Failure of Therapy at Premortem Diagnosed Pulmonary Thromboembolism

Yıl 2016, , 237 - 243, 01.09.2016

Aysun Yakar Fatih Yakar Sibel Çağlar Atacan Muhlis Yıldız İbrahim Üzün

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• 1. Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. European Heart J 2014; 35:3033-3080.
• 2. Kürkciyan I, Meron H, Sterz F, et al. Pulmonary embolism as cause of cardiac arrest. Arch Intern Med 2000; 160:1529-1535.
• 3. Böttiger BW, Böhner H, Bach A, et al. Bolus injection of thrombolytic agents during cardiopulmonary resuscitation for massive pulmonary embolism. Resuscitation 1994; 28:45-54.
• 4. Konstantinides SV, Geibel A, Heusel G, et al. Heparin plus Alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med 2002; 347:1143-50.
• 5. Agnelli G, Becattini C, Kirschstein T. Thrombolysis vs. heparin in the treatment of pulmonary embolism. Clinical outcome based meta-analysis. Arch Intern Med 2002; 162:2537-2541.
• 6. Meneveau N, Séronde MF, Blonde MC, et al. Management of Unsuccessful Thrombolysis in Acute Massive Pulmonary Embolism. Chest 2006;129:1043–1050.
• 7. Wood KE. Major Pulmonary Embolism. Crit Care Clin 2011;27:885-906.
• 8. Saad N. Aggressive Management of Pulmonary Embolism. Semin Intervent Radiol 2012; 29:52-56.
• 9. Bensaid Y, Ameur A, Kabiri H, et al. Arterial complications of Behcet’s disease. Report of 13 cases. J Mal Vasc 1997; 22:24-28.
• 10. Marik PE, Plante L.A. Venous Thromboembolic Disease and Pregnancy. N Engl J Med 2008;359:2025-33.
• 11. Wartman WB, Hellerstein HK. The incidence of heart disease in 2000 consecutive autopsies. Ann Intern Med 1948; 28:41-65.
• 12. Kinney EL, Wright RJ. Efficacy of treatment of patients with echocardiographically detected rightsided heart thrombi-a meta analysis. Curriculum in Cardiology, Feb. 9,1989.
• 13. European Working Group on Echocardiography and pulmonary embolism. Ann Intern Med 1977;7:720-721.
• 14. Farfel Z, Shechter M, Vered Z, et al. Review of echocardiographically diagnosed right heart entrapment of pulmonary emboli in transit with emphasis on management. Am Heart J 1987;113:171-178.
• 15. Panidis IP, Kotler MN, Mintz GS, et al. Clinical and echocardiographic features of right atrial masses. Am Heart J 1984;107:745-758.
• 16. Rose PS, Punjabi NM, Pearse DB. Treatment of right heart thromboemboli. Chest 2002; 121:806-814.
• 17. Pierre-Justin G, Pierard LA. Management of mobile right hearts thrombi: A prospective series. Int J Cardiol 2005; 99:381-388. 18. Mohan B, Chhabra ST, Gulati A, et al. Clinical and echocardiographic diagnosis, follow up and management of right sided cardiac thrombi. Indian Heart J 2013; 65:529-535.
• 19. Torbicki A, Galie N, Covezzoli A, et al. Right Heart Thrombi in Pulmonary Embolism. Results from the International Cooperative Pulmonary Embolism Registry. Journal of the American College of Cardiology 2003;41:2245-2251.
• 20. Sahin M, Arslan C, Tunc SE, et al. A fatal case of Behçet’s disease with rare complications. Saudi Med J 2006; 27 (11):1754–1757.
• 21. Kale A, Akyıldız L, Akdeniz N, et al. Pregnancy complicated by superior vena cava thrombosis and pulmonary embolism in a patient with Behçet’s disease and the use of heparin for treatment. Saudi Med J 2006;27(1):95-97.
• 22. Saghil G, Doghmil N. Intracardiac thrombosis in Behçet’s disease: a rare complication. Pan Afr Med J 2013;15:91. 23. Marc K, Iraqui G, Jniene A, et al. [Intracardiac thrombus and pulmonary artery aneurysm in Behçet’s disease]. Rev Mal Respir, 2008; 25(1):69-72.
• 24. Xing W, Swaminathan G, Appadorai DR, et al. Rare Case of Behçet’s Disease Presenting with Pyrexia of Unknown Origin, Pulmonary Embolism, and Right Ventricular Thrombus. Int J Angiol, 2013;22:193-198.
• 25. Chang JE, Lee YH, Lee J. Multiple cardiovascular complications in a patient with Behcet’s disease. Korean J Intern Med 2008; 23 (2):100–102.
• 26. San Luis Miranda R, Lázaro Castillo JL, Enciso Gómez R, et al. [Right ventricular thrombus and pulmonary artery aneurysms in Behçet’s disease. Report of one case]. Arch Cardiol Mex, 2007;77(2):130–136.
• 27. Desbois AC, Wechsler B, Resche-Rigon M, et al. Immunosuppressants reduce venous thrombosis relapse in Behçet's disease.Arthritis Rheum 2012;64:2753-60.
• 28. Hammami R, Abid L, Frikha F, et al. Intracardiac Thrombus in a Young Man: Don’t Forget Behçet’s Disease. Intern Med 2012; 51:1865-1867.
• 29. Dogan SM, Birdane A, Korkmaz C, et al. Right ventricular thrombus with Behçet’s syndrome: successful treatment with warfarin and immunosuppressive agents. Tex Heart Inst J 2007;34:360-362.
• 30. Stein PD, Goodman LR, Hull RD, et al. Diagnosis and management of isolated subsegmental pulmonary embolism; review and assessment of the options. Clin Appl Thromb Hemost 2012;18:20-26.