Clinical features and short term outcomes of patients with acute pulmonary embolism. The Italian Pulmonary Embolism Registry (IPER)

Casazza, Franco; Becattini, Cecilia; Bongarzoni, Amedeo; Cuccia, Claudio; Roncon, Loris; Favretto, Giuseppe; Zonzin, Pietro; Pignataro, L; Agnelli, Giancarlo

doi:10.1016/j.thromres.2012.08.292

Cited by 146 publications

(91 citation statements)

References 19 publications

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“…1 Current management algorithms emphasize risk stratification to identify patients who may benefit from early advanced therapies in addition to anticoagulation. [2][3][4] Risk categories of massive, submassive, and low-risk PE are based on clinical, radiological, and laboratory criteria.…”

Section: Introductionmentioning

confidence: 99%

Surgical Pulmonary Embolectomy

et al. 2015

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A 66-year-old man with a recent prosthetic knee infection, status postprosthesis removal, was admitted with recurrent septic arthritis. On his seventh hospital day, as he was signing his discharge paperwork, he developed acute respiratory distress. On physical examination, he was tachycardic to 118 beats/min, relatively hypotensive from 144/78 mm Hg earlier in the day to 94/54 mm Hg, and hypoxemic, with an oxygen saturation of 94% on a 100% nonrebreather facemask. The ECG showed sinus tachycardia. An urgent contrast-enhanced chest computed tomogram (CT) demonstrated large saddle pulmonary embolism (PE) and severe right ventricular (RV) enlargement, with an RV diameterto-left ventricular (LV) diameter ratio of 1.8 (Figure 1). The patient was administered a bolus of intravenous unfractionated heparin followed by a continuous infusion. An urgent bedside transthoracic echocardiogram showed severe RV dilation, moderateto-severe pulmonary hypertension, and RV pressure overload as suggested by systolic deviation of the interventricular septum toward the LV (Figure 2). The Vascular Medicine and Cardiac Surgery services were consulted for consideration of advanced therapies. Because of concern for major bleeding associated with fibrinolytic therapy in the setting of recent major surgery, surgical pulmonary embolectomy was recommended. IntroductionDespite advances in diagnostics and therapeutics, acute PE remains a life-threatening condition with an in-hospital mortality rate of ≈7% for all-comers and 31% for patients with hemodynamically unstable (massive) PE.1 Current management algorithms emphasize risk stratification to identify patients who may benefit from early advanced therapies in addition to anticoagulation.2-4 Risk categories of massive, submassive, and low-risk PE are based on clinical, radiological, and laboratory criteria. Massive PE is characterized by systemic arterial hypotension, syncope, cardiogenic shock, cardiac arrest, or respiratory failure. Submassive PE is defined by evidence of RV dysfunction on imaging (RV/LV diameter >0.9 on contrastenhanced chest CT or RV dilation and hypokinesis on echocardiography), elevated cardiac biomarkers (such as cardiac troponin), or both, in a patient with preserved systemic arterial pressure. Submassive PE comprises a patient population at increased risk of adverse outcomes and early mortality. Low-risk PE patients have none of these features and typically have an uneventful clinical course when treated with therapeutic anticoagulation alone.Advanced therapies are often considered for patients with submassive or massive PE to rapidly relieve RV pressure overload and avert hemodynamic deterioration. Advanced therapies for reperfusion include systemic fibrinolysis, catheter-based pharmacomechanical intervention, and surgical pulmonary embolectomy. A recent meta-analysis showed a 1.7% absolute mortality

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Section: Introductionmentioning

confidence: 99%

Surgical Pulmonary Embolectomy

et al. 2015

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“…These findings agree with those of most recent studies. 10,11 Moreover our study demonstrates that legs ultrasonography for DVT detecting is routine practice in Internal Medicine.…”

Section: Discussionmentioning

confidence: 53%

“…22,[31][32][33][34] In TUSCAN-PE recent infectious diseases, especially affecting the respiratory system, were found as the main risk factors of PE. Despite this percentage is much greater compared to the most recently published studies on topic, 10,11,14,17 this finding is not completely surprising, since than in the recent years many literature reports have focused on link between infectious diseases, inflammation and thrombosis. 35,36 Further investigations are warranted to better define the role of infectious diseases as risk factors for PE.…”

Section: Discussionmentioning

confidence: 80%

“…Compared with other studies, the population of TUSCAN-PE is older, even when considered other Italian populations enrolled in registries, such as those of IPER, an Italian registry performed in 49 Centers of which 37 Cardiology Units, 6 Emergency Medicine Units and 6 Internal Medicine Units, and RIETE, an international multicenter registry. [6][7][8][9][10][11][12][13][14]27 One of the most important findings emerged in TUSCAN-PE study was that around one third of patients received diagnosis of PE from Internists in the first hours from admission in their wards. Diagnosis of acute PE remains a challenge due to non-specific presentation in terms of signs, instrumental and laboratory findings, especially in the older patients such as those of our study.…”

Section: Discussionmentioning

confidence: 99%

“…However many of these have been performed in the settings of Cardiology, Emergency Medicine or Respiratory Diseases settings, such as the PIOPED I and II, MAPPET, ICOPER, the more recently published IPER and EMPEROR or the oldest PISA-PED. [6][7][8][9][10][11][12] Furthermore other studies or registries such as MASTER, RIETE and the ongoing SCOPE, despite enclosing Italian Internal Medicine Units, were conducted in Centers of recognized experience in the field of venous thromboembolism, whereas other studies such as ZATPOL and SWIVTER were conducted in European countries out of Italy. [13][14][15][16][17] Practical recommendations on prevention, diagnosis, prognostic stratification and acute treatment have had wide diffusion in the last years [18][19][20][21] but evidence about their application in real life lack.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics and clinical management of acute pulmonary embolism in real world: findings from TUSCAN-PE Study

Masotti

Pieralli

Panigada³

et al. 2014

Ital J Med

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Acute pulmonary embolism (PE) remains one of the leading causes of mortality and morbidity in cardiovascular setting. Despite much information about clinical aspects and recommendations or clinical guidelines is available from literature, few data exist about the management of PE in real world of internal medicine scenario. Therefore the aim of the present study was to report on characteristics and management of PE patients admitted in this setting. TUSCAN-PE study was a multicenter, observational, retrospective, cohort study aimed to analyze data of PE patients admitted in Internal Medicine wards of Tuscany. Each center was invited to submit anonymously data of at least ten patients consecutively discharged for acute PE in 2012. Data were referred to demographic, clinical, instrumental, prognostic and therapeutic characteristics. A total of 452 patients from 28 Tuscan centers (60.2% F), with mean age 76.01±12.34 years, were enrolled. A total of 87% of patients was admitted from Emergency Department, but only 65.2% of patients with diagnosis of PE. Around one third of diagnoses of PE was performed by internists. In 14.8% of diagnoses was incidental. In 86% of patients, diagnosis was performed by computer tomography pulmonary angiography. Overall mortality was 9.5%, 5.75% being PE-related. Main risk factors enclosed recent respiratory tract infections (55.3%), immobility (42.25%), recent hospital admissions (33.6%) and cancer (30.3%). In 65.8% of patients, PE was associated with deep vein thrombosis. 16.6% of patients had a shock index ≥1 and 84.75% simplified pulmonary embolism severity index (PESI) score ≥1. A number of 51.5% of patients presented echocardiographic right heart dysfunction, 50.6% and 55.9% of patients presented increased values of troponins and natriuretic peptides, respectively. The following percentage, 6.5%, 71.1% and 22.4%, were defined as high, intermediate and low risk according to the European Society of Cardiology (ESC) criteria, respectively. Antithrombotic treatment was started in Internal Medicine wards in 60.6% of patients. 4.9% of patients were treated with systemic thrombolysis, 15.1% with intravenous unfractionated heparin, whereas low molecular weight heparins and fondaparinux were performed in 39.2% and 39.8% of patients, respectively. Vitamin K antagonists were prescribed in 52.1% of patients at hospital discharge. Fatal and non-fatal major bleedings occurred in 1.7% of patients. TUSCAN-PE study contributes to the knowledge of real life management of acute PE in the Internal Medicine setting.

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Treatment of Pulmonary Embolism

Conde

Katzen

2016

Interventional Cardiology

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Clinical features and short term outcomes of patients with acute pulmonary embolism. The Italian Pulmonary Embolism Registry (IPER)

Cited by 146 publications

References 19 publications

Surgical Pulmonary Embolectomy

Surgical Pulmonary Embolectomy

Characteristics and clinical management of acute pulmonary embolism in real world: findings from TUSCAN-PE Study

Treatment of Pulmonary Embolism

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