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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE
A Journal on Internal Medicine and Pharmacology
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Gazzetta Medica Italiana Archivio per le Scienze Mediche 2007 April;166(2):69-74
Retrospective analysis of pulmonary embolism management in Emergency Department
Guglielmelli E. 1, Bravi M. C. 1, Colombo G. M. 1, Culasso F. 2, Cicchinelli M. 1
1 Emergency Department, San Camillo Hospital, Rome, Italy;
2 Department of Experimental Medicine, “La Sapienza” University, Rome, Italy
Aim. Pulmonary embolism (PE) is an important and underestimated disease, related to high morbidity and mortality. The real incidence of PE is often detected at autopsy.
Methods. We have reviewed all the data about 93 patients with PE (38 male, 40.8%; 55 female, 59.2%; mean age 67.5 years, range 19-95 years), from January ’03 to December ’03, admitted in our Sub intensive Care Unit, after a first treatment in Emergency Department (ED). The patients with unstable vital signs (shock index >1) were 12 (12.9%), while in 81 (87, 1%) were normal (shock index ≤1).
Results. The Well test evaluation showed 54 patients (58%) with intermediate and 7 (7.5%) with high probability of PE; 36 patients (38.8%) with unstable vital signs underwent to local thrombolysis (only 3, 8.3%, needed also the positioning of an inferior vena cava filter); 56 patients (60.2%) had anticoagulation; 1 patient (1.0%) with anticoagulant therapy contraindication had only the positioning of an inferior vena cava filter. The morbidity was 4.3% and the early mortality 6.4%: 6 patients died within 24 hours after treatment (anticoagulant therapy). The follow up was at 1 year and the data were complete for 75 patients (80.6%) with a mortality of 33.3 % (25/75), related to pre-existent pathologies, while only in 1 patient we had a further episode of PE.
Conclusion. The statistical evaluation of follow up at 1 year didn’t show difference between patients treated with local thrombolytic therapy rather than those with anticoagulation alone (p<0.08).