Öz
ABSTRACT: Pulmonary Thromboembolism is a serious disease which can result in mortality and create difficulty from time to time during the diagnosis stage due to the nonspecific clinical course. Our main aim is to evaluate the predisposing factors, clinical correlation, diagnosis procedures and treatment responses in patients who applied to our hospital between May 2010 and May 2013 and got PTE diagnosis. Total 30 patients who got mPTE diagnosis as a result of radiological and echocardiography findings and who were kept under observation by receiving thrombolytic treatment were retrospectively examined in terms of their demographical findings, complication, mortality developed in hospital and recurrence. In total, whose age change between 27 and 90, who got mPTE diagnosis and received thrombolytic treatment were included in the study. Male vs. female rate was 2/3. Mortality developed in 2 patients, who were included in the study. Intracranial hemorrhage which is one of the major complications occurred in only one patient . Recurrence thromboembolism was not followed in none of the patients after the thrombolytic treatment. In mPTE, early diagnosis and rapid treatment are life saving. With the help of the diagnostic methods developing and becoming widespread lately, diagnosis of the mPTE can be made more rapidly and the treatment can be started without losing time. Moreover, it can be said that thrombolytic treatment is definitely a life saving treatment way in mPTE when it is made with close follow-up.
Anahtar Kelimeler
massive pulmonary thromboembolism thrombolytic treatment mortality
Kaynakça
- Cushman M, Tsai A, Heckbert SR, et al. Incidence rates, case fatality, and recurrence rates of deep vein thrombosis and pulmonary embolus: the Longitudinal Investigation of Thromboembolism Etiology (LITE). Thromb Haemost. 2001;86:OC2349. Nielsen HK. Pathophysiology of venous thromboembolism. Semin Thromb Hemost 1991; 17(Suppl 3): 250 Timmons S, Kingston M, Hussain M, et al. Pulmonary embolism: differences in presentation between older and younger patients. Age Ageing 2003;32:601-5. Le Gal G, Righini M, Roy PM, et al. Differential value of risk factors and clinical signs for diagnosing pulmonary embolism according to age. J Thromb Haemost 2005;3:2457-64. Saro G, Campo JF, Hernandez MJ et al. Diagnostic approach to patients with suspected pulmonary embolism:A report from real world. Postgrad Med J 1999;75:285-9. Findik S, Erkan L, Light RW, et al. Massive pulmonary emboli and CT pulmonary angiography. Respiration2008; 76: 403 Tapson VF, Witty LA. Massive pulmonary thromboembolism: Diagnostic and therapeutic strategies. Clin
- Chest Med 1995;16:329-40. Goldhaber SZ, Elliott CG. Acute pulmonary embolism: Epidemiology, pathophysiology and diagnosis. Circulation 2003; 108: 2726-9. James E. Dalen. Pulmonary Embolism: What have we learned since Virchow? Natural History, pathophysiology, and diagnosis. Chest 2002; 122: 1440–56. Markel A, Meissner M, Manzo RA, et al. Deep venous thrombosis: rate of spontaneous lysis and thrombosis extension.
- Int Angiol 2003; 22: 376-82. Piovella F, Crippa L, Barone M, et al. Normalization rates of compression ultrasonography in patients with a first episode of deep venous thrombosis of the lower limbs: association with recurrence and new thrombosis. Haematologica 2002; 87: 515 Nijkeuter M, Honevs M, Davidson B, Huisman MV.
- Resolution of thromboemboli in patients with acute pulmonary embolism; a systematic rewiev. Chest 2006; 129: 192 Levine MN. Thrombolytic therapy for venous thromboembolism: Complications and contraindications. Clin
- Chest Med 1995;16:321-8. Arcasoy SM, Kreit JW. Thrombolytic therapy of pulmonary embolism: A comprehensive review of current evidence. Chest 1999;115:1695-707. Filipecki S, Tomkowski W, Hajduk B, et al. Outcome of patients with clinically acute massive pulmonary embolism. Pneumonol Alergol Pol 1994; 62: 132-7. Aniteye E, Tettey M, Sereboe L, et al. Outcome of trombolysis for massive pulmonary embolism. Ghana Med J 2009; 43: 19-23. Özsu S, Özlü T, Bülbül Y. Ulusal verilerle pulmoner tromboemboli. Tuberk Toraks 2009; 57: 466-82. PIOPED Investigators. Tissue plasminogen activator for the treatment of acute pulmonary embolism: A collaborative study by the PIOPED Investigators. Chest 1990; 97:528-33. Levine M, Hirsh J, Weitz J et al. A randomized trial of a single bolus dosage regimen of recombinant tissue plasminogen activator in patients with acute pulmonary embolism. Chest 1990;98:1473-9. Goldhaber SZ, Haire WD, Feldstein ML et al. Alteplase versus heparin in acute pulmonary embolism: Randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet 1993;341:507-11
Öz
ÖZET: Pulmoner Tromboemboli mortalite ile sonuçlanabilen ve zaman zaman klinik olarak nonspesifik seyir nedeniyle tanı aşamasında zorluk yaşanabilen ciddi bir hastalıktır. Amacımız 2010 mayıs-2013 mayıs süresi içinde hastanemize başvuran ve masif pulmoner tromboemboli tanısı alan 30 hastada predispozan faktörlerin, klinik korelasyonun, tanı yöntemlerinin ve tedavi yanıtlarının değerlendirilmesidir. Klinik bulgular, radyolojik ve ekokardiografi bulguları neticesinde masif pulmoner tromboemboli tanısı konulan ve trombolitik tedavi verilerek yakın takip edilen toplam 30 hasta demografik bulguları, komplikasyon, hastanede gelişen mortalite ve rekürrens açısından retrospektif olarak incelendi. Toplamda yaşları 27 ile 90 arasında değişen masif pulmoner tromboemboli tanısı almış ve trombolitik tedavi verilmiş hasta çalışmaya dahil edildi. Kadın / erkek oranı 2/3'tü. Çalışmaya dahil edilen 2 hastada trombolitik tedaviyi takiben eksitus oluştu. Sadece 1 hastada major komplikasyonlardan olan intrakranial kanama meydana geldi. Hiçbir hastada trombolitik tedavi sonrasında rekürren tromboemboli izlenmedi. Masif pulmoner tromboembolide erken teşhis ve hızlı tedavi hayat kurtarıcıdır. Son dönemlerde gelişen ve yaygınlaşan tanısal metodlarla masif pulmoner tromboembolinin tanısı daha hızlı konabilmekte ve tedaviye başlanabilmektedir. Trombolitik tedavi masif pulmoner tromboemboli de yakın takip ve monitorizasyon ile birlikte yapıldığında hayat kurtarıcıdır.
Anahtar Kelimeler
Kaynakça
- Cushman M, Tsai A, Heckbert SR, et al. Incidence rates, case fatality, and recurrence rates of deep vein thrombosis and pulmonary embolus: the Longitudinal Investigation of Thromboembolism Etiology (LITE). Thromb Haemost. 2001;86:OC2349. Nielsen HK. Pathophysiology of venous thromboembolism. Semin Thromb Hemost 1991; 17(Suppl 3): 250 Timmons S, Kingston M, Hussain M, et al. Pulmonary embolism: differences in presentation between older and younger patients. Age Ageing 2003;32:601-5. Le Gal G, Righini M, Roy PM, et al. Differential value of risk factors and clinical signs for diagnosing pulmonary embolism according to age. J Thromb Haemost 2005;3:2457-64. Saro G, Campo JF, Hernandez MJ et al. Diagnostic approach to patients with suspected pulmonary embolism:A report from real world. Postgrad Med J 1999;75:285-9. Findik S, Erkan L, Light RW, et al. Massive pulmonary emboli and CT pulmonary angiography. Respiration2008; 76: 403 Tapson VF, Witty LA. Massive pulmonary thromboembolism: Diagnostic and therapeutic strategies. Clin
- Chest Med 1995;16:329-40. Goldhaber SZ, Elliott CG. Acute pulmonary embolism: Epidemiology, pathophysiology and diagnosis. Circulation 2003; 108: 2726-9. James E. Dalen. Pulmonary Embolism: What have we learned since Virchow? Natural History, pathophysiology, and diagnosis. Chest 2002; 122: 1440–56. Markel A, Meissner M, Manzo RA, et al. Deep venous thrombosis: rate of spontaneous lysis and thrombosis extension.
- Int Angiol 2003; 22: 376-82. Piovella F, Crippa L, Barone M, et al. Normalization rates of compression ultrasonography in patients with a first episode of deep venous thrombosis of the lower limbs: association with recurrence and new thrombosis. Haematologica 2002; 87: 515 Nijkeuter M, Honevs M, Davidson B, Huisman MV.
- Resolution of thromboemboli in patients with acute pulmonary embolism; a systematic rewiev. Chest 2006; 129: 192 Levine MN. Thrombolytic therapy for venous thromboembolism: Complications and contraindications. Clin
- Chest Med 1995;16:321-8. Arcasoy SM, Kreit JW. Thrombolytic therapy of pulmonary embolism: A comprehensive review of current evidence. Chest 1999;115:1695-707. Filipecki S, Tomkowski W, Hajduk B, et al. Outcome of patients with clinically acute massive pulmonary embolism. Pneumonol Alergol Pol 1994; 62: 132-7. Aniteye E, Tettey M, Sereboe L, et al. Outcome of trombolysis for massive pulmonary embolism. Ghana Med J 2009; 43: 19-23. Özsu S, Özlü T, Bülbül Y. Ulusal verilerle pulmoner tromboemboli. Tuberk Toraks 2009; 57: 466-82. PIOPED Investigators. Tissue plasminogen activator for the treatment of acute pulmonary embolism: A collaborative study by the PIOPED Investigators. Chest 1990; 97:528-33. Levine M, Hirsh J, Weitz J et al. A randomized trial of a single bolus dosage regimen of recombinant tissue plasminogen activator in patients with acute pulmonary embolism. Chest 1990;98:1473-9. Goldhaber SZ, Haire WD, Feldstein ML et al. Alteplase versus heparin in acute pulmonary embolism: Randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet 1993;341:507-11
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Orjinal Çalışma |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Eylül 2013 |
| Yayımlandığı Sayı | Yıl 2013 Cilt: 3 Sayı: 3 |