Residual pulmonary thromboemboli after acute pulmonary embolism
Residual pulmonary thromboemboli after acute pulmonary embolism
复制标题
DOI：
10.1016/j.ejim.2011.08.018
复制
发表时间：
2012-06-01
影响因子：
8
通讯作者：
Gomez Herrero, Helena
中科院分区：
文献类型：
--
作者：
Luis Alonso-Martinez, Jose;Javier Anniccherico-Sanchez, Francisco;Gomez Herrero, Helena
背景：急性肺栓塞（PE）后，血栓栓塞的完全解决可能无法常规实现。持续率可能取决于时间和用于评估的诊断技术。患者和方法：患者通过计算机断层血管造影（CTA）诊断为急性PE。当他们接受抗凝治疗时，第二次CTA用于探索残余血栓栓塞的持续率。在初始发作期间，评估血浆肌钙蛋白I和利钠肽水平、患者人口统计学、血流动力学和气体交换数据作为肺血栓栓塞持续存在的危险因素。结果：本组共166例患者确诊。46例（28%）患者因不同原因未做第二次CTA。120例（72%）患者在首次发作后4.5 [SD2.34]个月（范围2-12个月）进行第二次CTA。89例（74%,95% CI 65-81）患者血栓完全清除。31例（26%,95% CI 18-34）患者仍残留血栓。在6%、13%和81%的患者中，残余血栓的大小分别比最初诊断的大、相似和小。残留血栓的危险因素包括血栓负荷（OR 1.95）、肺泡与动脉氧差（OR 1.64）和静脉血栓栓塞性疾病的临床前因（OR 0.65）。结论：抗凝治疗4.5个月后，26%的患者仍存在残余肺血栓栓塞。残留血栓栓塞的危险因素包括更大的初始血栓负担，更深的气体交换干扰和以前的静脉血栓栓塞史。(C) 2011年欧洲内科联合会。Elsevier B.V.版权所有。
Background: After an acute pulmonary embolism (PE), the complete resolution of thromboemboli may not be routinely achieved. The rate of persistence may depend on the time and the diagnostic technique used for evaluation.Patients and methods: Patients were diagnosed with acute PE by means of computed tomography angiography (CTA). While they were receiving anticoagulant therapy, a second CTA was used to explore the rate of persistence of residual thromboemboli. During the initial episode, the plasma levels of Troponin I and natriuretic peptide, patient demographics, and hemodynamic and gas exchange data were evaluated as risk factors for persistence of pulmonary thromboemboli.Results: In this study 166 patients were diagnosed. A second CTA was not made in 46 (28%) patients for different reasons. In 120 (72%) patients a second CTA was made 4.5 [SD2.34] months after the initial episode (range 2-12 months). Complete clearance of thrombi occurred in 89 (74%, 95% CI 65-81) patients. Residual thrombi remained in 31 (26%, 95% CI 18-34) patients. In 6%, 13% and 81% of the patients the size of the residual thrombi was greater, similar to and smaller than initially diagnosed, respectively. The risk factors for residual thrombi included the thrombotic burden (OR 1.95), the alveolar to arterial difference of oxygen (OR 1.64), and the clinical antecedents of venous thromboembolic disease (OR 0.65).Conclusions: After 4.5 months of anticoagulant therapy, residual pulmonary thromboemboli persisted in 26% of the patients. The risk factors for residual thromboemboli include a greater initial thrombotic burden, a deeper gas exchange disturbation and a history of previous venous thromboembolism. (C) 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.