PulmonaryThrombo-Embolism
It is a blockage of the pulmonary artery or its tributaries by an embolus coming from DVT in 90% of cases, while the other 10% comes from the heartThe burden of PTE
PM finding :5% of hospital death are due to PTE
While 40-50% who die in hospital were found to have DVT.
This indicates that PTE is a common problem in hospital practice
Thromboembolism epidemiology
5 million DVT’s900,000
PE’s
290,000 fatalities
Heit J. Blood. 2005;106:910.
Thromboembolism is a disease of hospitalized patients
Heit Mayo Clin Proc 2001; 76:1102Goldhaber Am J Cardiol 2004; 93:259
50% in nursing homes or
<90 days post-discharge
71% received no prophylaxis
in prior 30 days
DVTClinical Features
Unilateral leg swelling & pain in the thigh & calf musclesO / E:
The leg is swollen, tender, hot & pitting oedema is present.
Virchow’s triad
Venous StasisHypercoagulable State
Endothelial Injury
Advancing age
ImmobilizationStroke - cord injury
Anesthesia
Heart or lung failure
Hyperviscosity
Surgery
Prior DVT
Venous access
Trauma
Sepsis
Vasculitis
Cancer
Estrogen
Family history
Sepsis
HIT
Protein C, S or AT III deficiency
Activated protein C resistance (Leiden)
Hyperhomocystenemia
Antiphospholipid antibody
Prothrombin 20210 mutation
