Pulmonary thromboembolism in adults: Experience from a tertiary care center

Abstract

Background: Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE). We aimed to analyze the risk factors, clinical presentations, evaluation and management strategies as well as outcomes of adult pulmonary thromboembolism cases at a tertiary care center.

Methods: In a retrospective observational study, all consecutive adult pulmonary thromboembolism cases admitted from January 2019 to September 2020 at our center were enrolled in this study.

Results: Forty-eight patients were included in the present study. The commonest presenting features were dyspnea (93.8%) and cough (79.2%). The risk factors included hypertension 11 (23%), diabetes 6 (12%), recent trauma and recent surgery 3 (6%) each, and malignancy in 2 (4%). DVT was present in 12 (25%) cases while history of smoking was significant, 31 present in (64.6%). Tuberculosis was also found to be an important risk factor for PE in 8 (16.7%). The current COVID-19 pandemic has come up as an important risk factor for PTE which was also true in our case with 13 (27%) patients being cases of moderate to severe COVID-19 pneumonia. Electrocardiogram revealed sinus tachycardia (56.25%), precordial lead T-wave changes (6.3%), and S1Q3T3 pattern (16.67%). Diagnosis was confirmed by computed tomographic pulmonary angiography (CTPA) in 81% of cases. Treatment options included low molecular weight heparin (LMWH) in 91%, newer oral anticoagulants (NOACs) in 2% of the patients and thrombolysis was needed in 12.5% of patients. There was no in-hospital mortality; however one patient had major bleeding.

Conclusion: The clinical presentation of PE varied from dyspnea to cough, though the commonest feature of dyspnea remains unchanged compared to prior studies. CTPA has been modality of choice for diagnosis, however few patients with high probability for PTE were diagnosed clinically along with suggestive echocardiography and ECG findings. Thus, a high index of suspicion and timely therapeutic anticoagulation with various agents led to effective management and better outcome in the studied patients.

Keywords: Computed tomographic pulmonary angiography; Deep vein thrombosis; Low molecular weight heparin; Newer oral anticoagulants; Pulmonary embolism; Venous thromboembolism.