Seda ÖZKAN, Mücahit AVCIL, Ali DUMAN, Ömer SALT, Polat DURUKAN

Demographic characteristics of patients with pulmonary thromboembolism

Amaç: Pulmoner tromboemboli (PTE) sık görülen, tanısında zorlanılan ve mortalitesi yüksek olan bir hastalıktır. Ülkemizdeki sıklığı ise yeterli ve düzenli veri bulunmadığı için hesaplanamamaktadır. Bu çalışmada acil servisimizde PTE tanısı alan hastaların demografik özellikleri, risk faktörleri, insidansı, Wells ve Geneva skorları, tanı ve tedavi yöntemlerini araştırmayı planladık.Yöntemler: Ocak 2010 - Şubat 2012 tarihleri arasında Erciyes Üniversitesi Tıp Fakültesi Acil Servisinde PTE tanısı konulan 112 hastanın dosyaları geriye dönük olarak incelendi. Veriler SPSS 17.0 programı ile değerlendirildi.Bulgular: Hastaların yaş ortalaması 65,02 ± 16,23 yıl idi. Hastaların 41'i (%36,6) erkek, 71'i (%63,4) kadın idi. Hastaların acil servise başvuru şikayetlerinde en sık nefes darlığı (%81,3) idi. Hastaların risk faktörlerinde immobilizasyon (%35,7), geçirilmiş cerrahi hikayesi (%19,6) mevcut idi. Hastaların troponin ortalaması 0,13 ± 0,48 ng/L ve d-dimer ortalaması 8779,92 ± 12698,12 µg/L idi. Hastaların Geneva Skorlamasında; 4 hastanın (%3,6) skoru düşük, 88 hastanın (%78,6) skoru orta ve 20 hastanın (%17,9) skoru yüksek iken Wells Klinik Olasılık Skorlamasında; 1 hastanın (%0,9) skoru düşük olasılıklı, 74 hastanın (%66,1) skoru orta olasılıklı ve 37 hastanın (%33) skoru yüksek olasılıklı idi. Hastaların tedavilerinde; heparin infüzyonu (% 36,6), enoxaparin (%59,8) ve tPA (%3,6) kullanıldı.Sonuç: Pulmoner tromboemboli tanı ve tedavi araçların gelişmesine rağmen tanı koymakta zorlanan bir hastalık olmaya devam etmektedir. Tanı için ilk adım risk faktörleri olan hastalarda şüphelenmekle başlamaktadır

Pulmoner tromboemboli hastalarının demografik özellikleri

Objective: Pulmonary thromboembolism (PTE) is a common disease with high mortality and difficult diagnosis. The incidence in our country cannot be calculated because there is no adequate and regular data. In our study, we aimed to investigate the demographic characteristics, risk factors, incidence, Wells and Geneva scores diagnostic and treatment methods of the patients in our emergency department with a diagnosis of PTE. Methods: Files of the 112 patients who were admitted to Erciyes University Medical Faculty Emergency Department between January 2010 - February 2012 were analyzed retrospectively. Data were analyzed with SPSS 17.0 statistical software.Results: The mean age of patients was 65.02 ± 16.23. Forty-one (36.6%) of the patients were male and 71 (63.4%) were female. The most common complaint of patients was shortness of breath (81.3%), respectively. Immobilization(35.7%) and history of previous surgery (19.6%) were among the risk factors of the patients. Average troponin levels of the patients was 0.13 ± 0.48 ng/L and average d-dimer levels was 12.698.12 ± 8.779.92 µg/L. Geneva scores of the patients were: 4 patients (3.6%) low score, 88 patients (78.6%) medium score and 20 patients (17.9%) high score. Wells Clinical Probability scores of the patients were; 1 patient (0.9%) low probability, 74 patients (66.1%) intermediate probability and 37 patients (33%) high probability. In the treatment of patients; heparin infusion (36.6%), enoxaparin sodium (59.8%) and tPA (3.6%) were used.Conclusion: In spite of improvements in diagnosis and treatment methods, pulmonary embolism diagnosis is stil a problem. The first step to diagnosis in patients with risk factors begin to suspect. J Clin Exp Invest 2015; 6 (1)

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Yılmaz S, Topçu F, Şen H.S, et al. Combination of Wells clinical score and high D-dimer levels in the in diagnosis of pulmonary embolism. J Clin Exp Invest 2014;5:557-562.
Şen HS, Abakay Ö, Taylan M, et al. The importance of mean platelet volume in early mortality of pulmonary embolism. J Clin Exp Invest 2013;4:298-301.
Torbicki A, van Beek E.J.R, Charbonnier B, et al. Task Force Report. Guidelines on Diagnosis and Manage- ment of Acute Pulmonary Embolism. Eur Heart J. 2000;21:1301-1336.
Şen HS, Abakay Ö, et al. Current diagnosis and treat- ment in pulmonary thromboembolism. J Clin Exp In- vest 2013;4:405-410.
Erkan L. Pulmoner Tromboembolizm Özel Sayısı. Ed. Numan Numanoglu. Türkiye Klinikleri Gögüs Hasta- lıkları 2003;1.
Nijkeuter M, Söhne M, Tick LW, et al. The natural course of hemodynamically stable pulmonary embo- lism. Chest 2007;131:517-523.
Yung GL, Fedullo PF. Disorders of the pulmonary cir- culation Part IX; Pulmonary Thromboembolic Disease in: Fishman A.P, Elias J.A, Fishman J.A, et al. Fish- man's Pulmonary Diseases and Disorders. 4th ed. Philadelphia 2008;2:14.
Stein PD, Hull RD, Saltzman HA, et al. Strategy for diagnosis of patients with suspected acute pulmonary embolism. Chest 1993;103:1553-1559.
Van B.A, Buller H.R, Huisman M.V, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer test- ing, and computed tomography. JAMA 2006;295:172.
Tsai AW, Cushman M, Rosamond W.D, et al. Cardio- vascular risk factors and venous thromboembolism in- cidence: the longitudinal investigation of thromboem- bolism etiology. Arch Intern Med 2002;162:1182-1189.
Sangyeub L, Hyecheol J, et al. Clinical characteristics of acute pulmonary thromboembolism in Korea. Inter- national Journal of Cardiology 2006;108:84-88.
Mashio N, Masahito S, Norikazu Y, et al. Risk factors of acute pulmonary thromboembolism in Japanese patients hospitalized for medical illness: results of a multicenter registry in the Japanese society of pul- monary embolism research. J Thromb Thrombolysis 2006;21:131-135.
Miniati M, Prediletto R, et al. Accuracy of clinical as- sessment in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med 1999;159:864-871.
White RH. The epidemiology of venous thromboem- bolism. Circulation 2003; 107: I4-I8.
Geibel A, Zehender M, et al. Prognostic value of the ECG on admission in patients with acute major pul- monary embolism. Eur Respir J 2005;25:843-848.
Güzel A, Yavuz Y, Şişman B, et al. Acil servise baş- vuran pulmoner tromboemboli olgularinin retrospek- tif olarak değerlendirilmesi. J Academ Emerg Med 2013.034.
Kelly J, Rudd A, Lewis RR, et al. Plasma D-dimers in the diagnosis of venous thromboembolism. Arch In- tern Med 2002;162:747-756.
Pollack CV, Schreiber D, Goldhaber SZ, et al. Clini- cal characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department. JACC 2011;57:700-706.
Pruszczyk P, Bochowicz A, Torbicki A, et al. Cardiac troponin T monitoring identifies high-risk group of nor- motensive patients with acute pulmonary embolism. Chest 2003;123:1947-1952.
Frémont B, Pacouret G, Jacobi D, et al. Prognostic value of echocardiographic right/left ventricular end- diastolic diameter ratio in patients with acute pulmo- nary embolism: results from a monocenter registry of 1416 patients. Chest 2008;133:358-362.
The PIOPED Investigators. Value of the ventilation/ perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary em- bolism diagnosis (PIOPED). JAMA 1990;263:2753- 2759.
Tapson VF. Acute pulmonary embolism. N Engl J Med 2008;358:1037-1052.
Buller HR, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease: the Sev- enth ACCP Conference on Antithrombotic and Throm- bolytic Therapy. Chest 2004;126:163-696.