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Antithrombotic Therapy and the Nearest Forecast of Pulmonary Embolism in Rutine Clinical Practice (Data of the Regional Vascular Center of the Ryazan Region)

https://doi.org/10.20996/1819-6446-2022-04-13

Abstract

Aim. To perform the analysis of antithrombotic therapy and immediate prognosis in patients with pulmonary embolism (PE) in routine clinical practice.

Materials and methods. During 13 months of follow-up (2018-2019) within the framework of the Russian SIRENA registry, the study included patients (n=103) with verified PE who were hospitalized at the regional vascular center. 

Main results. Thrombolytic therapy was performed in 63 patients (61.2% of the sample), of which 48 (76.2%) had no indications. In these cases, the most common reason for performance was the results of the PESI score (n=17) and/or a significant amount of damage to the pulmonary artery (n=10) and/or severe shortness of breath (n=3) and/or the presence of a thrombus in the right parts of the heart or deep veins of the lower extremities (n=2), in addition, in a number of medical records, the cause is indicated as “for health reasons” (n=6) or there were no data (n=10). Patients who underwent thrombolysis had a larger volume of pulmonary lesions, more pronounced signs of respiratory failure and overload of the right heart, as well as a shorter duration of clinical manifestations. Anticoagulant therapy was used in 94.2% of cases, of which 90.3% of patients used parenteral forms at the start, then direct oral anticoagulants were mainly used, the frequency of warfarin prescription was only 5.8% of cases. Bleeding was registered in 19.4% of patients (significant – in 11.7%). PE recurrence after diagnosis and initiation of therapy was observed in 4 cases (3.9%). Hospital mortality was 9.7%. Predictors of poor prognosis were hospitalization with a different diagnosis (risk ratio [RR] 16.2; p=0.001), advanced age (RR 10.1; p=0.028), unstable hemodynamics (RR 7.6; p=0.002), chronic kidney disease C3- 5 (RR 5.6; p=0.03), history of stroke (RR 5.3; p=0.016) and chronic heart failure (RR 3.9; p=0.035).

Conclusion. In modern clinical practice, the indications for thrombolysis often differ from those recommended, which leads to an increase in the number of bleeding and leveling of the positive effect on the prognosis. Factors such as advanced age, chronic heart failure and atrial fibrillation, stroke, chronic kidney disease, hemodynamic instability, hospitalizations with a different primary diagnosis, and the need for oxygen therapy increase the risk of early mortality. 

About the Authors

N. N. Nikulina
Ryazan State Medical University
Russian Federation

Natalia N. Nikulina

Ryazan 



Yu. V. Terekhovskaya
Ryazan Regional Clinical Cardiology Dispensary
Russian Federation

Yuliya V. Terekhovskaya

Ryazan 



S. S. Yakushin
Ryazan State Medical University
Russian Federation

Sergey S. Yakushin

Ryazan 



References

1. Barco S, Mahmoudpour SH, Valerio L, et al. Trends in mortality related to pulmonary embo-lism in the European Region, 2000-15: analysis of vital registration data from the WHO Mortality Da-tabase. Lancet Respir Med. 2020;8(3):277-87. DOI:10.1016/S2213-2600(19)30354-6.

2. Nikulina NN, Terekhovskaya YuV. Epidemiology of pulmonary embolism in today’s context: analysis of incidence, mortality and problems of their study. Russian Journal of Cardiology. 2019;(6):103-8 (In Russ.) DOI:10.15829/1560-4071-2019-6-103-108.

3. Laporte S, Mismetti P, Décousus H, et al.; RIETE Investigators. Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation. 2008;117(13):1711-6. DOI:10.1161/CIRCULATIONAHA.107.726232.

4. Shah P, Arora S, Kumar V, et al. Short-term outcomes of pulmonary embolism: A National Perspective. Clin Cardiol. 2018;41(9):1214-24. DOI:10.1002/clc.23048.

5. Meyer G, Vicaut E, Danays T, et al for the PEITHO Investigators. Fibrinolysis for Patients with Intermediate-Risk Pulmonary Embolism. N Engl J Med. 2014;370(15):1402-11. DOI:10.1056/ NEJMoa1302097.

6. Menzorov MV, Filimonova VV, Erlikh AD, et al. Renal dysfunction in patients with pulmo-nary embolism: data from the SIRENA register. Russian Journal of Cardiology. 2021;26(2S):4422 (In Russ.) DOI:10.15829/1560-4071-2021-4422.

7. Cherepanova NA, Mullova IS, Pavlova TV, et al. Thrombolytic Therapy in Treatment in Pa-tients with Pulmonary Embolism not High-risk: SIRENA Registry Data. Rational Pharmacotherapy in Cardiology. 2021;17(3):401-7 (In Russ.) DOI:10.20996/1819-6446-2021-06-11.

8. Konstantinides S, Torbicki A, Agnelli G, et al. 2014 ESC 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). Endorsed by the Europe-an Respiratory Society (ERS). Eur Heart J. 2014;35(43):3033-69. DOI:10.1093/eurheartj/ehu283.

9. Konstantinides SV, Meyer G, Becattini C, et al. ESC Guidelines for the diagnosis and man-agement of acute pulmonary embolism developed in collaboration with the European Respiratory So-ciety (ERS). Eur Heart J. 2020;41(4):543-603. DOI:10.1093/eurheartj/ehz405.

10. Сherepanova NA, Mullova IS, Kiselev AR, et al. Thrombolytic Therapy in Normotensive Pa-tients with Pulmonary Embolism (Data from the Retrospective Study). Rational Pharmacotherapy in Cardiology. 2020;16(5):742-8 (In Russ.) DOI:10.20996/1819-6446-2020-10-13.

11. Kurakina EA, Duplyakov DV, Khokhlunov SM, et al. Syncope in non-massive pulmonary embolism as a predictor of high-risk mortality. Rational Pharmacotherapy in Cardiology. 2012;8(2):158-62. (In Russ.) DOI:10.20996/1819-6446-2012-82-158-162.

12. Mullova IS, Pavlova TV, Khokhlunov SM, Duplyakov DV. Prognostic Value of ECG in Pa-tients with Pulmonary Embolism. Rational Pharmacotherapy in Cardiology. 2019;15(1):63-8 (In Russ.) DOI:10.20996/1819-6446-2019-15-1-63-68.

13. Mazur ES, Mazur VV, Rabinovich RM, Bachurina MA. Clinical and angiopulmonographic association in pulmonary embolism. Terapevticheskii Arkhiv. 2021;93(4):363-8 (In Russ.) DOI:10.26442/00403660.2021.04.200674.

14. Terekhovskaya YuV, Okorokov VG, Nikulina NN. The modern position of anticoagulants in acute pulmonary embolism: achievements, limitations, prospects. I.P. Pavlov Russian Medical Biolog-ical Herald. 2019;27(1):93-106 (In Russ.)DOI:10.23888/PAVLOVJ201927193-106.


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For citations:


Nikulina N.N., Terekhovskaya Yu.V., Yakushin S.S. Antithrombotic Therapy and the Nearest Forecast of Pulmonary Embolism in Rutine Clinical Practice (Data of the Regional Vascular Center of the Ryazan Region). Rational Pharmacotherapy in Cardiology. 2022;18(2):135-142. (In Russ.) https://doi.org/10.20996/1819-6446-2022-04-13

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