assesment of pulmonary thromboembolism patients diagnosed in our clinic a. Şimşek , g.Ö....
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ASSESMENT OF PULMONARY THROMBOEMBOLISM PATIENTS DIAGNOSED IN OUR CLINIC A. Şimşek , G.Ö. Türkkan, K. Melek F.Ö.Eyüboğlu. University of Baskent, Department of Chest Disease. INTRODUCTION. - PowerPoint PPT PresentationTRANSCRIPT
ASSESMENT OF PULMONARY THROMBOEMBOLISM
PATIENTS DIAGNOSED IN OUR CLINIC
A. Şimşek, G.Ö. Türkkan, K. Melek
F.Ö.Eyüboğlu
University of Baskent, Department of Chest Disease
INTRODUCTION
• Venous thromboemboli (VTE) is the third most common cardiovascular disease after the ischemic heart disease and stroke.
• The risk of PTE increases with advanced age
• It was seen in male and female with same ratio
PULMONARY THROMBOEMBOLISM (PTE)
• Annual incidence : 0.23-1.83/1000
• Mortality rate :– without treatment: 30 %– with treatment: 14.7
• Cause can not be identified at 19-47%
• Recurrance:– First year: 7-8 %
– After 8-10 years: 30 %
RISK FACTORS FOR PTE
• Immobilization• Malignancy
• Trauma• Advanced age• Cardiopulmonary dis.
• Surgery• Previous VTE• Obesity• Cerebrovasculary disease• OC usage
ACQUIRED RISK FACTORS
RISK FACTORS
• Antiphospholipid Antibody Synd
• Prothrombin 20210 A mut.
• Increased Lipoprotein A • Methylentetrahydrofolate
reductase mutation(?)
GENETIC RISK FACTORS
• Antithrombin III deff
• Protein C defficiency
• Protein S defficiency
• FV Leiden mutation
• Hyperhomocysteinemie
AIM
The aim of this study was to define risk factors for PTE, clinical characteristics, demographic data of subjects, diagnostic procedures, and treatment responses
MATERIAL AND METHOD
We retrospectively analysed data from 164 patients admitted to our clinic with PTE in our hospital between 2000 to 2005
MATERIAL AND METHOD • Sex• Age• Risk factors• Symptoms• Thorax CT• Lower extremities
venous doppler US
MATERIAL AND METHOD
• Severity of PTE
• Drugs used for treatment
• Mortality rate
• Recurrance rate
RESULTS
• Female ratio : 55.5 %• Male ratio : 44.5 %
• Mean Age : - Female : 69.3 ± 13.6 - Male : 62.7 ± 18.3 - General : 66.3 ± 16.1
RESULTS
• Risk factors for PTE were absent in 25.6% of patients (idiopathic)
29,9%
15,2%
1,2%0,6%
12,5%
6,1%9,2%
28%
16,5% Immobilization
Surgery
Heart Failure
Malignancy
Trauma
Previous VTE
OralContraceptiveVasculitis
Cerebrovasculary disease
RISK FACTORS FOR PTE
2,1%
4,5% 4,5%6,5%
6,5%
8,7%
10,8%13%
39%
Lower extremitysurgeryThorax-lumbalsurgeryGynecologicalsurgeryCoronary arterialbypass graftAbdominoplasty
Urological surgery
Cranial
Aorta surgery
Cataract surgery
Rectum Surgery
Mastectomy
Tympanectomy
SURGERY TYPE
13,6%
18,1%
4,5% 9%9%
13,6%
13,6%13,6%
Prostate
Liver
Breast
Heamatologic
GIS
Lung
Gynecologic
Surrenal
MALIGNANCY
76.2
50
26.823.8
15.914.6 148.5 6.1
01020304050607080 Dyspnea
Chest pain
Edema,rednessat extremitiesCough
Fever
Weakness
Sputum
hemoptysis
syncope
SYMPTOMS
38,4
16,5
11,6
84,8
63,6
4,2
33,1
11,9
0 20 40 60 80 100
Tachycardia
Hypotention
Tacypnea
Hypoxia
Hypocapnia
Hypercapnia
Res.alcalosis
Acidosis
Arterial blood gasesPhysical examination
SIGNS
Bilateral embolism 70.7 %
Unilateral embolism
- Right
- Left
29.3 %
61.4 %
38.6 %
LOCALIZATION OF PTE
Minör embolism 62.3 %
Submassive embolism 21 %
Massive embolism 16.7 %
SEVERITY OF PTE
THROMBUS (+) 45.6 %
THROMBUS (-) 54.4 %
BILATERAL 23.5 %
UNILATERAL -RIGHT -LEFT
76.5 % - 59.6 % - 40.3 %
PRESENCE OF LOWER EXTREMİTES VENOUS THROMBUS
The ratio of cardiac thrombus was 5.5 %
Heparin 68.3 %
Low moleculer weight heparin
43.3 %
Warfarin 84.8 %
Thrombolytic drugs 9.8 %
DRUGS USED FOR TREATMENT
Mortality 11 %
Recurrance 14.8 %
FOLLOW UP
DISCUSSION
• Most frequently seen risk factors– Immobilization– Surgery
• Most frequently seen surgery
Sugery to lower extremities
Idiopathic Immobilisation Surgery Malignancy Heart Failure
Trauma Previous VTE
ICOPER(1999)
19 % 28.1 % 28.9 % 22.5 % 10.5 % 11.2 % 24.9 %
Heit et al.(2000)
26 % 59 % 24 % 18 % 10 % 12 % 5 %
Cushman et al(2001)
47 % 25 % 25 %
Richard at al(2003)
41 % 23 % 18 % 2 %
Present Study( 2007)
25.6 % 29.9 % 28 % 12.8 % 16.5 % 9.2 % 6.1 %
RISK FACTORS FOR PULMONARY EMBOLISM
Prostate CA
Liver CA Breast CA Lung CA Colon CA Pancreas CA
Rickler ve ark.(1983)
6.5 % 2 % 25.6 % 15.2 % 17.4 %
Levitan et al(1999)
17 % 21 % 18 %
Kolomansky et al(2006)
14 % 16 % 11 % 10 %
Present Study(2007)
18.1 % 13.6 % 13.6 % 9 % 4.5 %
MALIGNANCY RATES IN PULMONARY THROMBOEMBOLISM
In this study;
• Lung and rectum cancer rates were lower than other studies
• Liver cancer rate was higher than other studies
• Pancreas cancer was not seen anymore
• According to our study, all malignancies can cause PTE
• Our hospital is a solid organ transplantation center, for that reason liver cancer rate might be found high
• Lower ext. thrombus rate
• Cardiac thrombus rateSimilar with literature
Recurrance rate was higher than literature
Recurrance Rate(%)
Prandoni et al (1996) 8.6 %
ICOPER (1999) 7.9 %
Hansson et al (2000) 7 %
Heit et al (2000) 12.9 %
Cushman et al (2001) 7.7 %
Our study (2007) 14.8 %
RECURRANCE RATE IN PULMONARY EMBOLISM
• The reason of high recurrance rate of PTE in our study may be associated with long term (5 year) follow up
• Long term follow up is more informative than 6-12 months follow up in determining recurrance rate
• Mortality rate was lower than literature
• Early diagnosis• Early treatment• Long term follow up
Effective in determining low mortality rates
Mortality Rate (%)
Anderson et al (1991) 25 %
ICOPER (1999) 17.4 %
Cushman et al (2001) 15.1 %
Murin et al (2002) 14.7 %
Our study (2007) 11 %
MORTALITY RATES IN PULMONARY EMBOLISM
RESULTS In order to determine correct recurrance
rates, 5 year follow up is necessary Long term and near follow up may reduce
mortality In presence of malignancy, VTE should be
kept in mind as a complication Because of high rate of idiopathic PTE,
hereditary thrombophylic factors should be searched in all patients