Management of Acute Pulmonary Embolism: a Four-Year Study


Department of Internal Medicine, Pulmonary Division, Imam-Khomeini Hospital, Tehran University of Medical Sciences and Health Services, TEHRAN- IRAN


Background: Pulmonary embolism is one of the most common preventable causes of death in hospitalized patients and its related mortality and morbidity rate can be reduced considerably by proper treatment. It seems that there are some problems in treatment of acute pulmonary embolism in most health care centers. In this study, treatment of pulmonary embolism was evaluated in Tehran Imam Khomeini Hospital and compared with the standard therapy. Materials and Methods: All records of patients hospitalized with the diagnosis of acute pulmonary embolism during four years (1998 to 2002) were examined thoroughly. Major points under the study are: Treatment with heparin regarding the dosage, time of performing Partial Thromboplastin Time (PTT) test during the treatment in order to determine the drug efficacy , modifying the drug dosage according to PTT results and prescribing oral anticoagulants. Results: Fifty four patients with mean age of 51.3 years entered the study. Bolus dose of heparin was administered to 16 patients (29.6%). In regard to later infusion rates of heparin, only in 2 patients the prescribed dosage (3.7%) was in accord with one of the standard protocols and in the remaining, drug dosage was less than the recommended rate. Therefore, the optimal therapeutic range of heparin according to PTT in the first 24 hours of treatment was achieved only in 12 cases.(22.2%) PTT was checked every 12 hours in one case and every 24 hours in 53 cases. The mean treatment period with heparin was 9.9± 4.6 days. The mean time of starting warfarin was 2.8± 2.3 days after heparin therapy and only 53.1% of the patients had International Normalized Ratio (INR) between 2 to 3 in two consecutive days at the time of discharge. Conclusion: Results of this study indicate that physicians usually tend to use insufficient doses of heparin and delay in starting warfarin. Furthermore, evaluation of the therapeutic effects was not performed in any patient by repeated PTT test specially in the first 24 hours of treatment. According to the results of various studies this type of therapy leads to increased rate of relapse, mortality and morbidity due to pulmonary embolism. (Tanaffos 2004; 3(12): 49-51)