Etiologies and treatment of acute pulmonary embolism at Srinagarind Hospital

Background: The incidence of acute pulmonary embolism has been increasing over the past few years. Prevention, early detection and appropriate treatment will decrease morbidity and mortality.

Objective: We identified the etiologies and treatment outcomes of acute pulmonary embolism.

Methods: We enrolled hospitalized patients diagnosed with acute pulmonary embolism at Srinagarind Hospital between January 1, 2002 and October 31, 2009.

Results: Over the eight-year period, 169 patients were diagnosed with acute pulmonary embolism; 95 (56.2%) females and 74 (43.8%) males. The mean age was 54.1 years (range, 18-85). 13% presented with massive pulmonary embolism. The most common presentation was dyspnea (65.1%). Arterial hypoxemia (88.8%) and sinus tachycardia (58.3%) were the common initial clinical findings. Twenty percent of chest radiograph were unremarkable. The most common etiology was cancer (62.1%), mostly solid malignancies (98/105) e.g., cholangiocarcinoma, gynecologic malignancy, and lung cancer. The second and the third common etiologies were immobilization/stasis (8.3%) and connective tissue disease (7.1%). After treatment, 58.6% of the patients improved while 21.3% died in hospital. The main therapeutic modality was anticoagulation. The treated group had better outcomes than those receiving only supportive care. Only one patient underwent thromboembolectomy but died. The complications during treatment were acute respiratory failure (34.9%), shock (18.3%), and bleeding (6.5%).

Conclusions: The most common etiology of acute pulmonary embolism was cancer, especially solid malignancies. Immobilization and connective tissue disease were the other common etiologies. The treatment group had a better prognosis than those with supportive care only.