Venöz Tromboemboli Tanısı Konulan Hastaların Tanımlayıcı Bulguları

Amaç: Bu çalışma; üniversite hastanesinde venöz tromboembolizmi (VTE) teşhisi ve tedavisi hakkında açıklayıcı veri toplanmasını ve böylece bir referans hastanesindeki VTE yaklaşımını yansıtmak için planlanmıştır. Materyal ve Metod: Çalışmamızda derin ven trombozu (DVT) ve pulmoner tromboembolizmi (PTE) tanısı konulan hastaların arşiv kayıtlarını değerlendirdik. Hastaların birçoğunun yaşı ileri ve cinsiyeti kadındı. PTE için en sık kullanılan tanı yöntemi; bilgisayarlı tomografi (CT), DVT için ise ultrasondu. VTE acil servislerde ve polikliniklerde en yaygın tanısı konulan hastalıktır. Hastalara sırasıyla DVT, PTE, DVT ve PTE uygulandı. VTE için en sık rastlanan kronik risk faktörleri kanser, kalp yetmezliği/romatizmal kalp rahatsızlığı, hiperlipidemi/ateroskleroz ve obesitedir. Ataklara özgü risk faktörleri hareketsizlik, ameliyat, gebelik, oral kontraseptif ilaç ve travmaydı. Bulgular: Hemostatik risk faktörlerinin araştırıldığı hastalarda; sırasıyla faktör V Leiden, protrombin 20210 ve MTHFR mutasyonları bulundu. PTE"li hastalarda bulunan bulgular ve semptomlar; dispne-takipne, taşikardi, palpitasyon, göğüs ağrısı, öksürük, ateş, boğaz ağrısı, hemoptiz, diyaforez ve hırıltılı solunumdu (vizing). Elektrokardiyografi, PTE vakalarının çoğu için olumlu sonuçlar verdi. D-Dimer testi ise yüksek oranda duyarlı bulunmuştur. Akut ataklar sırasında uygulanan tedaviler; düşük molekül ağırlıklı heparin (LMWH), standart heparin, trombolitik tedavi, ameliyat, aspirin ve inferior vena kava filtresi yerleştirilmesidir.Akut dönem komplikasyonları ölüm, kanama ve heparin kaynaklı trombositopeniydi. Sonuç: Bu retrospektif çalışma bir referans hastanesindeki VTE tanı ve tedavi yaklaşımlarını yansıtmakta olup ileriye dönük çalışmalar için yol gösterici olabilir.

Anahtar Kelimeler:

Venöz tromboembolizm, pulmonar tromboembolizm, derin ven trombozu

Descriptive Data of Patients with Venous Thromboembolism

Purpose: This study was designed for collecting descriptive data about diagnosis and treatment of patients diagnosed with venous thromboembolism (VTE) in an university hospital and for reflecting approach to VTE in such a reference hospital in this way. Material and Methods: We evaluated archive records of patients disgnosed with deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) between 2000 an 2005. Age average of patients was advanced and most of them were women. They had DVT, PTE, DVT and PTE respectively. Most common diagnostic method used for PTE was computed thomogrphy (CT), for DVT was ultrasonography (USG). VTE was diagnosed most frequently in emergency services and policlinics. Most common chronic risk factors for VTE were cancer, heart failure/romathismal cardiac disease, hyperlipidemia/atherosclerosis and obesity. Risk factors spesific to the attacks (or temporary) were immobilization, surgery, pregnancy, taking oral contraseptive drugs and trauma. Results: In patients investigated for hemostatic risk factors, Factor V Leiden, Prothrombin 20210 A , and MTHFR mutations were found respectively. Symptoms and findings of patients admitted with PTE were dyspnea-tachipnea, tachycardia, palpitation, pleural pain, caugh, fever, anginal pain, hemopthysis, diaphoresis and wheezing . Echocardiography gave positive results for the most of PTE cases. D-dimer test was found high sensitive. Treatments during accute attacks were low moleculer weight heparin (LMWH), standart heparin, thrombolytic therapy, surgery, aspirine and vena cava inferior filter placement. Acute term complications were death, bleeding and heparin induced thrombocytopenia. Conclusion: This retrospective study reflects the approach of VTE diagnosis and treatment in a reference hospital and it may guide for prospective studies.

Keywords:

Venous thromboembolism (VTE), Pulmonary thromboembolism (PTE), Deep vein thrombosis (DVT),

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Yazışma Adresi / Address for Correspondence: Dr. Gül İlhan Hatay Antakya Government Hospital gullhan2002@yahoo.com geliş tarihi/received :03.03.2013 kabul tarihi/accepted:29.03.2013