate and peak NT-proBNP levels. The relative risks of 60-day mortality, shock development, use of inotropes/vasopressors, mechanical ventilation, and extracorporeal life support were 9.2 (95% confidence interval: 3.3–25.3), 10.1 (4.3–24), 2.7 (1.4–5.2), 2.3 (1.4–3.7), and 5.7 (1.4–23.1), respectively. Conclusions: The baseline AST/ALT ratio can be a predictor of shock, multiorgan failure, and mortality in patients with a pulmonary embolism. Full article
(This article belongs to the Special Issue Recent Advances in Pulmonary Embolism and Thrombosis)
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24 pages, 2826 KiB  
Article
Enhancing Pulmonary Embolism Mortality Risk Stratification Using Machine Learning: The Role of the Neutrophil-to-Lymphocyte Ratio
by Minodora Teodoru, Mihai Octavian Negrea, Andreea Cozgarea, Dragoș Cozma and Adrian Boicean
J. Clin. Med. 2024, 13(5), 1191; https://doi.org/10.3390/jcm13051191 - 20 Feb 2024
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Abstract
(1) Background: Acute pulmonary embolism (PE) is a significant public health concern that requires efficient risk estimation to optimize patient care and resource allocation. The purpose of this retrospective study was to show the correlation of NLR (neutrophil-to-lymphocyte ratio) and PESI (pulmonary embolism [...] Read more.
(1) Background: Acute pulmonary embolism (PE) is a significant public health concern that requires efficient risk estimation to optimize patient care and resource allocation. The purpose of this retrospective study was to show the correlation of NLR (neutrophil-to-lymphocyte ratio) and PESI (pulmonary embolism severity index)/sPESI (simplified PESI) in determining the risk of in-hospital mortality in patients with pulmonary thromboembolism. (2) Methods: A total of 160 patients admitted at the County Clinical Emergency Hospital of Sibiu from 2019 to 2022 were included and their hospital records were analyzed. (3) Results: Elevated NLR values were significantly correlated with increased in-hospital mortality. Furthermore, elevated NLR was associated with PESI and sPESI scores and their categories, as well as the individual components of these parameters, namely increasing age, hypotension, hypoxemia, and altered mental status. We leveraged the advantages of machine learning algorithms to integrate elevated NLR into PE risk stratification. Utilizing two-step cluster analysis and CART (classification and regression trees), several distinct patient subgroups emerged with varying in-hospital mortality rates based on combinations of previously validated score categories or their defining elements and elevated NLR, WBC (white blood cell) count, or the presence COVID-19 infection. (4) Conclusion: The findings suggest that integrating these parameters in risk stratification can aid in improving predictive accuracy of estimating the in-hospital mortality of PE patients. Full article
(This article belongs to the Special Issue Recent Advances in Pulmonary Embolism and Thrombosis)
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Review

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22 pages, 1439 KiB  
Review
Cutting-Edge Techniques and Drugs for the Treatment of Pulmonary Embolism: Current Knowledge and Future Perspectives
by Lorenzo Falsetti, Emanuele Guerrieri, Vincenzo Zaccone, Giovanna Viticchi, Silvia Santini, Laura Giovenali, Graziana Lagonigro, Stella Carletti, Linda Elena Gialluca Palma, Nicola Tarquinio and Gianluca Moroncini
J. Clin. Med. 2024, 13(7), 1952; https://doi.org/10.3390/jcm13071952 - 28 Mar 2024
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Abstract
Pulmonary embolism (PE) is a potentially life-threatening condition requiring prompt diagnosis and treatment. Recent advances have led to the development of newer techniques and drugs aimed at improving PE management, reducing its associated morbidity and mortality and the complications related to anticoagulation. This [...] Read more.
Pulmonary embolism (PE) is a potentially life-threatening condition requiring prompt diagnosis and treatment. Recent advances have led to the development of newer techniques and drugs aimed at improving PE management, reducing its associated morbidity and mortality and the complications related to anticoagulation. This review provides an overview of the current knowledge and future perspectives on PE treatment. Anticoagulation represents the first-line treatment of hemodynamically stable PE, direct oral anticoagulants being a safe and effective alternative to traditional anticoagulation: these drugs have a rapid onset of action, predictable pharmacokinetics, and low bleeding risk. Systemic fibrinolysis is suggested in patients with cardiac arrest, refractory hypotension, or shock due to PE. With this narrative review, we aim to assess the state of the art of newer techniques and drugs that could radically improve PE management in the near future: (i) mechanical thrombectomy and pulmonary embolectomy are promising techniques reserved to patients with massive PE and contraindications or failure to systemic thrombolysis; (ii) catheter-directed thrombolysis is a minimally invasive approach that can be suggested for the treatment of massive or submassive PE, but the lack of large, randomized controlled trials represents a limitation to widespread use; (iii) novel pharmacological approaches, by agents inhibiting thrombin-activatable fibrinolysis inhibitor, factor Xia, and the complement cascade, are currently under investigation to improve PE-related outcomes in specific settings. Full article
(This article belongs to the Special Issue Recent Advances in Pulmonary Embolism and Thrombosis)
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25 pages, 1370 KiB  
Review
Portal Vein Thrombosis: State-of-the-Art Review
by Andrea Boccatonda, Simone Gentilini, Elisa Zanata, Chiara Simion, Carla Serra, Paolo Simioni, Fabio Piscaglia, Elena Campello and Walter Ageno
J. Clin. Med. 2024, 13(5), 1517; https://doi.org/10.3390/jcm13051517 - 6 Mar 2024
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Abstract
Background: Portal vein thrombosis (PVT) is a rare disease with an estimated incidence of 2 to 4 cases per 100,000 inhabitants. The most common predisposing conditions for PVT are chronic liver diseases (cirrhosis), primary or secondary hepatobiliary malignancy, major infectious or inflammatory abdominal [...] Read more.
Background: Portal vein thrombosis (PVT) is a rare disease with an estimated incidence of 2 to 4 cases per 100,000 inhabitants. The most common predisposing conditions for PVT are chronic liver diseases (cirrhosis), primary or secondary hepatobiliary malignancy, major infectious or inflammatory abdominal disease, or myeloproliferative disorders. Methods: PVT can be classified on the basis of the anatomical site, the degree of venous occlusion, and the timing and type of presentation. The main differential diagnosis of PVT, both acute and chronic, is malignant portal vein invasion, most frequently by hepatocarcinoma, or constriction (typically by pancreatic cancer or cholangiocarcinoma). Results: The management of PVT is based on anticoagulation and the treatment of predisposing conditions. The aim of anticoagulation in acute thrombosis is to prevent the extension of the clot and enable the recanalization of the vein to avoid the development of complications, such as intestinal infarction and portal hypertension. Conclusions: The treatment with anticoagulant therapy favors the reduction of portal hypertension, and this allows for a decrease in the risk of bleeding, especially in patients with esophageal varices. The anticoagulant treatment is generally recommended for at least three to six months. Prosecution of anticoagulation is advised until recanalization or lifelong if the patient has an underlying permanent pro-coagulant condition that cannot be corrected or if there is thrombosis extending to the mesenteric veins. Full article
(This article belongs to the Special Issue Recent Advances in Pulmonary Embolism and Thrombosis)
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