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Pulmonary Vascular Disease |

Clinical Presentation, Management, and Outcomes of Saddle vs. Non Saddle Pulmonary Embolism

Bashar Alkinj, MD; Charat Thongprayoon, MD; Vivek Iyer, MD
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Critical Care, Mayo clinic Rochester, Rochester, MN


Chest. 2015;148(4_MeetingAbstracts):1007A. doi:10.1378/chest.2265660
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Abstract

SESSION TITLE: Venous Thromboembolism Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Patients with saddle pulmonary embolism (SPE) are generally thought to have a poor prognosis due to high clot burden and risk of hemodynamic decompensation. To date, there have been no large studies comparing the hemodynamic presentation, management and outcomes of SPE vs. non-SPE patients.

METHODS: We used a customized in house search tool (DDQB) to identify a random sample of SPE and non-SPE patients diagnosed at our institution from 1999 to 2014. Both groups were divided into massive (any PE requiring intubation, CPR, vasopressors or signs of organ hypoperfusion); submassive (presence of right ventricular dysfunction, elevated troponin or BNP and not meeting criteria for massive PE) or low-risk PE (not meeting criteria for massive or submassive PE). , compared with regards to hemodynamic presentation (massive, submassive or low risk PE); We also compared the hospital course, management as well as short and long term outcomes in both groups.

RESULTS: We identified 135 patients in the SPE and the non-SPE group respectively. The SPE group presented more frequently with massive PE (17% vs. 9%) and submassive PE (57% vs. 38%) whereas low risk PE was more common in the non-SPE group (53% vs. 26%). Vasopressors were used more frequently in the SPE group (10% vs 3%, P=0.02) along with systemic thrombolysis (10% vs. 4%, p=0.03) and mechanical ventilation (5% vs. 1%, p=0.03). However, overall in-hospital mortality was low in both groups (4% SPE vs. 3% non-SPE, p= 0.73). Long term mortality was also similar in both groups

CONCLUSIONS: Although SPE patients presented with greater hemodynamic compromise and higher need for thrombolysis, vasopressors and mechanical ventilation, we found no difference in short and long term outcomes as compared to non-SPE patients. Overall in-hospital mortality was low in both groups

CLINICAL IMPLICATIONS: These findings challenge current assumptions regarding management and outcomes for patients with SPE

DISCLOSURE: The following authors have nothing to disclose: BASHAR ALKINJ, Charat Thongprayoon, Vivek Iyer

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