Triggers of acute pulmonary thromboembolism developed in hospital, with focusing on toilet activities as triggering acts

Triggering of cardiovascular incidents by micturition and defecation

“…Hayashi et al [4] reported that toilet use preceded sudden cardiac death more often than non-fatal acute myocardial infarction. In comparison to data collected for other cardiovascular incidents including APTE, Yamada et al [7] reported a surprisingly high 22% of patients in whom toilet activities preceded APTE. Although the authors suggested that the use of a Japanese-style lavatory may underlay such a difference, it is still much higher than in the study on acute myocardial infarction and sudden cardiac death in the Japanese population [4].…”

“…Also in the Japanese population, Hayashi et al [4] have estimated that time to half an hour per day, which amounts to 2.1% of the entire day. As a significant part of the population in the study of Yamada et al [7] were likely to be less mobile, they might spend more time on toilet activities, as well as those with prostate problems, diarrhea, urinary infections, etc. Conversely, constipated, oliguric, anuric patients or those immobilized in bed would spend considerably less time.…”

“…Earlier observational studies have related toilet activities to the onset of acute pulmonary thromboembolism (APTE) [1,2], acute myocardial infarction [3 -5], sudden cardiac death [4] and subarachnoidal hemorrhage [6]. In the February issue of the journal, an interesting study by Yamada et al [7] further described clinical features of these external triggers and reported their frequent occurrence before the onset of APTE among Japanese patients.…”

“…An important limitation of the present study [7] is that the case-crossover design [10,11] was not used. This design cannot prove the causal relationship, but has proved to be highly useful in studying the triggering of disease onset, offering reliable evidence about association and a valid quantitative estimation of the relative risk.…”

Triggering activities of acute pulmonary embolism and paradoxical embolism

“…To the Editor, I read with interest the recent article by Yamada et al [1] on triggers of acute pulmonary embolism (PE) by toilet activities during hospitalization. The authors found that half of their patients developed acute PE during toilet activities (defecation and micturition).…”