B.M. Todurov, A.I. Iachnik, G.I. Kovtun, V.O. Shevchenko, I.M. Kuzmich, V.A. Iachnik. Venous thromboembolism: effectiveness of diagnosing and provision of medical care at present.

The aim of the study was to evaluate the effectiveness of the out-patient and in-patient diagnosis and care of pulmonary artery thromboembolism and their conformity to the international and national guidelines. Two hundred and forty five cases of patients with acute or relapsing pulmonary embolism (PE), or chronic post-embolic pulmonary hypertension (CPEPH) were analyzed. Overall mortality rate was 3.6 %. Diagnosis discordance rate was 13.87 %. Major complaint, dyspnea, was registered in 231 patients, while 14 patients (5.7 %) had no complaints. Among 25 CPEPH cases an episode of acute pulmonary TE was documented in 21 patients (84,0 %). Concomitant thrombophlebitis was diagnosed in 202 patients (82.4 %). The other underlying causes of PE were distributed as follows: diabetes mellitus, 30–32 weeks pregnancy or neoplasm – 4.89 %, surgery – 2.0 %, trauma – 3.7 %, pathological delivery – 1.6 %, atrial fibrillation – 3.3 %, acute phlebitis – 5.3 %. In one case the cause of PE was liposaction. PE was similarly often observed in men (49.18 %) and in women (50.9 %). Mean age of patients was 53.3±0.9 years. In most cases PE was diagnosed in overweight patients: mean body mass index was 29.4±0.4 kg/m2. Mean duration of the disease was 25.2±4.3 days. Concomitant pleurisy was revealed in 24, pericarditis – in 13, pulmonary infarction – in 24, hemophthysis – in 3 patients. Blood fibrinogen was 5.0±0.1 g/l; activated partial tromboplastin time – 60.07±5.06 sec. Mean pulmonary artery pressure during echocardiography was 61.2±1.5 mm Hg, during angiopulmonography – 61.9±1.5 mm Hg. Vena cava filter was placed in 136 (55.5 %), thrombolysis – in 52.7 %, embolectomy – in 4.9 % patients. Therapeutic interventions decreased pulmonary artery pressure from 61.2±1.5 to 47.8±1.5 mm Hg. Further long-term out-patient management is required.

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