Incidence Of Acute Pulmonary Embolism Research Articles

Trends in admissions for COVID-19 in the United States between April 2020 and December 2021 and cardiovascular events

IntroductionCoronavirus disease 2019 (COVID-19) can lead to cardiovascular complications. We aimed to understand the trends in admission for COVID-19 and the incidence of various cardiovascular events.Material and methodsThe 2020 and 2021 National Inpatient Sample (NIS) was studied for cases of COVID-19 between April 2020 and December 2021 in the United States. Linear-by-linear association helped us understand the trends of various events.ResultsThe number of cases of COVID-19 was highest in January 2021 (261,469 patients). The incidence of acute pulmonary embolism rose from 2.08% in April 2020 to 4.82% in November 2021, while deep vein thrombosis cases rose from 1.74% in April 2020 to 2.63% in December 2021. The incidence of cardiac arrest varied, with a maximum of 3.00% in August 2021. Similarly, acute ischemic stroke cases experienced their highest incidence in January 2021 (0.91%). The incidence of myocarditis was highest in April and May 2020 (0.42% each). Peak takotsubo cases were seen between October and December 2021. The highest overall all-cause mortality among COVID-19 cases was seen in April 2020 (16.74%).ConclusionsThroughout the 21 months of our analysis, various trends in COVID-19 cases and incidence of cardiac events were noticed. This could relate to the different variants of COVID-19, their direct and indirect impact on coagulation pathways and the myocardial tissues, and the protective roles of the vaccines.

Impact of COVID-19 on cardiac surgery outcomes.

This study aimed to assess the impact of COVID-19 infection on cardiac surgery outcomes in patients who contracted COVID-19 peri-operatively or had recently recovered from COVID-19. The study prospectively enrolled 95 patients scheduled for cardiac surgery who had recently recovered from COVID-19. This formed the post-COVID-19 group. The other group consisted of 25 patients who contracted COVID-19 peri-operatively. Patients were followed for all-cause mortality as the primary endpoint and postoperative course complications as the secondary endpoint. Data were compared to a historical cohort of 280 non-COVID-19 patients. The peri-operative COVID-19 group exhibited a significantly higher prevalence of primary outcome all-cause mortality (28%), compared with 4.3% in the controls (p < 0.01), as well as the secondary composite endpoint (stroke, peri-operative myocardial infarction and pneumonia) (52 vs 13.9%, p < 0.01). The post-COVID-19 group had a higher incidence of acute pulmonary embolism (3.2 vs 0%, p < 0.01) and atrial fibrillation (23.4 vs 11.4%, p < 0.01). Patients who contracted COVID-19 peri-operatively had an increased rate of mortality and postoperative complications, while cardiac surgery in the recently recovered COVID-19 group was associated with a higher incidence of pulmonary embolism and atrial fibrillation.

Early diagnosis for pulmonary embolism: A systematic review and meta-analysis.

The incidence of acute pulmonary embolism (APE) (especially early diagnosis) has increased annually in recent years, but the diagnosis of APE is a great challenge for every clinician. However, few studies have evaluated multiple diagnostic indicators simultaneously. A systematic search was performed using CNKI, Wan fang data, VIP, PubMed and Web of Science for studies on the diagnosis of pulmonary embolism published up to October 31, 2022. Using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), we evaluated the risk of bias in included studies, and used a random-effects meta-analysis to obtain the summary sensitivity and specificity. The data that were extracted and calculated for this study included the first author, year of publication, country, study type, sample size, disease type, gold standard, diagnostic indicators and 4-compartment table data. We strictly followed the Preferred Reporting Items for Systematics reviews and Meta-Analysis (PRISMA) guidelines in this review. This study included 30 articles with a total sample size of 8947 cases, involving 4 detection methods: D-dimer, Geneva rules, Wells rules, and lung imaging. The combined effect size showed that lung imaging had the highest diagnostic value (SEN = 0.95, SPE = 0.89), followed by D-dimer (SEN = 0.92, SPE = 0.60), Geneva rules (SEN = 0.78, SPE = 0.68), and Wells rules (SEN = 0.77, SPE = 0.67). The area of lung imaging was largest under the Summary Receiver Operator Characteristic (SROC) curve (AUC = 0.97), followed by Geneva rules (AUC = 0.80), Wells rules (AUC = 0.79), and D-dimer (AUC = 0.74). All 4 detection methods showed good ability to diagnose PE, and lung imaging was the best. Clinical trials are recommended to build an early decision-making model for the diagnosis of pulmonary embolism in order to increase the detection rate and improve prognosis.

Incidence of acute pulmonary embolism in hospitalized COVID-19 Italian patients. A pooled meta-analysis

Acute pulmonary embolism (PE) represents a frequent and prognostically relevant complication of COVID-19. We performed a systematic review and meta-analysis, according to the PRISMA guidelines to determine the in-hospital incidence of acute PE, based on Italian studies published on this issue. We searched PubMed and Scopus to locate all articles published between February 2020 to October 15, 2021, reporting the incidence of acute PE in Italian COVID-19 patients. The pooled in-hospital incidence of acute PE was calculated using a random-effect model and presented with relative 95% confidence interval (CI). We analysed data from 3287 Italian COVID-19 patients (mean age 65.7 years) included in 20 studies. The pooled in-hospital incidence of acute PE was 20% (95% CI 13.4-28.7%; I2 = 95.1%); the incidence was lower among patients hospitalized in intensive care unit (ICU) (32.3%; 95% CI 20.2-44.0%; I2 = 77.2%) compared to those admitted in general wards (47.6%; 95% CI 18.7-78.2%; I2 = 94.4%). Meta-regression showed a significant direct correlation of acute PE incidence using age, male gender and previous coronary artery disease as moderating variables. Conversely, an inverse correlation was observed in relation to the use of anticoagulation at therapeutic dose. Prophylactic and therapeutic anticoagulation was administered in 80.2% of patients (95% CI 72.5-86.2%; I2 = 91.0%); the former regimen was more frequently used compared to the latter (63.5% vs 14.3%; p<0.001). Computed tomography angiography (CTPA) was used only in 10.7% of infected patients across 7 studies. One in five COVID-19 patients experienced acute PE as complication of the infection during hospitalization. The in-hospital incidence of acute PE was lower in ICU compared to general wards. CTPA was scantly used. Early prophylactic anticoagulation was associated with a lower incidence of acute PE.

Microneedle patch-assisted transdermal administration of recombinant hirudin for the treatment of thrombotic diseases

The painless microneedle patch (MNP), widely explored for transdermal drug delivery of macromolecules, can overcome the limitations of traditional administrations of protein and polypeptide anticoagulant drugs. We constructed a recombinant hirudin-loaded microneedle patch, suitable for patients with thrombotic diseases requiring long-term preventive medication. The recombinant hirudin-loaded dissoluble microneedle patch (RHDMNP) was created using a mold casting technique and polyvinylpyrrolidone and polyvinyl alcohol were used as the matrix material with a 1:1.2 ratio. We prepared bilayer RHDMNPs with pyramidal appearance and 0.37 N/needle strength. The intradermal dissolution height of the microneedle reached approximately 78.67% of the total height, and 68.12% of the drug was delivered into the skin. The 12-hour cumulative permeation of the MNP was 21.69 ± 3.90 μg/cm2. The MNP showed a Tmax of 1.5 h, Cmax of 144 ± 71 ng/mL, and area under curve (AUC) of 495 ± 66 ng/mL·min compared to Tmax of 0.5 h, Cmax of 249 ± 89 ng/mL, and AUC of 944 ± 65 ng/mL·min for the subcutaneous injection group. Both in vivo and in vitro experiments showed that the RHDMNP exerted effective anticoagulant effects, prevented the incidence of acute pulmonary embolism, and revealed the potential for venous thrombosis prevention.

The Incidence of Acute Pulmonary Embolism with COVID-19 Pneumonia in Saudi Arabia: A Retrospective Single-Center Study.

Acute pulmonary embolism (APE) is a common and prognostically significant complication of COVID-19 infection. We investigated the clinical characteristics and chest CT findings of COVID-19 positive patients complicated with APE. A retrospective, record-based, case-series study was performed examining 483 patients admitted to King Saud Medical City during the pandemic, from April 2020 to June 2020. Of these, 92 patients who underwent chest CT scans were included in the final analysis. The incidence of APE, clinical presentations, radiological patterns, and patient outcomes were assessed and compared against those for patients without PE. The incidence of APE was 22% [95% confidence interval (95% CI): 19%–39%], detected by chest CT. Men constituted 85.0% of patients, with a mean age of 48.9 ± 16.7 years. For most patients with APE, risk factors for thromboembolism were established but did not differ significantly from those without PE. The mean D-dimer level of 9.1 (range 7.0–10.2) was significantly higher among patients diagnosed with APE (OR: 1.021; 95% CI: 1.012–1.028; P = 0.001) compared with that in patients without PE. Moreover, the mean levels of lactate dehydrogenase (LDH, 628.5; range: 494.0–928.3; OR: 1.002; 95% CI: 1.000–1.003; P = 0.02), C-reactive protein (CRP; 158.5; range: 105.3–204.5; OR: 1.025; 95% CI: 1.015–1.035; P = 0.001), and cardiac troponin (3.5; range; 2.6–3.8; OR: 1.016; 95% CI: 0.971–1.067; P = 0.01) were also significantly higher in patients with APE than those in patients with PE. The chest CT presentations of APE included massive, segmental, and sub-segmental APE. The need for Intensive Care Unit admission was higher among patients diagnosed with APE, who presented a fatality rate of 10%.. Our study pointed to the incidence and predictors of APE in COVID-19 patients. High levels of D-dimer, CRP, cardiac troponin, and LDH should alert the clinician to the possibility of APE in COVID-19 patients..

Incidence of acute pulmonary embolism among patients hospitalized with COVID-19: a systematic review and meta-analysis

Background: Coronavirus disease 2019 (COVID-19) is a global pandemic, which is associated with venous thromboembolism and pulmonary embolism (PE). This study aimed to estimate the pooled incidence of PE among patients hospitalized with COVID-19 within the published literature. Methods: This systematic review and meta-analysis was performed according to PRISMA guidelines. An electronic search using MEDLINE /PubMed, ScienceDirect, Cochrane, and OpenGray databases was conducted May 19th, 2020. Eligible studies included sufficient data to calculate the incidence of PE diagnosed during hospitalization in patients with COVID-19. Case reports were excluded. Quality was assessed using the Newcastle-Ottawa scale (observational cohort and case-control), AXIS tool (cross-sectional), and quality assessment tool (case series). Demographics and PE incidence data were extracted from the included studies and analyzed with R language. The pooled incidence of PE in patients hospitalized with COVID-19 was calculated. Results: The database search identified 128 records. Ten observational studies were eligible and were included in the meta-analysis with a total of 1722 patients (mean age= 63.36). .The incidence of PE was noted to be higher in males. The D-dimer levels were specified between PE group and non-PE group in only three studies, while the remaining either reported it improperly or had missing data.The pooled PE incidence in patients hospitalized with COVID-19 was 17% (95% CI: 0.1-0.26). There was a high degree of study heterogeneity (I2 = 94%, p&lt;0.01). Conclusion: The pooled PE incidence in patients hospitalized with COVID-19 is 17%. This increased incidence is greater than that previously reported in the general population of non-COVID-19. Attention and further investigation of this risk is warranted.

Incidence of acute pulmonary embolism among patients hospitalized with COVID-19: a systematic review and meta-analysis

Background: Coronavirus disease 2019 (COVID-19) is a global pandemic, which is associated with venous thromboembolism and pulmonary embolism (PE). This study aimed to estimate the pooled incidence of PE among patients hospitalized with COVID-19 within the published literature. Methods: This systematic review and meta-analysis was performed according to PRISMA guidelines. An electronic search using MEDLINE /PubMed, ScienceDirect, Cochrane, and OpenGray databases was conducted May 19th, 2020. Search terms included "COVID 19", "SARS-CoV-2”, "coronavirus disease 2019", "2019-nCoV", "Wuhan coronavirus", “Pulmonary embolism”, "pulmonary thromboembolism", “Pulmonary embol*”, “pulmonary thrombo*” and “PE”. Eligible studies included sufficient data to calculate the incidence of PE diagnosed during hospitalization in patients with COVID-19. Case reports were excluded. Quality was assessed using the Newcastle-Ottawa scale (observational cohort and case-control), AXIS tool (cross-sectional), and quality assessment tool (case series). Demographics and PE incidence data were extracted from the included studies and analyzed with R language. The pooled incidence of PE in patients hospitalized with COVID-19 was calculated. Results: The database search identified 128 records. Ten observational studies were eligible and were included in the meta-analysis with a total of 1722 patients (mean age= 63.36). The pooled PE incidence in patients hospitalized with COVID-19 was 17% (95% CI: 0.1-0.26). There was a high degree of study heterogeneity (I2 = 94%, p&lt;0.01). Conclusion: The pooled PE incidence in patients hospitalized with COVID-19 is 17%. This increased incidence is greater than that previously reported in the general population of non-COVID-19. Attention and further investigation of this risk is warranted.

Increased Incidence of Acute Pulmonary Embolism in Emergency Department Patients During the COVID‐19 Pandemic

Early detection of acute pulmonary embolism (PE) in patients with SARS-CoV-2 infection is integral to the clinical management of these patients. Many recently published studies have evaluated incidence of PE in hospitalized patients with COVID-191-9 , however there is relatively limited data describing patients with SARS-CoV-2 infection and concomitant diagnosis of acute PE upon initial presentation. Therefore, the purpose of this study is to (i) evaluate the incidence of acute pulmonary embolism (PE) in patients undergoing computed tomography pulmonary angiography (CTPA) in the emergency department (ED) across six hospitals in New York City during the height of the COVID-19 pandemic compared to a non-pandemic period, and (ii) compare the characteristics and early outcomes of patients presenting with PE during the pandemic (n=87) to patients presenting with PE during a non-pandemic period (n=34).

Appropriateness of Emergency CT Utilization During the Initial Peak of the COVID-19 Pandemic.

Appropriateness of Emergency CT Utilization During the Initial Peak of the COVID-19 Pandemic.

PS1524 WHEN IS A CT NEEDED TO DIAGNOSE ACUTE PULMONARY EMBOLISM IN INDIVIDUALS WITH SICKLE CELL DISEASE

Background:Sickle cell disease (SCD) is a hypercoagulable state that results in an increased incidence of thromboembolic events including deep venous thrombosis and pulmonary embolism (PE). However, the diagnosis of acute pulmonary embolism (APE) in individuals with SCD is more difficult due to other potential pulmonary complications such as acute chest syndrome, vaso‐occlusive pain, or an exacerbation of pulmonary hypertension. A D‐dimer is also unreliable in SCD as it is often elevated at baseline. Validated diagnostic tools, such as the Wells criteria are used to determine the likelihood of a healthy person (without SCD) having an APE but these have not been tested in individuals with SCD. Instead, adults with SCD who present to the hospital with chest pain often undergo lung imaging as the first line test although many other pathologies could mimic the presenting symptoms of an APE. Thus, there is often unnecessary exposure to radiation and intravenous contrast for individuals with SCD presenting with chest symptoms in the acute setting.Aims:The primary aim of this study was to evaluate the positive predictive value of the Wells criteria in predicting APE in SCD using a retrospective cohort to potentially identify a new, more specific diagnostic algorithm.Methods:This is a retrospective case cohort study. Index cases were individuals with SCD (confirmed) who underwent a CT of the chest with IV contrast (to assess for a pulmonary embolism) in the emergency department, outpatient clinic or inpatient setting from January 1, 2013 to October 1, 2017. Each encounter was evaluated for demographic data, presenting symptoms, laboratory assessments, final diagnosis and scored using the Wells criteria. Charts were excluded if CT scans were obtained for any other reason than to evaluate for APE or if the patient had did not have SCD.Results:There were 349 charts that fit the inclusion criteria. Most individuals were &gt; 18 years (97%) and female (62%). HbSS was the most common phenotype (80%), followed by HbSC (15%) and HgbS‐Beta thalassemia (6.5%). The overall incidence of APE was 9.7%. The most common final diagnosis was vaso‐occlusive crisis (60%) and/or acute chest syndrome (18%). For patients in this cohort with an APE, the average Wells score was 5.14 (p &lt; .001). Evaluating specifics of the Wells criteria, “signs and symptoms of a DVT” and “PE most likely diagnosis” were additionally statistically significant in determining an APE (p &lt; .020 and p &lt; .001). HbSS genotype (p &lt; .030) was also statistically significant. There was no statistical difference between cases and controls for oxygen saturation, heart rate, hemoglobin, shortness of breath, age or sex. A Wells score &gt;4 provided the best sensitivity (73.5%) and specificity (72%) in our sample. A Wells score of &gt;/5 caused the sensitivity to decline significantly, making the three‐tier model less effective in our population.Summary/Conclusion:The Wells criteria can adequately predict who should undergo a CT with IV contrast to evaluate for APE. When using the Wells criteria, the two‐tier model allowed for the best sensitivity and specificity in our population. Logistic regression analysis did not reveal any variables that increased the sensitivity or specificity to a more specific algorithm than what was attained with the Wells Score. This study is being replicated at other institutions with large sickle cell populations to validate these findings.

Sickle cell disease and venous thromboembolism: A retrospective comparison of the rate of positive CT pulmonary angiography in the emergency department

BackgroundPrevious authors have reported an increased incidence of acute pulmonary embolism (PE) in patients with sickle cell disease (SCD) based on retrospective analysis of ICD codes. It is unknown whether patients with SCD have higher rates of positive CT pulmonary angiogram (CTPA) in the emergency department (ED). MethodsThe institutional review board (IRB) approved this retrospective study; informed consent was waived. Between January 1, 2005 and May 31, 2015, 28 patients with SCD underwent a total of 78 CTPA studies in the ED. A control group of 75 non-SCD patients matched for age, gender and race underwent 78 consecutive CTPA studies in the emergency department. Modified Wells' (mWells') scores were calculated for each CTPA study performed. The studies for both groups were blind read by two fellowship trained body radiologists. Descriptive statistics were performed, with significance considered if p < 0.05. ResultsThe rate of positive CT pulmonary angiogram in patients with SCD was 6.4% (5/78), compared with 12.8% (10/78) in non-SCD matched controls. There was no significant difference in the rate of positive CTPA (p = 0.277). There was also no difference in the mean mWells' score between the two groups (2.44 for SCD vs. 1.95 for controls, p = 0.120). ConclusionSCD patients did not have a significantly different rate of acute PE when compared with matched controls undergoing CTPA in the ED.

Thromboembolism in Hospitalized Cirrhotic Patients

Introduction: Liver disease resets the coagulation hemostasis; leaving the liver cirrhotic individuals at increased risk of bleeding as well as thrombosis. The liver is involved not only in producing coagulation factors, but it also synthesizes anticoagulation factors. The outcome of the study is to investigate the difference between mortality of acute pulmonary embolism and lower extremity deep thrombosis in hospitalized cirrhotic versus noncirrhotic patients. Methods: We performed a retrospective analysis using the de-identified patient data from the national health database, NIS-HCUP, derived from the Nationwide Inpatient Sample (NIS) between January 1, 2014, and December 31, 2014. The incidence of acute pulmonary embolism and lower extremity deep thrombosis was calculated in both cirrhotic and noncirrhotic patients. Hospital visits with the diagnosis of acute pulmonary embolism and lower extremity deep thrombosis were identified using ICD-9 code included in the study. There was further classified based on liver cirrhosis: acute pulmonary embolism and lower extremity deep thrombosis and cirrhotic (case group) and acute pulmonary embolism and lower extremity deep thrombosis in non-cirrhotic patients (control-group). Results: A total of 161,822 admissions (2.3%) for cirrhotic patients and 6909940 (97.7%) for non-cirrhotic patients during the study period. The incidence of acute pulmonary embolism and acute lower extremity deep venous thrombosis was 76475 (1.1%) in the whole cohort. This included 1550 (1%) cases of PE and/or DVT identified in cirrhotic group and 74925 (1.1%) in non-cirrhotic group. The odds of having thrombosis was 0.88 times less in cirrhotic versus non-cirrhotic patients (confidence interval 0.84-0.93). Mortality in cirrhotic patinet with DVT/PE was 142 (9.2%) versus 4645 (6.2%) in noncirrhotic group (OR 1.52, 1.28-1.81). Conclusion: Although cirrhotic patients were found to have lower odds of developing blood clots, they had higher mortality as compared to non-cirrhotic patients. Patients with liver cirrhosis had a longer hospital stay; more hospital cost spent on the admission and more number of diagnoses on discharge as compared to non-cirrhotic patients.

The incidence of acute pulmonary embolism following syncope in anticoagulant-naïve patients: A retrospective cohort study.

BackgroundA recently published, large prospective study showed unexpectedly high prevalence of acute pulmonary embolism (APE) among patients hospitalized for syncope. In such a case, a high incidence of recurrent pulmonary embolism is expected among patients who were discharged without APE workup.ObjectivesTo determine the incidence of symptomatic APE among patients hospitalized for a first episode of syncope and discharged without APE workup or anticoagulation.MethodsThis retrospective cohort study included patients hospitalized at Rambam Health Care Campus between January 2006 and February 2017 with a primary admission diagnosis of syncope, who were not investigated for APE and were not taking anticoagulants. The patients were followed up for up to three years after discharge. The occurrence of venous thromboembolism (VTE) during the follow-up period was documented.ResultsThe median follow-up duration was 33 months. 1,126 subjects completed a three-year follow-up. During this period, 38 patients (3.38%) developed VTE, 17 (1.51%) of them had APE. The cumulative incidence of VTE and APE was 1.9% (95% CI 1.3%-2.5%) and 0.9% (95% CI 0.4%-1.3%) respectively. Only seven subjects developed APE during the first year of follow-up. The median times from the event of syncope to the development of APE and VTE were 18 and 19 months respectively.ConclusionsThe cumulative incidence of VTE during a three-year follow-up period after an episode of syncope is low. In the absence of clinical suspicion, a routine diagnostic workup for APE in patients with syncope cannot be recommended.

Incidence of acute pulmonary embolism, related comorbidities and survival; analysis of a Swedish national cohort

BackgroundThe aim of the study was to determine the incidence of acute pulmonary embolism (PE) in Sweden and any regional differences. To assess short- and long-term survival analysis after an episode of PE, before and after excluding patients with known malignancies, and to determine the most common comorbidities prior to the PE event.MethodsAll in-hospital patients, including children, diagnosed with acute PE in 2005 were retrieved from the Swedish National Patient Registry (NPR) and incidence rates were calculated. All registered comorbidities from 1998 until the index events were collected and survival up to 4 years after the event were calculated and compared to matched controls.ResultsThere were 5793 patients of all ages diagnosed with acute PE in 2005 resulting in a national incidence of 0.6/1000/year. The mean age was 70 years and 52% were women. The most frequent comorbidities were cardiac-, vascular-, infectious- and gastrointestinal diseases, injuries and malignancies. The mortality rates were more than doubled in patients with recent PE compared to that in a matched control group (49.1% vs 21.9%), and the excess mortality remained after exclusion of deaths occurring within one year and after exclusion of patients with any malignancy prior to the event.ConclusionsPE is associated with high age as well as with multiple comorbidities, and with an increased short- and long-term mortality. This study highlights the importance of a proper follow-up after an acute PE.

Massive Pulmonary Embolism In A Postpartum Case of Caesarean Section A Case Report

Introduction : The overall incidence of acute pulmonary embolism is 0.004% per year1; among post-partum women, the incidence of venous thromboembolism is approximately 3 to 7 every 10,000 deliveries, which is 15 to 35 times that of females of the same age who are not pregnant2. Venous thromboembolism contributes to 20% of pregnancy-related mortalities. The highest risk is in the puerperium3. Thrombolysis is standard of care in pulmonary thromboembolism with shock and right ventricular hypokinesia4-7, however, immediate postoperative state compels conventional treatment. Patients do well with anticoagulation and proper supportive treatment as illustrated in this case.Case report : We report a case of a 34-year old female who developed sudden onset breathlessness while walking on the 2nd post-operative day of an uneventful caesarean section. She was dyspneic, cyanosed and in hypotension. CXR was normal, ECG showed S1Q3T3 pattern, and d-dimer was raised. CTPArevealed features of pulmonary embolism. Thrombolysis was contemplated but was abandoned in view of recent surgery. She received anticoagulation with Heparin (and later warfarin) and supportive care including intravenous fluids, oxygen and Dopamine and Doubutamine. She improved and was discharged after 10 days on warfarin anticoagulation.Conclusion: Breathlessness in a patient in the post-operative period or pregnancy should lead to the possibility of pulmonary thromboembolism. PTE with hypotension or RV hypokinesia has a high mortality, merits thrombolysis plus anticoagulation. But patients with contraindication to thrombolysis should receive anticoagulation and standard supportive care. JMS 2016; 19(2):90-94.

Etiologies and treatment of acute pulmonary embolism at Srinagarind Hospital

Background: The incidence of acute pulmonary embolism has been increasing over the past few years. Prevention, early detection and appropriate treatment will decrease morbidity and mortality. Objective: We identified the etiologies and treatment outcomes of acute pulmonary embolism. Methods: We enrolled hospitalized patients diagnosed with acute pulmonary embolism at Srinagarind Hospital between January 1, 2002 and October 31, 2009. Results: Over the eight-year period, 169 patients were diagnosed with acute pulmonary embolism; 95 (56.2%) females and 74 (43.8%) males. The mean age was 54.1 years (range, 18-85). 13% presented with massive pulmonary embolism. The most common presentation was dyspnea (65.1%). Arterial hypoxemia (88.8%) and sinus tachycardia (58.3%) were the common initial clinical findings. Twenty percent of chest radiograph were unremarkable. The most common etiology was cancer (62.1%), mostly solid malignancies (98/105) e.g., cholangiocarcinoma, gynecologic malignancy, and lung cancer. The second and the third common etiologies were immobilization/stasis (8.3%) and connective tissue disease (7.1%). After treatment, 58.6% of the patients improved while 21.3% died in hospital. The main therapeutic modality was anticoagulation. The treated group had better outcomes than those receiving only supportive care. Only one patient underwent thromboembolectomy but died. The complications during treatment were acute respiratory failure (34.9%), shock (18.3%), and bleeding (6.5%). Conclusions: The most common etiology of acute pulmonary embolism was cancer, especially solid malignancies. Immobilization and connective tissue disease were the other common etiologies. The treatment group had a better prognosis than those with supportive care only Keywords: Acute pulmonary embolism, etiology, outcome

Acute pulmonary embolism after pneumonectomy.

Pulmonary embolism (PE) by occlusion of the pulmonary arterial bed may lead to acute life-threatening but potentially reversible right ventricular failure, one of the most severe complications of thoracic surgery. Still, the incidence of acute pulmonary embolism after surgery is reduced by comprehensive anticoagulant prevention, improved surgical techniques, appropriate perioperative management and early ambulation. However, there is difficulty in diagnosing PE after thoracic surgery due to the lack of specific clinical manifestations. So that optimal diagnostic strategy and management according to the clinical presentation and estimated risk of an adverse outcome is fundamental.

Estimated Incidence of Acute Pulmonary Embolism in a Korean Hospital

Patients with acute pulmonary embolism (PE) were identified retrospectively from patients hospitalized during a 2-year period from 2005 to 2007. Among adult patients (≥20 years), the incidence of established acute PE was 88 (0.17%) of 50 882 in Dongsan Hospital. The incidence of acute PE at Dongsan Hospital was 26% lower than that at Henry Ford Hospital (P < .01). Among patients more than 50 years of age, PE was more frequent in women (0.32%; 95% CI, 0.24-0.4) than in men (0.15%; 95% CI, 0.1-0.21; P < .01). Among all patients with PE older than 20 years of age, 68 (0.21%) of 31 869 (95% CI, 0.17-0.26) were from the medical service and 18 (0.08%) of 23 139 (95% CI, 0.04-0.11; P < .01) were from the surgical service. The estimated incidence of PE in a university teaching hospital in Korea was 0.17%, it was about two thirds of that in North America.

Estimated Incidence of Acute Pulmonary Embolism in a Community/Teaching General Hospital

This study attempts to determine the incidence of established acute pulmonary embolism (PE) in a community/teaching general hospital. The reported incidence of objectively diagnosed acute PE among hospitalized adults in a large urban hospital or major university hospital ranges from 0.27 to 0.40%. Whether the incidence of PE in other categories of hospitals fits within this narrow range is unknown. Patients with acute PE diagnosed by ventilation/perfusion lung scan, pulmonary angiography, compression ultrasound in a patient with suspected PE, autopsy, or (by coincidence) lung biopsy were identified among patients hospitalized during a 2-year period from 1998 to 2000. The incidence of PE was also determined according to age, sex, and race. Among adult patients (> or = 20 years old), the incidence of established acute PE was 95 of 34,567 patients (0.27%; 95% confidence interval [CI], 0.22 to 0.34%). No PE was diagnosed in patients < 20 years old. The incidence of PE in men was 36 of 13,722 patients (0.26%; 95% CI, 0.18 to 0.36%); in women, it was 59 of 20,845 patients (0.2%; 95% CI, 0.22 to 0.36%; not significant [NS]). The incidence in African-Americans adults was 10 of 4,344 patients (0.23%; 95% CI, 0.11 to 0.42%); in white adults, it was 84 of 28,615 patients (0.29%; 95% CI, 0.23 to 0.36%; NS). The incidence of PE in a community/teaching general hospital was comparable to the incidence in a large urban-care center and in a major university hospital.