PURPOSE: Although deaths within a few days of stroke are usually due to the direct consequence of brain damage, those occurring over the following weeks are mainly due to potentially preventable problems including Pulmonary Embolism (PE). In view of limited data on the frequency of PE as the cause of death in patients with stroke, we undertook this investigation.
METHODS: Death from PE among patients who died with stroke was determined from the United States Bureau of the Census Compressed Mortality File. The mortality data on the Compressed Mortality Files are based on records of death certificates for all deaths occurring in the fifty states and the District of Columbia. We analyzed deaths from 1980 to 1998.
RESULTS: Among patients with Ischemic Stroke who died over this 19-year period of study, PE was the listed cause of death in 11,101 of 2,000,963 (0.55 %). Based on an assumed sensitivity of death certificates for fatal PE of 26.7 % to 37.2 % the corrected rate of fatal PE was 1.5 % to 2.1 %. Death rate from PE among patients with Ischemic Stroke decreased from 1980 through 1998. The uncorrected death rate from PE among patients with ischemic stroke, 0.55%, was similar to the average uncorrected death certificate rate from PE in the general population (0.45%). Death certificate data can provide epidemiological information if errors of misclassification are randomly distributed. We assume that whatever inaccuracy exists in the death certificates was constant throughout the 19-year period of study, and the trends are accurate.
CONCLUSION: In conclusion, a decline over two decades in the proportion of deaths from PE in patients who died with ischemic stroke is compatible with an increasing and effective use of antithrombotic prophylaxis in these patients.
CLINICAL IMPLICATIONS: The decreasing proportion of deaths from PE among patients with ischemic stroke who died suggests an increased and effective use of antithrombotic prophylaxis in these patients.
DISCLOSURE: Elias Skaf, None.