Autopsy Proven Pulmonary Embolism in Hospital Patients: Are We Detecting Enough Deep Vein Thrombosis?

Abstract

To investigate the present status of pulmonary embolism as a cause of death in a general hospital patient population, a 5-year retrospective study of all autopsy reports and associated hospital records was undertaken. Pulmonary embolism was thought to be the cause of death in 239 of 2388 autopsies performed (10%): 15% of these patients were aged less than 60 years and 68% did not have cancer. Of these patients, 83% had deep-vein thrombosis (DVT) in the legs at autopsy, of whom only 19% had symptoms of DVT before death. Only 3% of patients who had DVT at autopsy had undergone an investigation for such before death. Twenty-four per cent of patients who died from pulmonary embolism had undergone surgery a mean of 6.9 days before. Screening tests for DVT should be applied widely in the hospital population.

Incremental Health Care Resource Utilization and Economic Burden of Venous Thromboembolism Recurrence from a U.S. Payer Perspective

“…When a clot breaks free, it can travel to the lungs causing pulmonary embolism (PE), a sequelae of VTE that is directly associated with 5% to 10% of all in-hospital deaths. [1][2][3] The incidence of VTE increases with age with the Centers for Disease Control and Prevention reporting average annual rates of VTE ranging from 60 per 100,000 population for persons aged 18-39 years to 1,134 per 100,000 for persons aged ≥ 80 years. 4 Mahan et al (2012) estimated that, in 2011 U.S. dollars, the annual cost of VTE ranges between $13.5 and $27.2 billion.…”

Commentaries on thromboprophylaxis in hip replacement surgery: Thromboembolism–An academic concern or a clinical reality?

“…Unfortunately, the autopsy rate was usually low in the patients who died. Indeed, recent autopsy data continue to show that the majority of the patients who die of pulmonary embolism, this diagnosis was not considered to be the cause of death prior to autopsy (Havig 1977, Sandler and Martin 1989, Karwinski 1995. Thus, it is evident that meta-analytic techniques which have recently been widely criticized (Greenland 1994, Olkon 1994, Khan et al 1996, Sacks et al 1997, cannot be recommended.…”

Pharmacological prophylaxis for deep vein thrombosis in acute spinal cord injury: an Indian perspective

“…1,2 The exact incidence of DVT in acute spinal cord injury (ASCI) is unknown because most studies are limited by the inherent inaccuracy of clinical diagnosis. 3,4 In hospitalized patients, the incidence of venous thrombosis is considerably higher and varies from 20 to 70% and PE ranges from 0.5 to 3%.…”