Pulmonary thromboembolism in patients with stroke: the results of the clinical-anatomic analysis

Authors

  • Silvia BAITOI Institute of Neurology și Neurosurgery „ Diomid Gherman”; USMF „Nicolae Testemițanu”
  • Oxana GROSU Institute of Neurology și Neurosurgery „ Diomid Gherman”
  • Lilia ROTARU Institutul de Neurologie și Neurochirurgie "Diomid Gherman"
  • Stela ODOBESCU Institutul de Neurologie și Neurochirurgie „ Diomid Gherman”
  • Ion MOLDOVANU Institute of Neurology and Neurosurgery "Diomid Gherman"

DOI:

https://doi.org/10.52692/1857-0011.2022.3-74.13

Keywords:

Stroke, pulmonary thromboembolism, risk factors, complication, death, morpho pathological analysis

Abstract

Pulmonary embolism is a major cause of mortality in stroke patients and up to 50% of premature deaths in hospitalized patients. The non-specific clinical picture causes diagnostic errors and severely limits the initiation of treatment in atimely manner.The aim of the study was to analyze missed cases of pulmonary embolism in stroke patients treated within the institutional cohort by analyzing the results of morpho pathological examinations. Materials and methods: Retrospective study. Pulmonary thromboembolism was studied as a major cause of death in patients with stroke, hospitalized in the Diomid Gherman Institute of Neurology and Neurosurgery during 2017-2020. 13 patients with a morpho pathologically confirmed diagnosis were included in the study. Results: The study included 5 men (38.5%) and 8 women (61.5%) with an average age of 65±5.2 years. In all patients the diagnosis of stroke was confirmed by CT: ischemic stroke was established in 6 patients (46.8%), hemorrhagic stroke in 4 patients (30.1%), of which 1 patient underwent surgery (7.7%), stroke with hemorrhagic transformation in 3 patients (23.1%). For 11 patients (84.6%) the stroke was primary, and for 2 patients (15.4%) it was repeated. The risk factors were hypertension - 12 patients (92.3%), in 8 patients (61.5%) obesity, diabetes mellitus -5 patients (38.5%), atrial fibrillation in 5 patients (38.5%), 1 patient (7.7%) with thrombosis in other areas. The morpho pathological diagnosis established that pulmonary embolism was the cause of death in all cases, but only 2 (15.4%) patients presented specific symptoms. Conclusion. Stroke patients are at increased risk of pulmonary embolism due to bed rest, limb paralysis and predisposing risk factors, but only a small number of patients are diagnosed in a timely manner, therefore it is important for the clinician to be aware of the severity of the problem and establishing strict prophylaxis and treatment protocols.

Author Biographies

Silvia BAITOI, Institute of Neurology și Neurosurgery „ Diomid Gherman”; USMF „Nicolae Testemițanu”

medic rezident

Oxana GROSU, Institute of Neurology și Neurosurgery „ Diomid Gherman”

dr. șt. med., cercet. șt.,

Lilia ROTARU, Institutul de Neurologie și Neurochirurgie "Diomid Gherman"

dr. șt. med., conf. cercet.,

Stela ODOBESCU, Institutul de Neurologie și Neurochirurgie „ Diomid Gherman”

dr. hab. șt. med., conf. cercet.,

Ion MOLDOVANU, Institute of Neurology and Neurosurgery "Diomid Gherman"

dr. hab. șt. med, prof. univ.

References

Quellette DR, Kamangar N, Harrington A. Pulmonary Embolism. Medscape. Available at http://emedicine.medscape.com/article/300901-overview (last accessed December 2015)

Liu LP, Zheng HG, Wang DZ, et al. Risk assessment of deep-vein thrombosis after acute stroke: a prospective study using clinical factors. CNS Neurosci Ther 2014; 20: 403-10; http://dx.doi.org/10.1111/cns.12227

Pongmoragot J, Rabinstein AA, Nilanont Y, et al.; Investigators of Registry of Canadian Stroke Network (RCSN) and University of Toronto Stroke Program for Stroke Outcomes Research Canada (SORCan [www.sorcan.ca]) Working Group. Pulmonary embolism in ischemic stroke: clinical presentation, risk factors, and outcome. J Am Heart Assoc 2013; 2: e000372

Stein PD, Beemath A, Matta F, et al. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med 2007; 120: 871-9; http://dx.doi.org/10.1016/j.amjmed.2007.03.024

Pelliccia F, Schiariti M, Terzano C, et al. Treatment of acute pulmonary embolism: update on newer pharmacologic and interventional strategies. Biomed Res Int 2014; 2014: 410341; http://dx.doi.org/10.1155/2014/410341

Torbicki A, Perrier A, Konstantinides S, et al.; ESC Committee for Practice Guidelines (CPG). Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008; 29: 2276-315; http://dx.doi.org/10.1093/eurheartj/ehn310

Piazza G, Goldhaber SZ. Acute pulmonary embolism: part II: treatment and prophylaxis. Circulation 2006; 114: e42-7; http://dx.doi.org/10.1161/CIRCULATIONAHA.106.620880

Gensini GF, Zaninelli A, Ricci S, et al. SPREAD, Stroke Prevention And Educational Awareness Diffusion, VII Edizione, Ictus cerebrale: linee guida italiane di prevenzione e trattamento. Raccomandazioni e sintesi. 14 marzo 2012. Available at http://www.siapav.it/pdf/SPREAD%202012.pdf (last accessed December 2015)

Regione Toscana. Linee guida per la profilassi del tromboembolismo venoso nei pazienti ospedalizzati. SNLG Regioni, 2015. Available at http://www.snlg-iss.it/cms/files/LG_Toscana_TEV.pdf (last accessed December 2015)

Barbar S, Noventa F, Rossetto V, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost 2010; 8: 2450-7; http://dx.doi.org/10.1111/j.1538-7836.2010.04044.x

Kahn SR, Lim W, Dunn AS, et al.; American College of Chest Physicians. Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 Suppl): e195S-226S

National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. Available at https://www.nice.org.uk/guidance/cg68 (last accessed December 2015)

CLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration, Dennis M, Sandercock P, et al. Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial. Lancet 2013; 382: 516-24; http://dx.doi.org/10.1016/S0140-6736(13)61050-8

Wells PS, Forgie MA, Rodger MA. Treatment of venous thromboembolism. JAMA 2014; 311: 717-28; http://dx.doi.org/10.1001/jama.2014.65; http://dx.doi.org/10.1001/jama.2014.6123

Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Consiliul pentru boala vasculară periferică; Consiliul pentru Cardiologie Clinică . Ghid pentru gestionarea timpurie a pacienților cu AVC ischemic acut: un ghid pentru profesioniștii din domeniul sănătății de la American Heart Association/American Stroke Association. Accident vascular cerebral. 2013; 44:870–947

Lindsay MP, Gubitz G, Bayfey M, Philips S. Canadian Best Practice Recommendations for Stroke Care. Disponibil la: http://www.strokebestpractices.ca. Accesat 27 mai 2013

Lansberg MG, O’Donnell MJ, Khatri P, Lang ES, Nguyen‐Huynh MN, Schwartz NE, Sonnenberg FA, Schulman S, Vandvik PO, Spencer FA, Alonso‐Coello P, Guyatt GH, Akl EA; American College of Chest Physicians. Antithrombotic and thrombolytic therapy for ischemic stroke: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence‐Based Clinical Practice Guidelines. Chest. 2012; 141(2 suppl):e601S–e636S. doi:10.1378/chest.11‐2302

Published

2022-12-12

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Research Article

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