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“BackgroundThrombolysis, though very effective, has not been embraced as routine therapy for symptomatic pulmonary embolism (PE) except in very severe cases. Rivaroxaban recently has been
approved for the treatment of venous thromboembolism (VTE). There are no data on the combined use of thrombolysis and rivaroxaban in PE.
HypothesisSafe dose thrombolysis (SDT) plus new oral anticoagulants Torin 2 clinical trial are expected to become an appealing, safe and effective approach in the treatment of moderate and severe PE in the near future, thereby drastically reducing hospitalization time.
MethodsOver a 12-month period, 98 consecutive patients with symptomatic PE were treated by a combination of SDT and rivaroxaban. The SDT was started in parallel with unfractionated heparin and given in 2 hours. Heparin was given for a total of 24 hours and rivaroxaban started at 15 or 20 mg daily 2 hours after termination of heparin infusion.
ResultsThere Selleckchem AZD5153 was no bleeding due to SDT. Recurrent VTE occurred in 3 patients who had been switched to warfarin. No patient on rivaroxaban developed VTE. Two patients died
of cancer at a mean follow-up of 12 2 months. The pulmonary artery systolic pressure dropped from 52.8 +/- 3.9 mm Hg before to 32 +/- 4.4 mm Hg within 36 hours of SDT (P < 0.001). The duration of hospitalization for patients presenting primarily for PE was 1.9 +/- 0.2 days.
Conclusions<p id=”"clc22216-para-0005″”>Safe GSK923295 dose thrombolysis plus rivaroxaban is highly safe and effective in the treatment of moderate and severe PE, leading to favorable early and intermediate-term outcomes and early discharge.”
“Purpose of review
We describe commonly used measures of knee pain
in longitudinal studies and review various analytic approaches to evaluating the effect of a risk factor on each type of pain measure.
Recent findings
In longitudinal epidemiologic studies of knee pain, frequent knee pain and activity-related pain severity are the most commonly used measures for pain. Various analytic approaches have been used to evaluate the effect of a risk factor on each type of pain measure. Analytic approaches utilized include the generalized estimating equations model and the mixed-effects linear regression model for pain severity assessed as a continuous outcome variable, the mixed-effects logistic regression model and conditional logistic regression model for pain exacerbation measured as a dichotomous outcome variable, and a mixed-effects regression model, stratified proportional odds model, and a multistate transition model for pain severity measured as an ordinal outcome variable.
Summary
Compared with cross-sectional studies, longitudinal studies allow investigators to assess the effect of change in a risk factor of interest on change in risk of knee pain or change in pain severity.