Abstract
Background: Although the incidence of acute pulmonary thromboembolism (APTE) has been increasing in Japan, patient characteristics, management strategies, and outcome have not yet been assessed in large series.
Hypothesis: The present study was designed to investigate the current status of APTE in Japan.
Methods: Of a total of 533 registry patients with pulmonary thromboembolism, 309 with APTE were analyzed with respect to clinical symptoms and signs, predisposing factors, diagnostic procedures, estimation of deep venous thrombosis, treatment, and clinical course.
Results: Main risk factors were recent major surgery, cancer, prolonged immobilization, and obesity; only a few patients had coagulopathy and 36% were in cardiogenic shock at presentation. The majority of registry patients underwent lung scans or pulmonary angiography; 30% were diagnosed only by lung scanning. Venous ultrasonography was used in only 34 patients, while 188 patients underwent at least one diagnostic procedure for deep venous thrombosis. Thrombolysis was more frequently performed in patients with cardiogenic shock, and only a few patients received thromboembolectomy. In‐hospital mortality rate was 14%. In patients with cardiogenic shock, the mortality rate was reduced by thrombolysis. The predictors of in‐hospital mortality were male gender, cardiogenic shock, cancer, and prolonged immobilization.
Conclusions: The patients in this registry had almost the same findings as those in Western patients, except for some points that had the possibility of demonstrating a difference between Westerners and Japanese in the development of APTE. These results can prove especially helpful in planning prospective, randomized trials that will clarify the impact of widely used treatment modalities on the outcome of patients with APTE.
Keywords: acute pulmonary thromboembolism, anticoagulation therapy, deep venous thrombosis, thrombolytic therapy
Full Text
The Full Text of this article is available as a PDF (753.8 KB).
References
- 1. Anderson FA, Wheeler HB, Goldberg RJ, Hosmer DW, Patwardhan NA, Jovanovic B., Forcier A., Dalen JE, A population‐based perspective of the hospital incidence and case‐fatality rates of deep vein thrombosis and pulmonary embolism: The Worcester DVT study. Arch Intern Med 1991; 151: 933–938 [PubMed] [Google Scholar]
- 2. Gore I., Hirst AE, Tanaka K., Myocardial infarction and thrombosis. Arch Intern Med 1964; 113: 323–330 [DOI] [PubMed] [Google Scholar]
- 3. Nakano T., Nakamura M., Fujioka H., Venous thrombosis and pulmonary thromboembolism. Jpn J Phlebol 1997; 8: 211–228 [Google Scholar]
- 4. Itou S., Clinico‐pathological studies on pulmonary thromboembolism. Mie‐Igaku 1982; 25: 586–597 [Google Scholar]
- 5. Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ III, Trend in the incidence of deep vein thrombosis and pulmonary embolisma 25‐year population‐based study. Arch Intern Med 1998; 158: 585–593 [DOI] [PubMed] [Google Scholar]
- 6. The PIOPED Investigators : Value of the ventilation‐perfusion scan in acute pulmonary embolism: Results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). J Am Med Assoc 1990; 263: 2753–2759 [DOI] [PubMed] [Google Scholar]
- 7. Kumasaka N., Sakuma M., Shirato K., Incidence of pulmonary thromboembolism in Japan. Jpn Circ J 1999; 63: 439–441 [DOI] [PubMed] [Google Scholar]
- 8. Stein PD, Willis PW, DeMets DL, History and physical examination in acute pulmonary embolism in patients without preexisting cardiac or pulmonary disease. Am J Cardiol 1981; 47: 218–223 [DOI] [PubMed] [Google Scholar]
- 9. Carson JL, Kelley MA, Duff A., Weg JG, Fulkerson WJ, Palevsky HI, Schwartz JS, Thompson BT, Popovich J. Jr., Hobbins TE, Spera MA, Alavi A., Tettin ML, The clinical course of pulmonary embolism. N Engl J Med 1992; 326: 1240–1245 [DOI] [PubMed] [Google Scholar]
- 10. Nakano T., Fujioka H., Okita N., Ito S., Konishi T., Takezawa H., Clinical evaluation of 79 patients with acute pulmonary embolism: A comparison of massive and submassive types. J Jpn Soc Intern Med 1984; 73: 1444–1450 [PubMed] [Google Scholar]
- 11. Stein PD, Willis PW III, DeMets DL, History and physical examination in acute pulmonary embolism in patients without preexisting cardiac or pulmonary disease. Am J Cardiol 1981; 47: 218–223 [DOI] [PubMed] [Google Scholar]
- 12. Tanaka H., Sudden death in acute pulmonary embolism. J Cardiol 1997; 29: 267–275 [PubMed] [Google Scholar]
- 13. Bell WR, Simon TL, DeMets DL, The clinical features of submassive and massive pulmonary emboli. Am J Med 1977; 62: 355–360 [DOI] [PubMed] [Google Scholar]
- 14. Kambayashi J., Fujimura H., Kawasaki T., Sakon M., Monden M., Suehisa E., Amino N., The incidence of activated protein C resistance among patients with deep vein thrombosis and healthy subjects in Osaka. Thromb Res 1995; 79: 227–279 [DOI] [PubMed] [Google Scholar]
- 15. Kasper W., Konstantinides S., Geibel A., Olschewski M., Heinrich F., Grosser KD, Rauber K., Iversen S., Redecker M., Kienast J., Management strategies and determinants of outcome in acute major pulmonary embolism: Results of a multicenter registry. J Am Coll Cardiol 1997; 30: 1165–1171 [DOI] [PubMed] [Google Scholar]
- 16. Cogo A., Lensing AWA, Prandoni P., Hirsh J., Distribution of thrombosis in patients with deep‐vein thrombosis: Implications for simplifying the diagnostic process with compression ultrasound. Arch Intern Med 1993; 153: 2777–2780 [PubMed] [Google Scholar]
- 17. Well PS, Hirsh J., Anderson DR, Lensing AW, Foster G., Kearon C., Weitz J., D'Qvidio R., Cogo A., Prandoni P., Accuracy of clinical assessment of deep‐vein thrombosis. Lancet 1995; 345: 1326–1330 [DOI] [PubMed] [Google Scholar]
- 18. Yamada N., Fujioka H., Yazu T., Nakamura M., Hiraoka N., Tanaka H., Isaka N., Nakano T., Diagnosis of deep vein thrombosis as source of pulmonary thromboembolism: Comparison between real‐time B‐mode ultrasonography and contrast venography. Jpn J Phlebol 1996; 7: 23–27 [Google Scholar]
- 19. Konstantinides S., Geibel A., Olschewski M., Heinrich F., Grosser KD, Rauber K., Iversen S., Redecker M., Kienast J., Just H., Kasper W., Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism: Results of a multicenter registry. Circulation 1997; 96: 882–888 [DOI] [PubMed] [Google Scholar]
- 20. Greenfield LJ, Michna BA, Twelve‐year clinical experience with the Greenfield vena cava filter. Surgery 1988; 104: 706–712 [PubMed] [Google Scholar]
- 21. Taylor FC, Awh MH, Kahn CE Jr., Lu CT, Vena Tech vena cava filter, Experience and early follow‐up. J Vasc Interv Radiol 1991; 2: 435–440 [DOI] [PubMed] [Google Scholar]
- 22. Meyer G., Tamisier D., Sors H., Stern M., Vouhe P., Makowski S., Neveux JY, Leca F., Even P., Pulmonary embolectomy: A 20‐year experience at one center. Ann Thorac Surg 1991; 51: 232–236 [DOI] [PubMed] [Google Scholar]
- 23. Inoue I., Takanashi A., Fukuda Y., Sakai K., Suenaga K., Wakamoto A., Fujioka Y., Kawamoto Y., Hamasaki O., Therapy for acute pulmonary embolism in patients with contraindication for thrombosis. J Jpn Coll Angiol 1996; 36: 427–430 [Google Scholar]
- 24. Hall RJC, Sutton GC, Kerr IH, Long‐term prognosis of treated acute massive pulmonary embolism. Br Heart J 1977; 39: 1128–1134 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25. Gulba DC, Schmid C., Borst HG, Lichtlen P., Dietz R., Luft FC, Medical compared with surgical treatment for massive pulmonary embolism. Lancet 1994; 343: 576–577 [DOI] [PubMed] [Google Scholar]
- 26. The Urokinase in Pulmonary Embolism Trial : A national cooperative study. Circulation 1973: 47 (suppl II): II‐1–108 [PubMed] [Google Scholar]
- 27. Carson JL, Kelley MA, Duff A., Weg JG, Fulkerson WJ, Palevsky HI, Schwartz JS, Thompson BT, Popovich J. Jr. Hobbins TE, Spera MA, Alavi A., Terrin ML, The clinical course of pulmonary embolism. N Engl J Med 1992: 326: 1240–1245 [DOI] [PubMed] [Google Scholar]
- 28. Ohteki H., Norita H., Sakai M., Narita Y., Emergency pulmonary embolectomy with percutaneous cardiopulmonary bypass. Ann Thorac Surg 1997; 63: 1584–1586 [DOI] [PubMed] [Google Scholar]