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Ted Post, M.D. Editor-in-Chief, UpToDate, Inc., Waltham, MA.
Apr 25, 2020 · Dr. Burton "Bud" Rose died April 24 due to complications from COVID-19. Rose was best known for creating UptoDate, one of the world's most widely used clinical reference tools. Rose was 77.
Dec 14, 2023 · Linezolid is a synthetic oxazolidinone with bacteriostatic activity against gram-positive organisms [ 1 ]. Tedizolid is a newer drug in the same class with comparable spectrum of activity but with limited US Food and Drug Administration-approved indications.
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Hemodynamically unstable PE (massive PE) is that which presents with hypotension; hypotension is defined as a systolic blood pressure (BP) <90 mmHg for a period >15 minutes, hypotension requiring vasopressors, or clear evidence of shock. Hemodynamically stable PE is defined as PE that does not meet the definition of hemodynamically unstable PE. The...
Empiric anticoagulation depending upon the clinical suspicion for PE, risk of bleeding, and expected timing of definitive diagnostic tests (see 'Empiric anticoagulation' below) For most patients who become hemodynamically stable following resuscitation and in whom the clinical suspicion for PE is high, we prefer immediate anticoagulation with unfra...
For patients with suspected PE who remain hemodynamically unstable and the clinical suspicion is low or moderate, the approach to empiric anticoagulation should be the same as for patients who are hemodynamically stable; empiric thrombolysis is not justified in this population. Low risk for bleeding Patients without risk factors for bleeding (tabl...
The decision to administer thrombolysis is strongly influenced by additional clinical factors. For example, while a patient with proven PE-induced shock who is unconscious requiring very high doses of pressors is a candidate for immediate intravenous thrombolytic therapy, a patient who has low blood pressure for 20 minutes but who is awake, alert, ...
Isoproterenol, amrinone, and milrinone have been investigated in animal models, but are not useful for hypotension due to acute PE [18,19]. Physiologic properties and use of vasopressors are discussed separately. (See \"Use of vasopressors and inotropes\".)
For most hemodynamically stable patients, we recommend against thrombolytic therapy (eg, low risk patients).
Initial anticoagulation (0 to 10 days) Initial anticoagulant therapy is administered as soon as possible in order to quickly achieve therapeutic anticoagulation. A detailed discussion of agent selection and patient selection for outpatient anticoagulation is presented separately. (See \"Venous thromboembolism: Initiation of anticoagulation (first ...
Long-term anticoagulation (10 days to three months) Long-term anticoagulant therapy is administered beyond the initial phase of anticoagulation for a finite period of typically three months (eg, transient VTE risk factors), or up to 6 or 12 months in some cases (eg, persisting risk factors, or unprovoked VTE). Agent selection and duration of long-...
No serious comorbid conditions (eg, ischemic heart disease, chronic lung disease, liver or renal failure, thrombocytopenia, or cancer) One open label, multicenter trial randomly assigned 344 patients with symptomatic PE and a low risk of death (PESI I/II; (table 6)) to receive either inpatient (intravenous heparin followed by warfarin) or outpatien...
Normal mental status with good understanding of risk and benefits, are not needle averse (if low molecular weight (LMW) heparin chosen), and have good home support (eg, do not live alone, have access to a telephone and physician, can return to the hospital quickly if there is clinical deterioration)
Additional findings that may support this decision include those in whom a false positive test is suspected, the absence of persistent risk factors, those with preserved baseline cardiorespiratory function, and/or those in whom a low pretest probability and normal D-dimer is present.
If the thrombus is in the renal vein (identified by the initial CT angiogram or during placement of the IVC filter), a suprarenal filter is appropriate. Rotational embolectomy A rotating device at the catheter tip can be used to fragment the thrombus, while fragmented clot is continuously aspirated [50-54]. In a series of 18 patients with shock du...
Because the catheter is large, the major disadvantage of rheolytic devices is that a venous cut-down (venotomy) is often required for insertion, which increases the risk of bleeding at the insertion site. In addition, the release of adenosine from disrupted platelets can lead to bradycardia, vasospasm, and hypoxia; similarly, red blood cell fragmen...
Dr. Ted Post, a nephrologist who joined UpToDate in 1996, was recently appointed Editor in Chief of UpToDate. Ted served most recently as Executive Editor, and previously as deputy editor and senior deputy editor of nephrology.
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