Combined Pulmonary Embolism Research Articles

ФАКТОРИ РИЗИКУ ТРОМБОЗУ У ОСІБ, ЯКІ ПЕРЕНЕСЛИ НЕГОСПІТАЛЬНУ ПНЕВМОНІЮ НА ТЛІ КОРОНАВІРУСНОЇ ХВОРОБИ (COVID-19)

The aim of the study was to identify the risk factors for thrombotic events in individuals who have experienced community acquired pneumonia associated with COVID-19 and did not have thrombotic events during the acute period of COVID-19. Materials and methods. 45 individuals were examined in postCOVID-19 period (age - 61.0 (54.0; 68.0) years, males - 22 (48,9 %), females - 23 (51,1 %)). All patients were examined twice: at visit 1 — 45,0 (40,0; 60,0) days from the onset of COVID-19, and at visit 2 — 150,0 (117,5; 160,0) days from the onset of COVID-19. Depending on whether the patients received anticoagulant therapy during post-COVID-19 period, the main group was divided into two subgroups: subgroup 1 included 25 (55,6 %) individuals who received anticoagulants during post-COVID-19 period (the course of acute COVID-19 was moderate in 7 (28,0 %) individuals, and severe or critical in 18 (72.0 %) individuals); subgroup 2 included 20 (44,4 %) individuals who did not receive anticoagulants during post-COVID-19 period (the course of acute COVID-19 was moderate in 12 (60,0 %) individuals and severe in 8 (40,0 %) individuals). Clinical methods, pulse oximetry, laboratory and instrumental methods as well as assessment of the probability of thrombosis according to the Wells and Padua scales were used. Results. There was not any thrombotic event occurred in subgroup 1 during post-COVID-19 period. The duration of anticoagulant use in patients from subgroup 1 was 63,0 (60,0; 90,0) days from the onset of COVID-19 symptoms. In subgroup 2, thrombosis was detected in 5 (25,0%) patients during post-COVID-19 period (4 patients had pulmonary embolism and 1 patient had a combination of pulmonary embolism and acute ischemic stroke). Thrombotic events had occurred before visit 1, at 40,0 (33,0; 45,0) days from the onset of COVID-19, which corresponded to 16,0 (15,0; 18,0) days after the end of anticoagulant therapy. Age, gender, body mass index, and comorbidities (hypertension, obesity, diabetes) were not associated with the occurrence of thrombotic events. Risk factors included severe COVID-19 (p=0,04) and the presence of hereditary thrombophilia. Conclusion. The risk of thrombosis in post-acute COVID-19 period is higher in patients after severe course of the acute period of COVID-19, in the absence of anticoagulant therapy during the post-COVID-19 period. On the other hand, the administration of anticoagulants during at least two months from the onset of COVID-19 symptoms, decreased the risk of thrombosis in the post-COVID-19 period not only in patients with severe course but in patients with critical course of the acute period of COVID-19 as well. Key words: COVID-19, post-COVID-19 period, thrombosis, pulmonary embolism, anticoagulants.

Modeling lung perfusion abnormalities to explain early COVID-19 hypoxemia

Early stages of the novel coronavirus disease (COVID-19) are associated with silent hypoxia and poor oxygenation despite relatively minor parenchymal involvement. Although speculated that such paradoxical findings may be explained by impaired hypoxic pulmonary vasoconstriction in infected lung regions, no studies have determined whether such extreme degrees of perfusion redistribution are physiologically plausible, and increasing attention is directed towards thrombotic microembolism as the underlying cause of hypoxemia. Herein, a mathematical model demonstrates that the large amount of pulmonary venous admixture observed in patients with early COVID-19 can be reasonably explained by a combination of pulmonary embolism, ventilation-perfusion mismatching in the noninjured lung, and normal perfusion of the relatively small fraction of injured lung. Although underlying perfusion heterogeneity exacerbates existing shunt and ventilation-perfusion mismatch in the model, the reported hypoxemia severity in early COVID-19 patients is not replicated without either extensive perfusion defects, severe ventilation-perfusion mismatch, or hyperperfusion of nonoxygenated regions.

Incidence of venous thromboembolism in psychiatric inpatients: a chart review.

PurposeVenous thromboembolism (VTE) is the combination of pulmonary embolism (PE) and deep vein thrombosis. In recent years, VTE has been gaining attention in the field of psychiatry as it can cause sudden deaths in patients hospitalized in psychiatric departments. The purpose of this study was to investigate the incidence of VTE in psychiatric inpatients using contrast-enhanced computed tomography (CT).Patients and methodsAt the psychiatric department of the Akita University Hospital, NANOPIA® D-dimer was measured in patients with suspected symptomatic VTE or believed to be at risk for asymptomatic VTE. A follow-up contrast-enhanced CT was also performed in cases of D-dimer values over 1 µg/mL. Patients diagnosed with VTE based on contrast-enhanced CT during hospitalizations between May 1, 2009 and April 30, 2017 were analyzed. VTE incidence was compared in restrained and unrestrained catatonic and noncatatonic patients. We also investigated whether VTE was symptomatic or asymptomatic as well as its outcomes.ResultsThe overall incidence of VTE was 2.3% (39/1,681) in the 8-year period. VTE was observed in 61.1% (11/18) of catatonic patients, 4.1% (11/270) of noncatatonic restrained patients, and 1.2% (17/1,393) of noncatatonic unrestrained patients. PE was observed in 76.9% (30/39) of VTE patients and 97.4% (38/39) of VTE patients were asymptomatic. Recovery was achieved in all cases of VTE treated with anticoagulation therapy.ConclusionThese results indicate that the risk of VTE is high in psychiatric inpatients and that PE is common in these population. The data may also suggest that contrast-enhanced CT is important in surveying thrombus in suspected cases of VTE. In the psychiatric field, proper attention must be given to VTE, regardless of the presence or absence of catatonia or restraint, particularly given that PE was observed in more than 75% of cases of VTE.

Incidence and risk factors of deep venous thrombosis of lower extremity in patients with pelvic or ac-etabular fracture

Objective To investigate the incidence and risk factors of deep venous thrombosis (DVT) of lower extremity in patients with pelvic or acetabular fracture. Methods From August 2015 to December 2016, 110 patients with pelvic or acetabular fracture were treated in our hospital. They were 76 males and 34 females with a mean age of 44.2 years (range, from 16 to 76 years). There were 48 pelvic fractures, including 12 anterior and posterior compression, 16 lateral compression and 20 vertical shear ones by the Young-Burgess classification; there were 62 acetabular fractures, including 26 simple and 36 complex ones by the Letournel-Judet classification. The incidence of lower extremity DVT was detected preoperatively and postoperatively using ultrasound detection. The factors associated with the incidence of DVT were analyzed statistically. The risk factors were screened by single factor logistic regression analysis; the major independent risk factors were determined by multi-factor logistic regression analysis. P< 0.05 was considered as statisti-cally significant. Results DVT occurred in 32 patients (29.09%), including 21 cases (19.09%) of proximal thrombosis and 3 cases of combined pulmonary embolism. The incidence of DVT in patients with acetabular fracture was significantly higher than in those with pelvic fracture (P 60 years, combined injuries and interval of >2 weeks from injury to surgery were independent risk factors for incidence of DVT (P< 0.05). Conclusions The risk of lower extremity DVT is high in patients with pelvic or acetabular fracture in spite of active prophylaxis, especially the risk of proximal thrombosis. Age of >60 years, combined injuries and interval of >2 weeks from injury to surgery may be the independent risk factors for incidence of DVT. Key words: Pelvis; Acetabulum; Fractures, bone; Venous thrombosis; Risk factors

Pulmonary embolism in combination with a reversible and irreversible airflow obstruction

Pulmonary thromboembolism, combined with bronchial obstruction is the most difficult in the diagnosis, because it can be presented as a combination of unventilated and not perfused areas and this disorders can occur in the acute phase of embolism, and also in long-term period after the onset. Aim: To evaluate influence of different disorders of blood circulation in the lungs on the development of bronchial obstruction in patients with different forms of PE. Material and Methods: We analyzed of the results of radiological methods: perfusion scintigraphy, single photon emission computed tomography using the combined technology (SPECT-CT) and multislice computed tomography - high-resolution computed tomography (VRKT), functional tests, multislice computed tomography angiography (MSCTA) in 250 patients (without concomitant pathology of bronchopulmonary system) suspicious of pulmonary embolism. Results and conclusions: Bronchoconstriction in patients with pulmonary embolism of small branches pulmonary artery increases severity of the disease. Analyzing the patients data we founded out that distinct clinical effect was achieved only with additional treatment with bronchodilators. In chronic course of the pulmonary embolism development of emphysema was detected, at first local - in ischemic segments, then involving the adjacent lung regions. In this case, the severity of the disease is caused not by embolism itself, but also because of development of persistent bronchial obstruction. These changes are considered as «postembolic pulmonary disease», and determine severity of perfusion and ventilation dysfunction.

Clinical epidemiology of venous thromboembolic disease. Results of a French Multicentre Registry.

Between July 1992 and December 1994, 16 French hospital centres, mainly cardiological, participated in a non-controlled observational study on venous thromboembolic disease. The objective of this survey was to collect data concerning the current status of pulmonary embolism and deep venous thrombosis. During this period, 547 patients were included: 446 with deep venous thrombosis and 387 with pulmonary embolisms. Mean age of patients was 63 +/- 21 years. There were no significant differences between the sexes. Pulmonary embolism and deep venous thrombosis tended to occur more frequently during the autumn and winter. In 30% of cases, prior deep venous thrombosis or pulmonary embolism was noted. No cause was found for the condition in 47% of cases. Ultrasound (echocardiography and/or venous ultrasound) was the most frequently requested investigation. Intravenous heparin remains the most widely used treatment (76%). Oral anticoagulation was begun before day 3 in less than 31% of cases. Thrombolytic treatment was used in 20% of pulmonary embolism cases, but was rarely prescribed for deep venous thrombosis (2.2%). The hospital recurrence rate (12/547 cases) was fairly low. The search for occult malignancy, performed in 48% of cases, seems to remain one of the major concerns of physicians. The combined pulmonary embolism and deep venous thrombosis mortality rate was 4.4%, while the death rate for pulmonary embolism alone was 6.2%.

Review of studies with plasminogen concentrates and proposals for further therapeutic strategies with plasminogen concentrates.

Since the introduction of thrombolytic treatment based on the activation of plasminogen (PLG) by streptokinase (SK) and urokinase (UK) the search for new and improved methods has been continuing. The pivotal issue is how to achieve clot-specific fibrinolysis without producing systemic fibrinogenolysis. One out of various approaches to enhance lysis rates has been the use of PLG either alone or in combination with UK or SK in the light of the fact that fibrinolytic treatment, particularly using SK, is associated with a consumption of PLG, and that thrombi contain relatively small amounts of native PLG, however, are capable of incorporating added PLG in vitro. PLG-concentrates from various manufactures have been administered intravenously for treatment of deep venous thrombosis, mainly in combination with SK, and of pulmonary embolism in combination with UK. Local intracoronary and intraarterial administration in combination with UK has been reported in patients with myocardial infarction, and peripheral arterial occlusions, respectively. Lysis rates obtained in these studies were in most cases superior to results obtained with SK or UK alone, without increasing the incidence of bleeding complications. In addition, excellent results in larger group of patients with cerebral thrombosis were obtained with PLG alone. The encouraging results of these studies may be explained by the fact that all of the preparations used contained partially activated forms of PLG (commonly designated lys-PLG) to a greater or lesser extent. Lys-PLG has a higher affinity for fibrin than the native glu-PLG and is activated by UK or SK by a manyfold faster. These properties allow for a rapid formation of plasmin which--bound to fibrin--is also protected from the attack of neutralizing antiplasmin. The design and results of previous studies with lys-PLG concentrates will be reviewed and approaches to further improve fibrinolytic regimens with lys-PLG-concentrates discussed.