Non-thrombotic PE does not represent a distinct clinical syndrome. It may be due to a variety of embolic materials and result in a wide spectrum of clinical presentations, making the diagnosis difficult. With the exception of severe air and fat embolism, the haemodynamic consequences of non-thrombotic emboli are usually mild. Treatment is mostly supportive but may differ according to the type of embolic material and clinical severity.

/pdf/guidelines-on-the-diagnosis-and-management-of-acute-1usqw9xdub.pdf

Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)

Antithrombotic therapy for venous thromboembolic disease.

Heparin and Low-Molecular-Weight Heparin Mechanisms of Action, Pharmacokinetics, Dosing, Monitoring, Efficacy, and Safety

https://www.minapharm.com/_handler/DownloadHandler.ashx?n=369.pdf&f=Attach&fileName=112303.pdf

Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.

Following the invention of electron optics during the 1930s, lens aberrations have limited the achievable spatial resolution to about 50 times the wavelength of the imaging electrons. This situation is similar to that faced by Leeuwenhoek in the seventeenth century, whose work to improve the quality of glass lenses led directly to his discovery of the ubiquitous "animalcules" in canal water, the first hints of the cellular basis of life. The electron optical aberration problem was well understood from the start, but more than 60 years elapsed before a practical correction scheme for electron microscopy was demonstrated, and even then the remaining chromatic aberrations still limited the resolution. We report here the implementation of a computer-controlled aberration correction system in a scanning transmission electron microscope, which is less sensitive to chromatic aberration. Using this approach, we achieve an electron probe smaller than 1 A. This performance, about 20 times the electron wavelength at 120 keV energy, allows dynamic imaging of single atoms, clusters of a few atoms, and single atomic layer 'rafts' of atoms coexisting with Au islands on a carbon substrate. This technique should also allow atomic column imaging of semiconductors, for detection of single dopant atoms, using an electron beam with energy below the damage threshold for silicon.

Sub-ångstrom resolution using aberration corrected electron optics

Background—The immunological type of heparin-induced thrombocytopenia (HIT) is the most frequent drug-induced thrombocytopenia. This study evaluated the efficacy of recombinant hirudin (r-hirudin or lepirudin), a potent thrombin inhibitor, for anticoagulation in patients with confirmed HIT. Methods and Results—Eighty-two patients in this prospective, multicenter study received 1 of 4 intravenous r-hirudin regimens: A1, HIT patients with thrombosis (n=51), 0.4-mg/kg bolus and then 0.15 mg · kg−1 · h−1; A2, HIT patients with thrombosis receiving thrombolysis (n=5), 0.2-mg/kg bolus and then 0.1 mg · kg−1 · h−1; B, HIT patients without thrombosis (n=18), 0.1 mg · kg−1 · h−1; and C, during cardiopulmonary bypass surgery (n=8), 0.25-mg/kg bolus and then 5-mg boluses as needed. Response criteria were increase in platelet count by ≥30% to >109/L and activated partial thromboplastin time (aPTT) values 1.5 to 3.0 times baseline values achieved with a maximum of 2 dose increases. No placebo control was used for ethi...

Recombinant Hirudin (Lepirudin) Provides Safe and Effective Anticoagulation in Patients With Heparin-Induced Thrombocytopenia A Prospective Study

Es wird von 6 Patienten mit einer Heparin-induzierten Thrombozytopenie und koronarer Herzkrankheit oder Aortenklappenstenose berichtet, die erfolgreich am Herzen operiert werden konnten, wobei rekombinantes (r) Hirudin als spezifischer und Cofaktoren-unabhangiger Thrombininhibitor fur den kardiopulmonalen Bypass (CPB) verwendet wurde. Ein intravenoser r-Hirudin-Bolus von 0,25 mg/kg Korpergewicht und eine Dosis von 0,2 mg/kg Korpergewicht ins Priming der Herz-Lungen-Maschine erwiesen sich als ausreichend fur eine effektive Antikoagulation wahrend CPB. Zusatzliche r-Hirudin-Boli von 5 mg (Gesamtdosis: 0,1–0,8 mg/kg Korpergewicht) wurden verabreicht, sobald der r-Hirudin-Plasmaspiegel unter 2,5 μg/ml abfiel. Bei 3 Patienten wurden koronare Bypassoperationen, bei den anderen 3 Patienten jeweils ein Aortenklappenersatz durchgefuhrt. Zum Monitoring der Antikoagulation wurden die Ecarinzeit (ECT) und die aktivierte partielle Thromboplastinzeit (aPTT) in Abstanden von 10 min bestimmt. ECT und aPTT-Werte korrelierten zuverlassig mit dem r-Hirudin-Plasmaspiegel. Die Perfusionszeit lag zwischen 83 und 180 min, die Aortenklemmzeit zwischen 0 und 83 min. Wahrend der Operation gab es keine Blutungs- oder thromboembolischen Komplikationen und der Einlasdruck am Oxygenator blieb konstant. Infolge der normalen Nierenfunktion kam es bei allen Patienten nach Ende des CPB zum zugigen Abfall des r-Hirudin-Plasmaspiegels und zur Normalisierung der Gerinnung. Bei einem Patienten konnte die r-Hirudin-Elimination mittels einer Hamofiltrationsphase von 15 min gegen Ende des CPB beschleunigt werden. Der postoperative Verlauf war bei allen Patienten unauffallig bis auf eine Rethorakotomie bei einem Patienten 6 h postoperativ wegen vermehrter Fordermenge aus den Thoraxdrainagen. Es fand sich eine chirurgische retrosternale Blutungsquelle, die durch Diathermie koaguliert wurde. Die ADP- und kollagen-induzierte Plattchenaggregation als Parameter fur die Thrombozytenfunktion war bei allen Patienten nach 60 min CPB-Zeit noch relativ gut erhalten. Die Ergebnisse zeigen, das r-Hirudin bei Patienten mit einer HIT erfolgreich als alternatives Antikoagulans wahrend CPB verwendet werden kann.

Rekombinantes Hirudin als Antikoagulans für den kardiopulmonalen Bypass in der Herzchirurgie: Klinische Erfahrungen

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Recombinant Hirudin (Lepirudin) Provides Safe and Effective Anticoagulation in Patients With Heparin-Induced Thrombocytopenia A Prospective Study

Rekombinantes Hirudin als Antikoagulans für den kardiopulmonalen Bypass in der Herzchirurgie: Klinische Erfahrungen