Abstract Number: PB0085
Meeting: ISTH 2020 Congress
Background: Timely diagnosis of pulmonary thromboembolism(PTE) is remaining problem in general practice and emergency department. Deep vein thrombosis(DVT) less often precedes PTE.
Aims: Aim of our study was to determine the most frequent reasons of PTE in general practice.
Methods: We observed 15 patients with acute respiratory insufficiency suspected for PTE. Besides common investigations was studied D-dimer, all patients were estimated according to revised Geneva clinical prediction rule for PTE. Patients with high or intermediate clinical probability of PTE were studied by computed tomographic pulmonary angiography (CTPA).
Results: Though in all these patients D-dimer was above age-adjusted cut-off level (1200 – 7520 µg/L), CTPA study confirmed PTE only in 10 patients. Among them echocardiologic evaluation revealed right ventricular enlargement, highly or severely increased PASP only in 6 patients, decreased TAPSE in 3 patients. DVP preceded PTE only in 2 cases (one 70-year-old woman with atherosclerosis, one 24-year-old woman with congenital MTHFR gene C677T homozygous mutation). The rest 8 patients were at age of 59-86 year (2men, 6-women) with arterial hypertension, atherosclerosis and/or heart failure as comorbidities and acute pneumonia, that appeared main trigger for the development of PTE. 2 patients were hemodynamically unstable during first 2 days. In coagulation tests INR and APPT was at the low level of normal range, fibrinogen was more than 4g/L in 5 patients (2 had >6g/L). All patients improved. Besides symptomatic appropriate therapy (antibiotics in cases of pneumonia) in acute stage patients were treated with UF Heparin on the 1st day, then with LMW Heparin for 7-10 days, continued with Rivaroxaban 30mg/day for a month and 20mg/day for 2-3months.
Conclusions: Our study shows that in all elderly patients with acute pneumonia, especially with high or intermediate clinical probability of PTE besides echocardiography, coagulation tests and D-dimmer should be investigated CTPA to precise diagnosis, give adequate treatment and escape complications.
To cite this abstract in AMA style:Saralidze T, Svanidze T, Mamatsashvili I, Gogokhia N, Noniashvili M. Pulmonary Thromboembolism in General Practice [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/pulmonary-thromboembolism-in-general-practice/. Accessed October 1, 2023.
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