Abstract Number: PB2318
Meeting: ISTH 2020 Congress
Background: Saddle pulmonary embolism (PE) is an uncommon type of venous thromboembolism (VTE) that can lead to sudden hemodynamic collapse and death. Saddle PE can be difficult to recognize, and data on its presentation, clinical features and associated complications are sparse.
Aims: To describe the demographics, presentation and outcomes of saddle PE.
Methods: Montage software (Nuance®, Burlington MA, US) was used to retrospectively identify patients >18 years of age that had been diagnosed with saddle PE from 1/1/2012 to 12/31/2018. Charts were reviewed for demographics, diagnostics, laboratory data, presenting vital signs, presence of DVT or malignancy, choice of anticoagulation and thrombolysis, in-hospital mortality, 6-month survival, and incidence of recurrent VTE.
Results: 120 patients with saddle PE were identified. Median age was 61 years and 57.5% were women. Events were provoked by a transient risk factor in 44.2%. We found a 9.2% in-hospital mortality and an 81% 6-month survival. In-hospital mortality was higher in women (11.6%), compared to men (3.9%) but this was not significant (p=0.28). Both Ventilation/Perfusion (VP) scans and CTPA were performed in 10 patients. None of the VP scans diagnosed the saddle PE; 6/10 diagnosed peripheral PEs and 4 were indeterminate. On presentation, mean systolic/diastolic blood pressures were 128.6/75.9 mmHg and mean heart rate was 103.8 bpm. Only 5% of patients presented with vitals concerning for massive PE. Right heart strain was present in 70/104 (67.3%). Thrombus was visualized in the right heart in 8/104 (7.7%) and this group had a 37.5% in-hospital mortality. Systemic tPA was administered in 19.2% of cases. Recurrent VTE occurred in 13/109 (11.9%) of survivors.
Conclusions: Despite presenting without accepted criteria for massive PE, saddle PE has a very high in-hospital mortality. VP scan is unable to diagnose saddle PE. Visualized right heart thrombi portend an even higher in-hospital mortality.
|Age, median (range)||61 (28-94)||Oxygen saturation, (range)||94.8 (78-100)||DVT Laterality|
|Race||Systolic BP, median (range)||126 (78 – 188)||Left||29 (23.3)|
|White, n (%)||28 (23.3)||Diastolic BP, median (range)||77 (26 – 122)||Right||32 (27.5)|
|Black, n (%)||54 (45.0)||Heart rate, median (range)||104 (60-150)||Bilateral||17 (15.0)|
|Other, n (%)||38 (31.7)||Respiratory rate, median (range)||22 (14-50)||None/Not Performed||42 (34.2)|
|Hispanic, n (%)||28 (23.3)||Hemoglobin g/dl, median (range)||12.8 (5.1 – 16.7)||DVT Location|
|Female, n (%)||69 (57.5)||Creatinine mg/dl, median (range)||1 (0.5 – 6.5)||Proximal||38 (32)|
|Prior history of VTE, n (%)||22 (18.3)||D-Dimer mcg/ml, mean, (range) n=27||14.8 (1.43-55)||Distal||4 (3)|
|Provoked Transient Risk, n (%)||53 (44.2)||BMI kg/m2, median (range) n=104||33 (18.6 – 64.6)||Both||36 (29)|
|Active Malignancy||23 (19.2)||Right heart strain (n=104), n (%)||70 (67.3)||N/A||42 (36)|
[Table 1. Presenting Patient Characteristics]
|Cardiac Arrest, n (%)||13 (10.8)|
|In-hospital Mortality, n (%)||11 (9.2)|
|Alive at 6 months, n=105, n (%)||85 (81.0)|
|ICU Admission, n (%)||71 (59.2)|
|LOS days, median (range)||9 (0 – 106)|
|IVC Filter placement, n (%)||41 (34.2)|
|Systemic tPA, n (%)||23 (19.2)|
|Recurrent VTE n (%)||13 (11.9)|
|On Anticoagulation||9 (69.2)|
|Off Anticoagulation||4 (30.8)|
[Table 2. Patient Outcomes]
To cite this abstract in AMA style:Wong K, Kushnir M, Billett H. Saddle Pulmonary Embolism: Demographics, Clinical Presentation, and Outcomes [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/saddle-pulmonary-embolism-demographics-clinical-presentation-and-outcomes/. Accessed November 30, 2021.
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