Fatal pulmonary embolism in hospitalised patients: A necropsy review

Article (PDF Available)inJournal of Clinical Pathology 57(12):1254-7 · January 2005with41 Reads
DOI: 10.1136/jcp.2003.013581 · Source: PubMed
Abstract
To carry out a retrospective review of all postmortem reports during the period 1991 to 2000 at King's College Hospital, London, as an extension of a previous analysis performed for the period 1965 to 1990. The number of deaths resulting from necropsy confirmed fatal pulmonary embolism in hospitalised patients was determined, and a limited analysis of the clinical characteristics of those patients who died was performed. During the 10 year period, 16 104 deaths occurred and 6833 (42.4%) necropsies were performed. The outcome measure, fatal pulmonary embolism, was recorded as cause of death in 265 cases (3.9% of all necropsies; 5.2% of adult cases). No deaths from pulmonary embolism occurred in patients under 18 years of age; 80.0% occurred in patients older than 60 years. Of the fatal emboli, 214 of 265 (80.8%) occurred in patients who had not undergone recent surgery. Of these patients, 110 (51.4%) had suffered an acute medical illness in the six weeks before death, most often an acute infectious episode (26 cases). Thromboembolic events remain a relatively common cause of death in hospitalised patients and appear to occur more frequently in non-surgical than in surgical patients.
    • "PE is one manifestation of venous thromboembolism (VTE) and is a frequent, recurrent and potentially fatal disease (Goldhaber and Bounameaux 2012; Goldhaber 2012). PE contributes to 5–10 % of deaths in hospitalized patients and VTE is a leading preventable cause of in-hospitalized death (Alikhan et al. 2004; Cohen et al. 2008). In USA, the incidence of all DVT/PE events is 300,000–600,000 cases per year (approximately 1–2 per 1000 persons per year) and the mortality rates of all DVT/PE events is 60,000–100,000 cases per year (Beckman et al. 2010). "
    [Show abstract] [Hide abstract] ABSTRACT: To evaluate SNPs (single nucleotide polymorphism) in PROC (protein C gene) associated with pulmonary embolism (PE) susceptibility in North Chinese Han population. A case-control study design was used, and patients with PE and healthy participants were enrolled from the Emerging Department of the several hospitals in Weifang, Shandong, China. SNPs in PROC were genotyped using Mass ARRAY system. The allele frequency of rs199469469 was significantly different between PE patients and the control [OR (95 % CI) = 5.00 (1.66–15.12), P = 0.004], and the difference remained significantly after controlling for age and gender [OR (95 % CI) = 5.34 (1.47–19.39), P = 0.011). The G(del)G in the haplotype includes rs1799809|rs199469469|rs2069928 was of a significantly difference (P = 0.016) among PE patients and the controls, and remained significant (P = 0.015) after adjustment for age and sex. Our study reports that PROC SNPs (rs199469469) might be associated with PE susceptibility, with the G allele of rs199469469 serving as the protective factors for incidence of PE. These findings may contribute to the understanding and primary prevention of PE.
    Full-text · Article · Dec 2016
    • "Hospitalization for acute medical illness is a significant risk factor of venous thromboembolism (VTE), accounting for up to 20% of all VTEs and 80% of in-hospital fatal cases of pulmonary embolism.[1][2][3]Pharmacological regimens have been shown to reduce thromboembolic events [4, 5] and for over a decade, consensus guidelines have recommended thromboprophylaxis for high-risk medical patients. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Misuse of thromboprophylaxis may increase preventable complications for hospitalized medical patients. Objectives: To assess the net clinical benefit of a multifaceted intervention in emergency wards (educational lectures, posters, pocket cards, computerized clinical decision support systems and, where feasible, electronic reminders) for the prevention of venous thromboembolism. Patients/methods: Prospective cluster-randomized trial in 27 hospitals. After a pre-intervention period, centers were randomized as either intervention (n = 13) or control (n = 14). All patients over 40 years old, admitted to the emergency room, and hospitalized in a medical ward were included, totaling 1,402 (712 intervention and 690 control) and 15,351 (8,359 intervention and 6,992 control) in the pre-intervention and intervention periods, respectively. Results: Symptomatic venous thromboembolism or major bleeding (primary outcome) occurred at 3 months in 3.1% and 3.2% of patients in the intervention and control groups, respectively (adjusted odds ratio: 1.02 [95% confidence interval: 0.78-1.34]). The rates of thromboembolism (1.9% vs. 1.9%), major bleedings (1.2% vs. 1.3%), and mortality (11.3% vs. 11.1%) did not differ between the groups. Between the pre-intervention and intervention periods, the proportion of patients who received prophylactic anticoagulant treatment more steeply increased in the intervention group (from 35.0% to 48.2%: +13.2%) than the control (40.7% to 44.1%: +3.4%), while the rate of adequate thromboprophylaxis remained stable in both groups (52.4% to 50.9%: -1.5%; 49.1% to 48.8%: -0.3%). Conclusions: Our intervention neither improved adequate prophylaxis nor reduced the rates of clinical events. New strategies are required to improve thromboembolism prevention for hospitalized medical patients. Trial registration: ClinicalTrials.gov NCT01212393.
    Full-text · Article · May 2016
    • "Postoperative VTE, such as deep vein thrombosis (DVT) or pulmonary embolism (PE), results in significant mortality, morbidity, and health-care resource expenditure [1]. Without thromboprophylaxis, the incidence of asymptomatic DVT has been reported to be 40–60% [2] , with approximately 5–10% of deaths among hospitalized patients being associated with PE [3]. Mild and moderate renal impairment has been shown to be associated with an increased risk of unprovoked and provoked http://dx.doi.org/10.1016/j.thromres.2016.05.014 0049-3848/© 2016 Elsevier Ltd. "
    Full-text · Dataset · May 2016 · PLoS ONE
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