Research Article
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Diagnosis and treatment of acute pulmonary embolism: A single center experience

Year 2022, Volume: 6 Issue: 1, 87 - 92, 27.03.2022
https://doi.org/10.30565/medalanya.1017887

Abstract

Aim: Pulmonary embolism is a potentially life-threatening cardiovascular disease frequently encountered in emergency departments. The computed tomography pulmonary angiography is the imaging modality of choice in the diagnosis of pulmonary embolism. This study aimed to examine the effects of clinical findings and treatment methods on prognosis and mortality by examining patients diagnosed with acute pulmonary embolism in the emergency department.

Methods: In this retrospective cohort study, records of patients with acute pulmonary embolism were accessed from the archive. Patients' age, gender, medical complaints, co-morbidities, the treatment method applied to the patients, and the clinical outcomes of the patients were analyzed. The statistical distribution of the patients' demographic and clinical information was calculated.

Results: The most common complaint of 206 patients with acute pulmonary embolism was dyspnea. 25.7% patients had massive pulmonary embolism. The blood d-dimer, lactate and troponin T levels of patients with massive pulmonary embolism were found to be higher than patients with sub-massive pulmonary embolism. Thrombolytic therapy was administered to 6.8% of acute pulmonary embolism patients and it was found to be a method that had a statistically positive effect on survival. D-dimer, white blood cell, neutrophil, blood urea nitrogen, lactate and troponin T values were found to be higher in mortal patients. It was determined that 13.1% of the patients died.

Conclusion: The sooner the early diagnosis of acute pulmonary embolism, which can be mortal in the emergency department, is made and the treatment is started, the mortality rate will decrease significantly.

References

  • 1. Jia D, Liu F, Zhang Q, Zeng GQ, Li XL, Hou G. Rapid on-site evaluation of routine biochemical parameters to predict right ventricular dysfunction in and the prognosis of patients with acute pulmonary embolism upon admission to the emergency room. J Clin Lab Anal. 2018;32(4):e22362. PMID: 29160572.
  • 2. Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ, et al. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol. 2014;34(11):2363-71. PMID: 25304324. 3. Wendelboe AM, Raskob GE. Global burden of thrombosis: epidemiologic aspects. Circ Res. 2016;118(9):1340-7. PMID: 27126645
  • 4. Crous-Bou M, Harrington LB, Kabrhel C. Environmental and genetic risk factors associated with venous thromboembolism. Semin Thromb Hemost. 2016;42(8):808-20. PMID: 27764878.
  • 5. 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):1524-31. PMID: 27797317.
  • 6. Penaloza A, Verschuren F, Meyer G, Quentin-Georget S, Soulie C, Thys F, Roy PM. Comparison of the unstructured clinician gestalt, the wells score, and the revised Geneva score to estimate pretest probability for suspected pulmonary embolism. Ann Emerg Med. 2013;62(2):117-124.e2. PMID: 23433653.
  • 7. Corrigan D, Prucnal C, Kabrhel C. Pulmonary embolism: the diagnosis, risk-stratification, treatment and disposition of emergency department patients. Clin Exp Emerg Med. 2016;3(3):117-25. PMID: 27752629.
  • 8. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 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. PMID: 31504429.
  • 9. Arseven O, Bingöl Z, Öngen HG, Uzun O, Okumuş NF. Pulmoner tromboembolizm tanı ve tedavi uzlaşı raporu 2021. Ankara: Optimus Yayıncılık; 2021. p. 13-17
  • 10. Sevim T, Ataç G, Öngen A, Özmen İ, Kapaklı N, Horzum G, et al. Evaluation of 25 patients with pulmonary embolism. Solunum Hastalıkları. 2001;12(1):39-43.
  • 11. Darılmaz Yüce G, Ortaç Ersoy E, Ergün R, Fırat H, Ardıç S. Retrospective Evaluation of Pulmonary Thromboembolism Patients. Solunum. 2013;15(2):109-14. doi:10.5152/solunum.2013.020.
  • 12. Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 Suppl):338S-400S. PMID: 15383478.
  • 13. Cohoon KP, Heit JA. Inherited and secondary thrombophilia. Circulation. 2014;129(2):254-7. PMID: 24421360.
  • 14. Goldhaber SZ. Echocardiography in the management of pulmonary embolism. Ann Intern Med. 2002;136(9):691-700. PMID: 11992305.
  • 15. Çalışkan HM, Eren ŞH, Taner A, Tülümen E, Demirbaş HM, Kaya Ş. Unnoticed symptoms of pulmonary embolism: Vertigo and syncope. Cumhuriyet Med J. 2014;36(3):382-7. doi: 10.7197/cmj.v36i3.5000006073
  • 16. Çil E, Karadeniz G. The Relationship Between Neutrophil Lymphocyte Ratio and Troponın I in Pulmonary Thromboembolism Patients. Tepecik Eğit. ve Araşt. Hast. Dergisi. 2021;31(1):53-7. doi:10.5222/terh.2021.59489
  • 17. Karalezli A. Pulmonary Embolism. Güncel göğüs hastalıkları serisi. 2018;6(2):16-35. doi:10.5152/gghs.2018.014

Akut pulmoner emboli tanı ve tedavisi: Tek merkez deneyimi

Year 2022, Volume: 6 Issue: 1, 87 - 92, 27.03.2022
https://doi.org/10.30565/medalanya.1017887

Abstract

Amaç: Pulmoner emboli, acil servislerde sıklıkla karşılaşılan, potansiyel olarak yaşamı tehdit eden bir kardiyovasküler hastalıktır. Bilgisayarlı tomografi pulmoner anjiyografi, pulmoner emboli tanısında tercih edilen görüntüleme yöntemidir. Bu çalışmada, acil serviste akut pulmoner emboli tanısı konulan hastaları inceleyerek klinik bulguların ve tedavi yöntemlerinin prognoz ve mortalite üzerine etkilerini incelemeyi amaçladık.

Yöntem: Bu retrospektif kohort çalışmada akut pulmoner emboli hastalarının kayıtlarına arşivden ulaşıldı. Hastaların yaşı, cinsiyeti, tıbbi şikayetleri, ek hastalıkları, hastalara uygulanan tedavi yöntemi ve hastaların klinik sonuçları analiz edildi. Hastaların demografik ve klinik bilgilerinin istatistiksel dağılımı hesaplandı.

Bulgular: Akut pulmoner embolili 206 hastanın en sık şikayeti nefes darlığıydı. Hastaların %25.7'sinde masif pulmoner emboli vardı. Masif pulmoner emboli hastalarında kan d-dimer, laktat ve troponin T düzeyleri submasif pulmoner emboli hastalarına göre daha yüksek bulundu. Akut pulmoner emboli hastalarının %6.8'ine trombolitik tedavi uygulanmış ve sağ kalımı istatistiksel olarak olumlu etkileyen bir yöntem olduğu saptanmıştır. Mortal hastalarda d-dimer, beyaz küre, nötrofil, kan üre nitrojen, laktat ve troponin T değerleri daha yüksek bulundu. Hastaların %13.1'inin hayatını kaybettiği belirlendi.

Sonuç: Acil serviste ölümcül olabilen akut pulmoner emboli ne kadar erken teşhis edilir ve tedavisine başlanırsa mortalite oranı önemli ölçüde azalacaktır.

References

  • 1. Jia D, Liu F, Zhang Q, Zeng GQ, Li XL, Hou G. Rapid on-site evaluation of routine biochemical parameters to predict right ventricular dysfunction in and the prognosis of patients with acute pulmonary embolism upon admission to the emergency room. J Clin Lab Anal. 2018;32(4):e22362. PMID: 29160572.
  • 2. Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ, et al. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol. 2014;34(11):2363-71. PMID: 25304324. 3. Wendelboe AM, Raskob GE. Global burden of thrombosis: epidemiologic aspects. Circ Res. 2016;118(9):1340-7. PMID: 27126645
  • 4. Crous-Bou M, Harrington LB, Kabrhel C. Environmental and genetic risk factors associated with venous thromboembolism. Semin Thromb Hemost. 2016;42(8):808-20. PMID: 27764878.
  • 5. 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):1524-31. PMID: 27797317.
  • 6. Penaloza A, Verschuren F, Meyer G, Quentin-Georget S, Soulie C, Thys F, Roy PM. Comparison of the unstructured clinician gestalt, the wells score, and the revised Geneva score to estimate pretest probability for suspected pulmonary embolism. Ann Emerg Med. 2013;62(2):117-124.e2. PMID: 23433653.
  • 7. Corrigan D, Prucnal C, Kabrhel C. Pulmonary embolism: the diagnosis, risk-stratification, treatment and disposition of emergency department patients. Clin Exp Emerg Med. 2016;3(3):117-25. PMID: 27752629.
  • 8. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 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. PMID: 31504429.
  • 9. Arseven O, Bingöl Z, Öngen HG, Uzun O, Okumuş NF. Pulmoner tromboembolizm tanı ve tedavi uzlaşı raporu 2021. Ankara: Optimus Yayıncılık; 2021. p. 13-17
  • 10. Sevim T, Ataç G, Öngen A, Özmen İ, Kapaklı N, Horzum G, et al. Evaluation of 25 patients with pulmonary embolism. Solunum Hastalıkları. 2001;12(1):39-43.
  • 11. Darılmaz Yüce G, Ortaç Ersoy E, Ergün R, Fırat H, Ardıç S. Retrospective Evaluation of Pulmonary Thromboembolism Patients. Solunum. 2013;15(2):109-14. doi:10.5152/solunum.2013.020.
  • 12. Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 Suppl):338S-400S. PMID: 15383478.
  • 13. Cohoon KP, Heit JA. Inherited and secondary thrombophilia. Circulation. 2014;129(2):254-7. PMID: 24421360.
  • 14. Goldhaber SZ. Echocardiography in the management of pulmonary embolism. Ann Intern Med. 2002;136(9):691-700. PMID: 11992305.
  • 15. Çalışkan HM, Eren ŞH, Taner A, Tülümen E, Demirbaş HM, Kaya Ş. Unnoticed symptoms of pulmonary embolism: Vertigo and syncope. Cumhuriyet Med J. 2014;36(3):382-7. doi: 10.7197/cmj.v36i3.5000006073
  • 16. Çil E, Karadeniz G. The Relationship Between Neutrophil Lymphocyte Ratio and Troponın I in Pulmonary Thromboembolism Patients. Tepecik Eğit. ve Araşt. Hast. Dergisi. 2021;31(1):53-7. doi:10.5222/terh.2021.59489
  • 17. Karalezli A. Pulmonary Embolism. Güncel göğüs hastalıkları serisi. 2018;6(2):16-35. doi:10.5152/gghs.2018.014
There are 16 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases
Journal Section Research Article
Authors

Ayşe Ertekin 0000-0002-9947-9917

Aydın Balcı 0000-0002-6723-2418

Erhan Bozkurt 0000-0002-1853-7098

Emre Atay 0000-0002-2378-1183

Ramazan Sami Aktaş 0000-0003-1072-382X

Publication Date March 27, 2022
Submission Date November 3, 2021
Acceptance Date January 21, 2022
Published in Issue Year 2022 Volume: 6 Issue: 1

Cite

Vancouver Ertekin A, Balcı A, Bozkurt E, Atay E, Aktaş RS. Diagnosis and treatment of acute pulmonary embolism: A single center experience. Acta Med. Alanya. 2022;6(1):87-92.

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