Pulmonary Embolism In Younger Patients Research Articles

Association of Cannabis Use Disorder With Hospitalizations for Pulmonary Embolism and Subsequent in-Hospital Mortality in Young Adults: A Contemporary Nationwide Analysis.

With the increase in popularity of cannabis and its use and the lack of large-scale data on cannabis use and venous thromboembolism and pulmonary embolism (PE), we used a nationally representative cohort of young adults (aged 18-44 years) to compare the odds of admissions and in-hospital mortality of PE with and without cannabis use disorder (CUD). Identified patients with PE using the National Inpatient Sample (2018) were compared for baseline, comorbidities, and outcomes. Multivariable regression analysis, adjusted for covariates, was used to compare the odds of PE in young patients with CUD (CUD+) versus those without (CUD-) and those with prior venous thromboembolism. Propensity score-matched analysis (1:6) was also performed to assess in-hospital outcomes. A total of 61 965 (0.7%) of 8 438 858 young adult admissions in 2018 were PE related, of which 1705 (0.6%) had CUD+. On both unadjusted (odds ratio, 0.80 [95% CI, 0.71-0.90]; P<0.001) and adjusted regression analyses, the CUD+ cohort had a lower risk of PE admission. The CUD+ cohort had fewer routine discharges (58.3% versus 68.3%) and higher transfers to short-term (7.9% versus 4.8%) and nursing/intermediate care (12.6% versus 9.5%) (P<0.001). The PE-CUD+ cohort of in-hospital mortality did not differ from the CUD- cohort. Propensity score-matched (1:6) analysis revealed comparable mortality odds with higher median hospital stay and cost in the CUD+ cohort. Young adults with CUD demonstrated lower odds of PE hospitalizations without any association with subsequent in-hospital mortality. The median hospital stay of the CUD+ cohort was longer, they were often transferred to other facilities, and they had a higher cost.

Pulmonary Embolism at High Altitude: Analysis of Risk Factors

Objective: To analyze the risk factors for pulmonary embolism stationed at high altitudes with high altitude as one of the determinants.&#x0D; Study Design: Retrospective longitudinal study.&#x0D; Place and Duration of Study: Combined Military Hospital Skardu Pakistan, from Jan 2016 to Jan 2020.&#x0D; Methodology: A total of 25 consecutive cases with pulmonary embolism reported to this hospital during the study period were enrolled. Medical records of all patients were retrospectively analyzed to determine the risk factors. In addition, patient demographic data, clinical features, and laboratory and radiological findings were recorded.&#x0D; Results: Mean age of the patient was 30.68±5.37 years with a range from 23 to 40 years, the mean height of deployment was 17223.00±3577.00 feet, while the mean duration of stay was 53.92±44.76 days. Dyspnoea (84%) was the commonest clinical presentation followed by palpitation, chest pain, headache and haemoptysis. Most patients (88%) were non-smokers, while no patient had known significant risk factors. Thrombophilia and vascultitic screening were negative for all patients. In the absence of any significant hereditary or acquired risk factor, high altitude remains the only thrombogenic risk factor patients deployed at heights.&#x0D; Conclusion: Stay at a high altitude is a major risk factor for pulmonary embolism in young patients without any other known risk factor.

Rivaroxaban treatment for young patients with pulmonary embolism (Review).

Pulmonary embolism (PE) is a serious, life-threatening condition that affects young populations (>18 and <50 years old, according to most literature reviews) with improved recognition of its clinical manifestations and the widespread use of sensitive imaging techniques, PE is increasingly diagnosed in younger patients. At present, there is limited understanding of the clinical features and adequate anticoagulant treatment options for this population. Most studies to date have yet to demonstrate significant differences in PE pathophysiology or symptoms between young and elderly patients. Although the overall incidence of PE is lower in young populations compared with elderly patients, important risk factors also apply for young patients. Hereditary thrombophilia is common and is a major cause of PE in younger patients. Immobilization, trauma, obesity, smoking and infection are also becoming increasingly frequent in young patients with PE. Among female patients, oral contraceptive use, pregnancy and postpartum status are predominant risk factors underlying PE. Rivaroxaban is a direct oral anticoagulant with a rapid onset of action that is associated with less drug-drug interactions compared with other therapies. Because the drug is administered at fixed doses with no requirement for routine coagulation monitoring, it is becoming an attractive option for anticoagulation treatment in young patients with PE. Therefore, the present literature review focuses on the clinical characteristics of PE and rivaroxaban therapy in younger patients.

Plasma skeletal muscle myosin phenotypes identified by immunoblotting are associated with pulmonary embolism occurrence in young adults

BackgroundPurified skeletal muscle myosin (SkM) binds factor Xa and is procoagulant. The molecular forms of SkM in human plasma have not been characterized. MethodHuman plasma SkM heavy chain (HC) isoforms of different molecular weights were detected by a newly developed immunoblotting protocol. In this pilot study, the distribution of SkM HC antigen isoforms in plasmas of healthy subjects and young adult patients with venous thrombosis was analyzed. ResultsMultiple SkM HC antigen bands were detected in human plasmas, corresponding to full-length SkM HC, heavy meromyosin, or the S1 fragment. Plasma immunoblots of healthy subjects displayed three major phenotypes: Type I with two primary bands for full-length SkM and heavy meromyosin, and two lesser bands including S1 fragment (54%); Type II with bands primarily for full-length SkM HC (34%); and Type III with only a band for the S1 fragment (12%). Plasma SkM HC antigen Type II phenotype was associated with an increased occurrence of isolated pulmonary embolism in younger patients, respectively (≤50 years old). ConclusionsThree SkM HC antigen phenotypes were identified in human plasma by immunoblotting, and Type II phenotype was correlated with the occurrence of isolated pulmonary embolisms in younger patients.

Pulmonary Embolism in Young Patients: About 24 Cases at the Cardiology Department of Dakar Principal Hospital in Senegal

Introduction: Pulmonary embolism is a relatively common life-threatening cardiovascular emergency. It remains a diagnostic problem because of its nonspecific clinical signs. Objective: The general objective was to study pulmonary embolism in young patients admitted to the cardiology department of Dakar Principal Hospital in Senegal. Methodology: This was a retrospective, descriptive and analytical study in the cardiology department of the Dakar Principal Hospital over a period of two (02) years from January 1, 2015 to December 31, 2016 in young patients admitted for pulmonary embolism. Results: We collected 24 patients with a hospital prevalence of 2.18%. The average age was 42.29 years ± 8.41 years with a male predominance (sex ratio of 1.6). The Wells probability score was low in 54.16% of patients and medium in 45.83%. Functional signs were dominated by chest pain (83.33% of cases) followed by dyspnea (79.16% of cases). The thromboembolic risk factors found were gynecological-obstetrical in 16.6% of cases followed by prolonged bed rest. One case of thrombophilia was present with a deficiency of protein C and antithrombin III. The electrocardiogram recorded sinus tachycardia in 29.16% of patients; the Mac Ginn White sign (S1Q3T3) was found in 25% of cases. Echocardiography showed pulmonary arterial hypertension in 12.48% of cases, dilation of the right ventricle and a paradoxical septal motion in 14.28% of cases. CT pulmonary angiography showed 63.63% of cases with bilateral pulmonary embolism; it was unilateral in 22.72% of cases. Long-term anticoagulation was based on acenocoumarol 4 mg (66.7%) and Rivaroxaban (33.3%). 62.5% of the patients were seen at the 3rd month, when a checking was made to evaluate the tolerance of the treatment, and the evolution of the patient. Conclusion: Pulmonary embolism is not a rare condition in young subjects but is often underdiagnosed. Gyneco-obstetrical factors are predominant in this age group. Direct oral anticoagulants are more and more prescribed in our countries.

Acute pulmonary embolism following adolescent idiopathic scoliosis correction surgery: Case report and review of literature

Pulmonary embolism is a significant complication of surgery. This report presents a case of suspected fatal postoperative acute pulmonary embolism following posterior correction surgery in a 16-year-old female with idiopathic scoliosis. The patient presented with a suspected pulmonary embolism 2 h postoperatively. She lost consciousness quickly, and cardiac respiratory arrest occurred. Cardiopulmonary resuscitation was started immediately. The patient was stabilized but underwent a further suspected pulmonary embolism the following day. Cardiopulmonary resuscitation was performed again, but she lost consciousness and respirator support was required. At 40 days after surgery, a computed tomography scan revealed an area of necrotic brain tissue near the lateral cerebral ventricle. The patient remained in a comatose state for 16 months, after which active management was withdrawn. This case reminds us to be alert to potentially fatal postoperative pulmonary embolism in young patients without any risk factors for thrombosis.

Cause of deep venous thrombosis and pulmonary embolism in young patients from India as compared with other ethnic groups

Venous thromboembolism (VTE), which consists of deep vein thrombosis (DVT) and pulmonary embolism, is a potentially fatal disease. The existing Asian literature has shown a wide variation in the prevalence of VTE, with very limited data from India. In the present study, the risk factors for VTE in Indian patients were compared with Caucasians and Blacks. We used data prospectively collected from total of 1396 Indian patients (716 males, 680 females) enrolled over a decade and compared with White (n = 2002) and Black (n = 395) patients objectively diagnosed with VTE. When compared with females, males had significantly higher episodes of pulmonary embolism and VTE (P = 0.0001). Amongst the known thrombophilia markers, only homocysteine was found to be significantly higher in males as compared with females (P = 0.006). Males had a higher proportion of rheumatic heart disease (RHD) and ischaemic heart disease (IHD) as compared with females. The prevalence of DVT amongst Indians was significantly higher as compared with Whites and Blacks. However, the rate of pulmonary embolism and VTE was lower in Indians as compared with both the races. Amongst the baseline characteristics identified as risk factors for VTE, Indians had a higher prevalence of infection as compared to both Whites and Blacks, but lower HIV infection as compared to Blacks. As compared to Whites, Indians had lower prevalence of idiopathic VTE (but similar to blacks) and had higher prevalence of idiopathic pulmonary embolism (P < 0.0001). This can be explained by different inherited and environment risk factors between these three populations.

A nationwide, retrospective analysis of symptoms, comorbidities, medical care and autopsy findings in cases of fatal pulmonary embolism in younger patients.

Our objective was to provide a comprehensive description of fatal pulmonary embolism (PE) in younger persons. Specifically, we recorded information on symptoms, comorbidity, medical contact, if this had been required, and subsequent autopsy findings. We reviewed all death certificates from persons aged 0-35 years who had died between 1 January 2000 and 31 December 2006, and retrospectively identified all cases of fatal PE. Additional information was retrieved from the National Patient Registry, autopsy reports, and clinical charts. Sixty-one cases of fatal PE were included; 38% of these were in males. The median age was 29 years. The predominant symptoms were dyspnea, syncope, leg pains, and chest pains. Sixty-three per cent of patients reportedly experienced symptoms for days, weeks, or months. More than half of the patients had sought medical care, and at the time of medical evaluation the majority of the patients were not hemodynamically compromised. In 21% cases, the correct diagnosis was reached before death; however, in only 5% of cases was this accomplished before clinical deterioration. Furthermore, clinical history and subsequent postmortem examinations showed that approximately half of younger persons dying from PE were otherwise healthy, and in no case was occult cancer diagnosed. Our data show that a substantial proportion of younger victims of fatal PE had experienced symptoms for an extended period of time. Furthermore, the correct diagnosis remained elusive in the majority of cases, even though approximately half of the subjects had sought medical evaluation for symptoms that, in retrospect, were most likely caused by a venothrombotic event.

Incidence of pulmonary embolism and other chest findings in younger patients using multidetector computed tomography

Multidetector computed tomography (MDCT) has become the first-line modality for imaging patients with suspected pulmonary embolism (PE). The disadvantages of MDCT, the use of ionizing radiation and iodinated contrast agents, are a reasonable cause of concern, especially in young patients, and therefore it is critical to understand the likelihood of PE in these patients to evaluate a risk benefit analysis. To calculate the incidence of PE and other chest findings on MDCT in a young adult population investigated for PE. 387 consecutive patients (age 31.5+/-13.5 years) underwent chest MDCT for clinically suspected PE between January 2004 and August 2006. Incidence of PE and other chest findings were calculated with a confidence interval of 95% using binomial distribution. PE incidence was 5%; negative PE with other chest findings was 60%. In 89% of the patients with other chest findings, these included findings of the pleura and/or lung parenchyma. The main patterns of disease were lung opacification suggesting pneumonia (41%), atelectasis (12.4%), and nodular/mass findings (17.5%). In 34% of the patients, there was no PE and no other findings present. There is a low incidence of PE in young patients imaged for PE with MDCT.