1887
Volume 2022, Issue 1
  • ISSN: 0253-8253
  • E-ISSN: 2227-0426

ملخص

Background: Acute pulmonary embolism (PE) is a common and potentially life-threatening condition. This comprehensive study from a Gulf Cooperation Council (GCC) country aimed to evaluate the clinical, radiological, and outcome characteristics associated with acute PE.

Methods: This retrospective observational study analyzed data of patients with confirmed acute PE who were admitted to the largest academic tertiary center in the State of Qatar from January 1, 2014, to December 31, 2018. Data on the clinical presentation, radiologic, and echocardiographic findings, as well as outcomes were collected.

Results: A total of 436 patients were diagnosed with acute PE during the study period (male, 53%). Approximately 56% of the patients were < 50 years old at presentation, with a median age of 47 years. In approximately 69% of cases, the PE occurred outside the hospital. The main associated comorbidities were obesity (34.6%), hypertension (29.4%), and diabetes (25%). Immobilization (25.9%) and recent surgery (20.6%) were the most common risk factors. The most frequent presenting symptom was dyspnea (39.5%), and the most frequent signs were tachycardia (49.8%) and tachypnea (45%). Cardiac arrest was the initial presentation in 2.2% of cases. Chest X-ray findings were normal in 41%. On computed tomography pulmonary angiography (CTPA), 41.3% of the patients had segmental PE, 37.1% had central PE, and 64.1% had bilateral PE. The main electrocardiographic (ECG) abnormality was sinus tachycardia (98%). In patients who underwent echocardiography, right ventricular (RV) enlargement was the main echocardiographic finding (36.4%). Low-, intermediate-, and high-risk PE constituted 49.8%, 31.4%, and 18.8% of the cases, respectively. Thrombolysis was prescribed in 8.3% of the total and 24.4% of the high-risk PE cases. Complications of PE and its treatment (from admission up to 6 months post-discharge) included minor bleeding (14%), major bleeding (5%), PE recurrence (4.8%), and chronic thromboembolic pulmonary hypertension (CTEPH) (5%). A total of 15 (3.4%) patients died from PE.

Conclusions: Acute PE can manifest with complex and variable clinical and radiological syndromes. Striking findings in this study are the younger age of acute PE occurrence and the low PE-related mortality rate.

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References

  1. Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol. 2015; 12:(8):464–474.
    [Google الباحث العلمي]
  2. Fernandes CJ, Luppino Assad AP, Alves-Jr JL, Jardim C, de Souza R. Pulmonary embolism and gas exchange. Respiration 2019;: 98:253–262.
    [Google الباحث العلمي]
  3. Beˇlohlávek J, Dytrych V, Linhart A. Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis, and non-thrombotic pulmonary embolism. Exp Clin Cardiol. 2013; 18:(2):129–138.
    [Google الباحث العلمي]
  4. Piazza G, Goldhaber SZ. Chronic thromboembolic pulmonary hypertension. N Engl J Med. 2011; 364: (4):351–360.
    [Google الباحث العلمي]
  5. Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ 3rd. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch. Intern. Med 1998; 158:(6):585–593.
    [Google الباحث العلمي]
  6. Cushman M, Tsai AW, White RH, Heckbert SR, Rosamond WD, Enright P, et al. Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. Am. J. Med. 2004; 117:(1):19–25.
    [Google الباحث العلمي]
  7. Spencer FA, Emery C, Lessard D, Anderson F, Emani S, Aragam J, et al. The Worcester Venous Thromboembolism study: a population-based study of the clinical epidemiology of venous thromboembolism. J. Gen. Intern. Med 2006; 21:(7):722–727.
    [Google الباحث العلمي]
  8. Huang W, Goldberg RJ, Anderson FA, Kiefe CI, Spencer FA. Secular trends in the occurrence of acute venous thromboembolism: the Worcester VTE study (1985–2009) Am. J. Med. 2014; 127:829.e5–839.e5.
    [Google الباحث العلمي]
  9. Zakai NA, McClure LA, Judd SE, Safford MM, Folsom AR, Lutsey PL, et al. Racial and regional differences in venous thromboembolism in the United States in 3 cohorts. Circulation 2014; 129:(14):1502–1509.
    [Google الباحث العلمي]
  10. Barco S, Mahmoudpour SH, Valerio L, Klok FA, Münzel T, Middeldorp S, et al. Trends in mortality related to pulmonary embolism in the European Region, 2000-15: analysis of vital registration data from the WHO Mortality Database. Lancet Respir Med 2020; 8:(3):277–287.
    [Google الباحث العلمي]
  11. Stein PD, Henry JW. Prevalence of acute pulmonary embolism among patients in a general hospital and at autopsy. Chest 1995; 108:(4):978–981.
    [Google الباحث العلمي]
  12. Stein PD, Henry JW. Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes. Chest 1997; 112:(4):974–979.
    [Google الباحث العلمي]
  13. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020; 41:(4):543–603.
    [Google الباحث العلمي]
  14. Schulman S, Kearon C. Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost 2005; 3:(4):692–694.
    [Google الباحث العلمي]
  15. AlGahtani FH, Bayoumi N, Abdelgadir A, Al-Nakshabandi N, Al Aseri Z, Al Ghamdi M, et al. Clinical characteristics and risk factors of pulmonary embolism: data from a Saudi tertiary-care center. J Thromb Haemost 2013; 11:(2):388–390.
    [Google الباحث العلمي]
  16. Ahmed MM, Akbar DH, Al-Shaikh AR. Deep vein thrombosis at King Abdul Aziz University Hospital. Saudi Med J. 2000; 21:(8):762–764.
    [Google الباحث العلمي]
  17. Planning and Statistics Authority (PSA). The State of Qatar. Qatar Census 2020 Main Results. Available from: https://www.psa.gov.qa/en/statistics1/StatisticsSite/Census/Census2020/res/Pages/population.aspx. (Accessed: January 1, 2022).
    [Google الباحث العلمي]
  18. Skeik N, Westergard E. Recommendations for VTE prophylaxis in medically ill patients. Ann Vasc Dis. 2020; 13:(1):38–44.
    [Google الباحث العلمي]
  19. Bozzato S, Galli L, Ageno W. Thromboprophylaxis in surgical and medical patients. Semin Respir Crit Care Med 2012; 33:(2):163–175.
    [Google الباحث العلمي]
  20. Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data. Arch Intern Med 2003; 163:(14):1711–1717.
    [Google الباحث العلمي]
  21. White RH, Zhou H, Romano PS. Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost 2003; 90:(3):446–455.
    [Google الباحث العلمي]
  22. Anderson DR, Morgano GP, Bennett C, Dentali F, Francis CW, Garcia DA, et al. American Society of Hematology 2019 guidelines for the management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients. Blood Adv. 2019; 3:(23):3898–3944.
    [Google الباحث العلمي]
  23. Pollack CV, Schreiber D, Goldhaber SZ, Slattery D, Fanikos J, O'Neil BJ, et al. Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: initial report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry). J Am Coll Cardiol 2011; 57:(6):700–706.
    [Google الباحث العلمي]
  24. Prandoni P, Lensing AW, Prins MH, Ciammaichella M, Perlati M, Mumoli N, et al. Prevalence of pulmonary embolism among patients hospitalized for syncope. N Engl J Med 2016; 375:(16):1524–1531.
    [Google الباحث العلمي]
  25. de Winter MA, van Bergen EDP, Welsing PMJ, Kraaijeveld AO, Kaasjager KHAH, Nijkeuter M. The prognostic value of syncope on mortality in patients with pulmonary embolism: A systematic review and meta-analysis. Ann Emerg Med 2020; 76:(4):527–541.
    [Google الباحث العلمي]
  26. Altınsoy B, Erboy F, Tanrıverdi H, Uygur F, Örnek T, Atalay F, et al. Syncope as a presentation of acute pulmonary embolism. Ther Clin Risk Manag. 2016;12:1023–1028.
    [Google الباحث العلمي]
  27. Worsley DF, Alavi A, Aronchick JM, Chen JT, Greenspan RH, Ravin CE. Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study. Radiology 1993; 189:(1):133–136.
    [Google الباحث العلمي]
  28. Moore AJE, Wachsmann J, Chamarthy MR, Panjikaran L, Tanabe Y, Rajiah P. Imaging of acute pulmonary embolism: an update. Cardiovasc Diagn Ther. 2018; 8:(3):225–243.
    [Google الباحث العلمي]
  29. Calwin Davidsingh S, Srinivasan N, Balaji P, Kalaichelvan U, Mullasari AS. Study of clinical profile and management of patients with pulmonary embolism - single-center study. Indian Heart J 2014; 66:(2):197–202.
    [Google الباحث العلمي]
  30. Barco S, Mahmoudpour SH, Planquette B, Sanchez O, Konstantinides SV, Meyer G. Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: a systematic review and meta-analysis. Eur Heart J 2019; 40:(11):902–910.
    [Google الباحث العلمي]
  31. Keller K, Hobohm L, Münzel T, Konstantinides SV, Lankeit M. Sex-specific and age-related seasonal variations regarding incidence and in-hospital mortality of pulmonary embolism in Germany. ERJ Open Res. 2020; 6:(2):00181–2020.
    [Google الباحث العلمي]
  32. Nakamura M, Fujioka H, Yamada N, Sakuma M, Okada O, Nakanishi N, et al. Clinical characteristics of acute pulmonary thromboembolism in Japan: results of a multicenter registry in the Japanese Society of Pulmonary Embolism Research. Clin Cardiol. 2001; 24:(2):132–138.
    [Google الباحث العلمي]
  33. Anderson FA Jr, Wheeler HB, Goldberg RJ, Hosmer DW, Patwardhan NA, Jovanovic B, et al. A Population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism: the Worcester DVT study. Arch Intern Med. 1991; 151:(5):933–938.
    [Google الباحث العلمي]
  34. Dentali F, Ageno W, Pomero F, Fenoglio L, Squizzato A, Bonzini M. Time trends and case fatality rate of in-hospital treated pulmonary embolism during 11 years of observation in Northwestern Italy. Thromb Haemost 2016; 115:(2):399–405.
    [Google الباحث العلمي]
  35. Al Otair HA, Al-Boukai AA, Ibrahim GF, Al Shaikh MK, Mayet AY, Al-Hajjaj MS. Outcome of pulmonary embolism and clinico-radiological predictors of mortality: experience from a university hospital in Saudi Arabia. Ann Thorac Med 2014; 9:(1):18–22.
    [Google الباحث العلمي]
  36. Al Dandan O, Hassan A, AbuAlola H, Alzaki A, Alwaheed A, Alalwan M, et al. Clinical and imaging profiles of pulmonary embolism: a single-institution experience. Int J Emerg Med 2020; 13:(1):47.
    [Google الباحث العلمي]
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  • نوع المستند: Case Report
الموضوعات الرئيسية clinical featuresmortalitypulmonary embolism and Venous thromboembolism

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