Use and results of fibrinolysis in pulmonary embolism. Experience in a tertiary hospital.

Introduction: Pediatric pulmonary embolism (PE) is rare but associated with adverse outcomes. We aimed to characterize PE cases admitted in a tertiary hospital and to evaluate sensitivity of PE diagnostic prediction tools. Methods: Retrospective, descriptive study of PE cases admitted from 2008 to 2020. Data was collected from hospital records. Patients were grouped according to PE severity and setting (outpatients, inpatients). Associations with demographic characteristics, risk factors, clinical presentation, management and outcomes were analyzed. PE diagnostic prediction tools were applied. Results: 29 PE episodes occurred in 27 patients, 62.9% female, mean age 14.1 years. Most PE were central and massive or submassive. One was diagnosed in autopsy. Outpatients (n=20), admitted for classic PE symptoms, were adolescents; in half the diagnosis had been missed previously. Risk factors included contraceptives (65%), thrombophilia (35%), obesity (20%) and auto-immunity (20%). Inpatients´ PE (n=8), diagnosed during cardiorespiratory deterioration (n=5) or through incidental radiological findings (n=3), were younger and had immobilization (87.5%), complex chronic diseases (75%), infections (75%) and central venous catheter (62.5%) as risk factors. Retrospectively, D-dimer testing and adults’ scores performed better than pediatrics’ scores (sensitivity 92.9-96% vs 85.7- 92.9%). Both pediatrics’ scores missed a case with a positive family history. Discussion: Pediatric PE diagnosis is often delayed or missed. To improve it, the development of pediatric prediction tools as from validated adult scores merits to be explored. We propose that clinical presentation and risk factors may be different in inpatients and outpatients. Family history should be included.

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Survival in cardiopulmonary resuscitation due to massive pulmonary embolism: A case series in a tertiary hospital

Resuscitation ◽

10.1016/j.resuscitation.2017.08.046 ◽

2017 ◽

Vol 118 ◽

pp. e14

Author(s):

Angel Caballero ◽

Marta Magaldi ◽

Roger Pujol ◽

Mireia Chanzá ◽

Antonio López-Hernández ◽

...

Keyword(s):

Pulmonary Embolism ◽

Cardiopulmonary Resuscitation ◽

Case Series ◽

Tertiary Hospital ◽

Massive Pulmonary Embolism

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S81 10 year retrospective audit from Ambulatory Pulmonary embolism pathway in a tertiary hospital

10.1136/thorax-2021-btsabstracts.87 ◽

2021 ◽

Author(s):

R Sudhir ◽

E Bailie ◽

N Parmar

Keyword(s):

Pulmonary Embolism ◽

Tertiary Hospital ◽

Retrospective Audit

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High mortality in patients presenting with acute pulmonary embolism and elevated INR not on anticoagulant therapy

Thrombosis and Haemostasis ◽

10.1160/th15-11-0869 ◽

2016 ◽

Vol 115 (06) ◽

pp. 1191-1199 ◽

Cited By ~ 5

Author(s):

Christopher Wong ◽

Jerrett Lau ◽

Vincent Chow ◽

Vivien Chen ◽

Andy Yong ◽

...

Keyword(s):

Pulmonary Embolism ◽

Anticoagulant Therapy ◽

Clinical Decision Making ◽

Prognostic Significance ◽

Severity Index ◽

Clinical Decision ◽

Tertiary Hospital ◽

Risk Of Death ◽

Net Reclassification Improvement ◽

Acute Pe

SummaryThe prognostic significance of patients presenting with pulmonary embolism (PE) and elevated International Normalised Ratio (INR) not on anticoagulant therapy has not been described. We investigated whether these patients had higher mortality compared to patients with normal INR. A retrospective study of patients admitted to a tertiary hospital with acute PE from 2000 to 2012 was undertaken, with study outcomes tracked using a state-wide death registry. Patients were excluded if they were taking anticoagulants or had inadequate documentation of their INR and medication status. Of the 1,039 patients identified, 94 (9 %) had an elevated INR (> 1.2) in the absence of anticoagulant use. These patients had higher mortality at six months follow-up (26 % vs 6 %, p< 0.001) compared to controls (INR ≤ 1.2). An INR > 1.2 at diagnosis was an independent predictor of death at six months post-PE (hazard ratio [HR] 2.9, 95 % confidence interval [CI] 1.8–4.7, p< 0.001). The addition of INR to a multivariable model that included the simplified pulmonary embolism severity index (sPESI), chest pain, and serum sodium led to a significant net reclassification improvement estimated at 8.1 %. The final model’s C statistic increased significantly by 0.04 (95 % CI 0.01–0.08, p=0.03) to 0.83 compared to sPESI alone (0.79). In summary, patients presenting with acute PE and elevated INR while not on anticoagulant therapy appear to be at high risk of death. Future validation studies in independent cohorts will clarify if this novel finding can be usefully incorporated into clinical decision making in patients with acute PE.

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Risk Stratification for Acute Pulmonary Embolism in Patients with Atrial Fibrillation: Role of CHADS2 Score

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0037-1604112 ◽

2017 ◽

Vol 43 (08) ◽

pp. 864-870 ◽

Cited By ~ 3

Author(s):

Zhi-Yuan Xu ◽

Uma Avula ◽

Jian-Zeng Dong ◽

Xin Du ◽

Jia-Hui Wu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Embolism ◽

Adverse Outcome ◽

Multivariable Analysis ◽

Severity Index ◽

Tertiary Hospital ◽

Operating Characteristics ◽

Chads2 Score ◽

Hospital Outcome ◽

Receiver Operating Characteristics Curve

AbstractPulmonary embolism (PE) is associated with atrial fibrillation (AF). This study sought to explore if the CHADS2 score could predict the prognosis of PE in patients with AF. In a tertiary hospital, 4,288 consecutive patients with diagnosis of PE were screened. In total, 305 patients with PE had AF and were included in this retrospective study. In-hospital outcome was defined as at least one of the following: death from any cause, need for intravenous catecholamine administration, endotracheal intubation, cardiopulmonary resuscitation, or thrombolytic therapy. The in-hospital outcome occurred in 10.2% of the patients. Patients with adverse outcome had higher CHADS2 score, CHA2DS2-VASc score, and simplified pulmonary embolism severity index (sPESI) score. The area under the receiver operating characteristics curve was 0.66, 0.62, and 0.71 for CHADS2 score, CHA2DS2-VASc score, and sPESI score, respectively, in predicting in-hospital outcome. The incidence of in-hospital outcome was 3.4 and 14.4% in sPESI = 0 and sPESI ≥1 groups (p < 0.01). CHADS2 also had good predictive value with the incidence of in-hospital outcome, being 4.6% in CHADS2 < 2 and 14.3% in CHADS2 ≥ 2 groups (p < 0.01). The incidences of in-hospital outcome were 2.6, 4.8, 7.4, and 17.3% in patients with sPESI = 0 and CHADS2 < 2, sPESI = 0 and CHADS2 ≥ 2, sPESI ≥ 1 and CHADS2 < 2, and sPESI ≥ 1 and CHADS2 ≥ 2 (p < 0.01), respectively. In multivariable analysis, CHADS2 (odds ratio: 1.50; 95% confidence interval: 1.11–2.02; p < 0.01) was an independent predictor of in-hospital adverse outcome. High CHADS2 score could predict worse in-hospital outcome in patients with PE and AF.

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An Incident of a Massive Pulmonary Embolism following Acute Aortic Dissection. A Case Report

The Journal of Critical Care Medicine ◽

10.2478/jccm-2021-0001 ◽

2021 ◽

Vol 7 (1) ◽

pp. 67-72

Author(s):

Sofia Fernandes ◽

Mariana Rodrigues ◽

Catarina Barreiros ◽

Hugo Côrte-Real ◽

Ricardo Ferreira ◽

...

Keyword(s):

Pulmonary Embolism ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Tertiary Hospital ◽

Massive Pulmonary Embolism ◽

Postoperative Recovery ◽

Type A Aortic Dissection ◽

Vein Thrombosis ◽

Life Threatening ◽

Deep Vein

Abstract Acute aortic dissection and acute pulmonary embolism are two life-threatening emergencies. The presented case is of an 81-year-old man who has been diagnosed with an acute Stanford type A aortic dissection and referred to a tertiary hospital for surgical treatment. After a successful aortic repair and an overall favourable postoperative recovery, he was diagnosed with cervical and upper extremity deep vein thrombosis and was anticoagulated accordingly. He later presented with massive bilateral pulmonary embolism.

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Prevalence of Venous Thromboembolism in Kumasi: A Postmortem-Based Study in a Tertiary Hospital in Ghana

Clinical Medicine Insights Circulatory Respiratory and Pulmonary Medicine ◽

10.1177/1179548420956364 ◽

2020 ◽

Vol 14 ◽

pp. 117954842095636

Author(s):

Paul Poku Sampene Ossei ◽

Isaac Kofi Owusu ◽

Gerald Owusu-Asubonteng ◽

Frank Ankobea-Kokroe ◽

William Gilbert Ayibor ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

The Elderly ◽

Tertiary Hospital ◽

Distribution Analysis ◽

Age Group ◽

Major Health Problem ◽

Vein Thrombosis ◽

Deep Vein

Background: There is a dearth of publications on the prevalence of venous thromboembolism in Ghana. Knowledge of the prevalence of venous thromboembolism, which is often undetected clinically, will help save lives as appropriate interventions can be made as well as provide a general clue to clinicians on detecting venous thromboembolism and pulmonary embolism. Methods: The study employs a retrospective design with data extracted from the Autopsy Daybook of the Pathology unit, Komfo Anokye Teaching Hospital, 2009 to 2016. Data on patients’ demographics were retrieved to establish diagnoses and age and gender distribution. Analysis was made of pulmonary embolism and deep vein thrombosis as a cause of death recorded on death certificates using the criteria of the International Classification of Diseases, version 10. Results: A total of 150 cases of deep vein thrombosis and/or pulmonary embolism were available for the study period and the results showed an average age of 45.3 years with a standard deviation of 19.96. The ages ranged between 3 years and 96 years with the age group 31 to 40 years being the modal age group. Males recorded the highest number of cases with 92 (59.35%) compared to females with 63 (40.65%). Respiratory disorders, of which pneumonia is the most prevalent, are the leading clinical condition that is often misdiagnosed in place of pulmonary thromboembolism. Conclusion: VTE is a major health problem especially among the elderly, but unfortunately the clinical diagnosis is usually missed by clinicians hence the need to maintain a high suspicion index.

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Incidence of deep venous thrombosis in COVID-19 hospitalized patients during the first peak of the Italian outbreak

Phlebology The Journal of Venous Disease ◽

10.1177/0268355520975592 ◽

2020 ◽

pp. 026835552097559

Author(s):

Domenico Baccellieri ◽

Luca Bertoglio ◽

Luca Apruzzi ◽

Vincenzo Ardita ◽

Armando D’Angelo ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Duplex Ultrasound ◽

Tertiary Hospital ◽

Hospitalized Patients ◽

High Rate ◽

Vein Thrombosis ◽

Therapeutic Anticoagulation ◽

Medical Wards ◽

Deep Vein

Objectives A high rate of thrombotic events has been reported in COVID-19 population. The study aims to assess the incidence of deep vein thrombosis (DVT) in COVID-19 patients admitted to a single tertiary hospital. Methods From April 2nd to April 18th, 2020, hospitalized patients with SARS-CoV-2 infection were screened by lower limb duplex ultrasound (DUS). Patients were on (low molecular weight heparin) LMWH prophylaxis in medical wards, and on therapeutic anticoagulation in intensive care unit (ICU). DVT risk factors, reported by the Padua prediction score and blood tests, were retrieved from institutional electronic charts. The study primary endpoint was the incidence of DVT in the in-hospital COVID-19 population and its association with clinical and laboratory risk factors. The secondary endpoint was the association of DVT with mortality. Results Two hundred patients (median age 62 years, 72% male, 40 in ICU) received DUS screening. DVT was observed in 29 patients (14.5%), with proximal extension in 16 patients, and in association with symptoms in four patients. The DVT rate was similar in ICU (12.5%) and non-ICU patients (15%). Eighty-seven patients underwent a computed tomography angiography (CTA) that showed pulmonary embolism in 35 patients (40.2%) not associated with DVT in 25/35 cases (71.4%). DVT in the ten patients with pulmonary embolism were symptomatic in four and with a proximal localization in eight cases. A D-dimer level ≥5 mg/l at admission was predictive of DVT (OR 1.02; IC95% 1.03-1.16; p = .003). At the multivariate analysis in-hospital mortality was predicted by age (OR 1.06; 95% CI 0.02-1.15; p = .004) and by being an ICU patient (OR 1.23; 95% CI 0.30-2.25; p = .01). Conclusions Despite LMWH prophylaxis or full anticoagulant therapy, the incidence of DVT, mainly asymptomatic, in hospitalized COVID-19 patients was 14.5%. Further research should focus on the appropriate antithrombotic therapy for COVID-19 patients.

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