Cor Vasa 2007, 49(1):19-24 | DOI: 10.33678/cor.2007.009

The incidence, diagnosis, and treatment of pulmonary embolism in a department of medicine. Part 2. Treatment, mortality and a comparison with a group of patients treated in the 1996-1998 period

Jan Mrózek^*, Vladimír Srp, Kamil Novobílský, Petr Černý

II. interní-kardiovaskulární oddělení, Městská nemocnice Ostrava, Ostrava, Česká republika

Background and methods:
These are described in the first part of our article (CV 2006;48/12/:433-440).

Results:
Unfractionated heparin (UFH) was administered to 76 patients (55.8%), low-molecular weight heparin (LMWH) (enoxaparin) s.c. to 55 patients (45.8%). Because of contraindications or bleeding complications, 18 patients (15%) could not receive anticoagulation and/or anticoagulation had to be discontinued. These patients had appreciably higher mortality rates (50%). Thrombolysis was administered to 14 (11.7%) patients, a vena cava inferior venous filter was implanted in 15 patients (12.5%), 19 patients (15.8%) were hospitalized in an intensive care unit, whilst the rest were hospitalized in normal wards or intermediate care units. Nine patients (7.5%) were receiving vasopressor agents. Two (1.7%) patients with severe ileofemoral phlebothrombosis were transferred to a specialist clinic of angiology to receive local thrombolysis. Ten patients of our group died (8.3%), of this number 7 within 24 hours since the onset of symptoms. The following variables were associated with an increased mortality rate: vasopressor administration, hospitalization in an intensive care unit, thrombolysis administration, inability to provide anticoagulation and initial hypotension.
Compared with the group treated in 1996-1998, our current group included fewer hemodynamically unstable patients (with hypotension and/or tachycardia in 8.9 vs. 19%), resulting in lower mortality rates. The range of noninvasive examinations was similar, with the exception of spiral CTA unavailable in the 1996-1998 period. The current group had fewer less invasive examinations (right-heart catheterization in 3.3% vs. 11.3% and pulmonary angiography in 2.5% vs. 8.7%). As regards therapeutic options, there was a clear trend toward increased LMWH use compared with UFH (45.8% vs. 15.7%) and a higher proportion of patients receiving thrombolysis (11.7 vs. 2.6%).

Conclusion:
Treatment of pulmonary embolism (PE) did not vary from the guidelines, i.e., UFH or LMWH administration with continued warfarin administration. Thrombolysis was administered not only to patients with massive PE but, also, to those experiencing submassive PE on an individual basis. The higher mortality rates in our series were associated with the clinical status on admission and the impossibility to administer anticoagulation. When compared with the group of patients treated in our hospital in the 1996-1998 period, our group showed less massive PE and lower mortality rates.

Keywords: Pulmonary embolism; Incidence; Diagnosis; Treatment

Published: January 1, 2007  Show citation