Failure of Therapy at Premortem Diagnosed Pulmonary Thromboembolism

Year 2016, , 237 - 243, 01.09.2016

Aysun Yakar Fatih Yakar Sibel Çağlar Atacan Muhlis Yıldız İbrahim Üzün

https://doi.org/10.5799/jcei.328615

Abstract

Objectives: We analyzed patients diagnosed premortem with pulmonary thromboembolism (PTE), focusing on causes
of failure of therapy together with clinical characteristics.
Methods: This was a retrospective study of 25 cases. We classified PTE as massive, submassive and nonmassive.
Results: Of the 25 cases, 76% (19/25) had two or more risk factors for PTE. The point of origin of PE could be
determined in only 44% of 25 cases. In 20 % (5/25) of cases diagnosed with PTE a maximum 3 months prior to death,
the main cause of death was unknown. Of 10/20 (50%) massive and 8/20 (40%) submassive PTE cases, 5 and 3
underwent thrombolysis therapy, respectively. Both of 2/20 (10%) non-massive PTE cases underwent LMWH; in 1 of
these cases, autopsy showed thrombus of a large pulmonary artery at 25 days after therapy. Submassive PTE cases
were older and had a greater number of risk factors than did massive PTE cases. The point of origin of PTE was a right
heart thrombus in six (24%) cases. Surgeries were performed in 3/6 (50 %) cases with right atrial thrombus. The survival
duration after therapy in those who underwent surgery was longer than those who received thrombolysis and LMWH
therapies.
Conclusions: Physicians may provide appropriate information to patients who have certain risk factors (trauma,
surgery, pregnancy, etc.) to predict acute PE at a preventable stage. If risk factors are present for a prolonged period,
or if new risk factors for PTE are identified, patients should be followed up carefully because of the risk of progression
of thrombosis.

Keywords

Causes, Failure of Treatment, PTE, Clinical Features, Fatal PTE

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