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Spontaneous Intraventricular Hemorrhage: When Should Intraventricular tPA Be Considered?
Semin Respir Crit Care Med 2017; 38: 745-759 DOI: 10.1055/s-0037-1607991Spontaneous intracerebral hemorrhage (ICH) is the most common cause of intraventricular hemorrhage (IVH) in adults. Complicating approximately 40% of ICH cases, IVH adds to the morbidity and mortality of this often fatal form of stroke. It is also a severity factor that complicates subarachnoid hemorrhage and traumatic brain injury, along with other less common causes of intracranial bleeding. Medical and surgical interventions to date have focused on limiting ICH and IVH expansion, controlling intracranial pressure, and relieving obstructive hydroceph...
Source: Seminars in Respiratory and Critical Care Medicine - December 20, 2017 Category: Respiratory Medicine Authors: Abdelmalik, Peter A. Ziai, Wendy C. Tags: Review Article Source Type: research

Reversal of Direct Oral Anticoagulants: Current Status and Future Directions
Semin Respir Crit Care Med 2017; 38: 040-050 DOI: 10.1055/s-0036-1597831Direct oral anticoagulants (DOACs) are increasingly used for prevention and treatment of venous thromboembolism and for prevention of stroke in patients with nonvalvular atrial fibrillation. In phase III clinical trials that included more than 100,000 patients, the DOACs were at least as effective as vitamin K antagonists (VKAs) and were associated with less serious bleeding, particularly less intracranial bleeding. Real-world evidence supports these outcomes. Despite this, some physicians and patients are concerned about serious bleeding or emergencie...
Source: Seminars in Respiratory and Critical Care Medicine - February 15, 2017 Category: Respiratory Medicine Authors: Weitz, Jeffrey I. Tags: Review Article Source Type: research

Massive Pulmonary Embolism: Extracorporeal Membrane Oxygenation and Surgical Pulmonary Embolectomy
Semin Respir Crit Care Med 2017; 38: 066-072 DOI: 10.1055/s-0036-1597559Massive pulmonary embolism (PE) refers to large emboli that cause hemodynamic instability, right ventricular failure, and circulatory collapse. According to the 2016 ACCP Antithrombotic Guidelines, therapy for massive PE should include systemic thrombolytic therapy in conjunction with anticoagulation and supportive care. However, in patients with a contraindication to systemic thrombolytics or in those who fail the above interventions, extracorporeal membrane oxygenation (ECMO) and/or surgical embolectomy may be used to improve oxygenation, achieve hem...
Source: Seminars in Respiratory and Critical Care Medicine - February 15, 2017 Category: Respiratory Medicine Authors: Weinberg, Aaron Tapson, Victor F. Ramzy, Danny Tags: Review Article Source Type: research