Acute pulmonary thromboembolism: Epidemiology, predictors, and long-term outcome – A single center experience

INTRODUCTION: Acute pulmonary thromboembolism (PTE) is a life-threatening disease. Mortality in PTE still remains very high in spite of progress in diagnostic tools. Mortality rate is about 30% in patients with unrecognized acute PTE. METHODS: It is a single center observational study of 31 consecutive patients who were hospitalized in the Department of Cardiology at MS Ramaiah Memorial hospital between January 1, 2010 and June 2015. All the patients confirmed with diagnosis of acute PTE by CT scan (either HRCT or CTPA) were included in the study. Following relevant investigations chosen patients were risk stratified as per standard guidelines into massive, sub massive or low risk and treated accordingly. The included patients were followed up for a period of 1 year with 2D-echocardiogram and other relevant investigations for comparison to assess improvement. Mortality due to either acute PTE or other causes was noted in the study. RESULTS: Of the 31 patients enrolled in our study, 71% (n = 22) of the patients belonged to the age range 20–50 years with those in the age group 31–40 years comprising 39% (n = 12) of the total. Elderly people over 65 years of age comprised only 19% (n = 6) of the total number of patients. Dyslipidemia, prolonged immobilization, deep vein thrombosis, post-operative state, malignancy and post-partum period were the commonly reported risk factors. We thrombolysed a total of 18 (58%) patients with massive and submassive PTE, of which 12 (39%) received tenecteplase and 6 patients received streptokinase (19%). Three (9%) patients required repeat thrombolysis with streptokinase due to failed thrombolytic therapy with tenecteplase. CONCLUSIONS: Our study reported higher incidence of acute PTE in the middle age group population. Prevalence of dyslipidemia was high in this cohort of patients studied although the exact association of it in APE could not be determined. Thrombolytic therapy can be considered for patients with both massive and submassive pulmonary thromboembolism. Repeat thrombolysis can be considered in case one thrombolytic agent failed to give the desirable results.