Prognostic significance of early diagnosis in acute pulmonary thromboembolism with circulatory failure

Abstract

Despite the advances in our understanding of venous thromboembolic disease, the prevalence of pulmonary thromboembolism (PTE) at autopsy has not changed over 3 decades. When patients survive long enough to have a diagnosis of massive PTE and start receiving treatment, the outlook is considered to be moderately good. However, the diagnosis is often difficult to obtain and is frequently missed. We hypothesize that mortality of acute PTE is reduced by early diagnosis. Eighty-five patients with acute PTE with circulatory failure who survived 1 h after the onset were divided into two groups: the early Dx group consisted of the patients whose disease was diagnosed as acute PTE within 24 h of the onset, and the Late Dx group included patients whose disease was not diagnosed within 24 h of onset, or died without clinical diagnosis between 1 and 24 h after the onset. Overall mortality was significantly low in the Early Dx group compared with that of the Late Dx group (21.6% vs 67.6%, P < 0.0001). Multiple logistic regression analysis demonstrated that a reduction in in-hospital mortality was associated with early diagnosis (odds ratio for in-hospital death, 0.094; 95% confidence interval, 0.03-0.33). The results of our study suggested that early diagnosis might favorably affect the in-hospital clinical outcome of hemodynamically unstable patients with acute PTE.

Apixaban for the Treatment of Japanese Subjects With Acute Venous Thromboembolism (AMPLIFY-J Study)

“…2 Whereas the early diagnosis and treatment of VTE can result in relatively good outcome, PE is a fatal disease characterized by a high rate of mortality; indeed, sudden death may be the presenting symptom of VTE. 3 Early diagnosis and early treatment, including inhibition of DVT progression and prevention of PE recurrence are therefore very important in the treatment enous thromboembolism (VTE) is broadly divided into pulmonary embolism (PE) and deep vein thrombosis (DVT). PE and DVT have a common pathophysiology: PE is present in approximately 70% of DVT cases, and DVT is present in >30-70% of PE cases when assessed on computed tomography (CT) or perfusion.…”

Multidetector-Row Computed Tomography-Based Clinical Assessment of Fondaparinux for Treatment of Acute Pulmonary Embolism and Acute Deep Vein Thrombosis in Japanese Patients

“…In severe cases associated with shock, the mortality increases to 30%, 7 with more than 40% of the deaths reportedly occurring within 1 h of the onset of symptoms. 8 PE is mostly caused by DVT in the legs or pelvis. Proximal DVT causes serious PE, which is fatal in over 20% of cases unless adequately treated.…”

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“…Early initiation of treatment significantly reduces morbidity and mortality [2,3]. Therefore, timely and accurate diagnosis is of utmost importance.…”