Pulmonary Vascular Disease: Pulmonary Vascular Disease: VTE |

Clinical Characteristics of Patients With Pulmonary Embolism in an Acute General Hospital in Singapore FREE TO VIEW

Jessica Quah, MMed
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Changi General Hospital, Singapore, Singapore

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A522. doi:10.1016/j.chest.2016.02.544
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SESSION TITLE: Pulmonary Vascular Disease: VTE

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: International guidelines have been created in an effort to prevent and decrease the incidence of pulmonary embolism (PE), but there remains controversy if these guidelines are applicable in Asian populations. This retrospective review aims to define the baseline characteristics and outcome of patients with PE.

METHODS: CT pulmonary angiograms (CTPA) performed between June 2013 and June 2014 were retrieved. A review of the electronic records was performed for patients with pulmonary embolism reported on imaging.

RESULTS: 623 CTPA were performed, of which 66 scans diagnosed PE with clinical yield of 10.6%. 32 (48%) were male and mean age was 64.2 + 15.7 years. 53.0% were Chinese, 4.5% Malay and 27.3% Indian. Majority of the patients were admitted to General Medicine Service (n=24, 36.4%) and Respiratory Service (n=15, 22.7%). Mean weight was 69.0 + 21.9kg. 33 (50.0%) of patients presented with respiratory failure, 10 (15.1%) with leg swelling and 6 (9.1%) with chest pain. 35 (53.0%) were in-hospital thromboembolic events. 55 (83.3%) of events were provoked. Massive PE comprised 5 (7.6%) of events, submassive 19 (29.8%), minor PE 34 (51.5%) and asymptomatic events 8 (12.1%). 2 (3%) received prior anticoagulation and 2 (3%) received chemo-prophylaxis. 11 (16.7%) patients required critical care support for PE. 33 (50.0%) of patient had concurrent collateral findings on CT scan that required further evaluation. Mean Well’s score was 5.71 + 2.6, mean Geneva Score 6.62 + 3.24. Mean Charlson Comorbidity Index was 4.11 + 2.90. If modified Well’s score (>4) was utilised as a limit for authorisation of CTPA scans, 24.2% of patients may have delayed or missed diagnoses. Median length of hospital stay was 14.0 + 27.6 days. In patients who required anticoagulation (n=56, 84.8%), patients who received warfarin stayed a median of 22.9 + 19.8 days whereas those who received rivaroxaban stayed 11.4 + 9.4 days (p=0.02). 9 (13.6%) patients suffered bleeding events. In-hospital all-cause mortality was 6.1% and 1-year all-cause mortality was 10.6%

CONCLUSIONS: Majority of patients had provoked PE and half of the patients suffered pulmonary embolism while hospitalised. These events are associated with significant mortality at 1 year.

CLINICAL IMPLICATIONS: Audits on inpatient thromboprophylaxis should be performed to evaluate consistency and variable in clinical practice amongst hospitalists. Implementation of protocolised screening of patients with high risk of venous thromboembolic events may reduce incidence by encouraging chemoprophylaxis.

DISCLOSURE: The following authors have nothing to disclose: Jessica Quah

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