title: The clinical impact of risk factor analysis and prophylaxis on pulmonary embolism.
abstract: Pulmonary emboli cause 50,000 deaths annually despite recognized risk factors and methods of prophylaxis. To determine the impact of risk factor analysis and the use of prophylaxis, a retrospective chart review of patients suffering pulmonary embolism (PE) at Georgetown University Hospital was performed. During a fifty-month period, 25,000 surgical and 36,000 nonsurgical admissions included 171 cases of PE. The incidence of PE among surgical patients was 0.24% (n = 61) and was 0.30% (n = 110) among nonsurgical patients as confirmed in 82% by pulmonary angiography or high-probability ventilation/perfusion scans. PE prophylaxis included pneumatic stockings, low-dose heparin, combination low-dose heparin/stockings, and coumarin. However, prophylactic measures were absent in 23% of the surgical and in all the nonsurgical patients suffering PE. On the basis of established criteria (SVS/ISCVS), 57% of surgical patients suffering PE were considered at high risk as compared with 13% of nonsurgical patients. Conversely, 54% of nonsurgical patients suffering a PE were considered to be at low risk. Standard treatment modalities were instituted after nonfatal PE: anticoagulation (61%), inferior vena cava filter (14%), and anticoagulation/filter (6%). While risk factor analysis identifies high-risk surgical patients, it may be less effective in identifying nonsurgical patients at increased risk for PE.
authors.affiliation: Department of Surgery, Georgetown University Medical Center, Washington, D.C.
authors.forename: M
authors.initials: M
authors.lastname: Shabahang
authors.forename: R F
authors.initials: RF
authors.lastname: Neville
authors.forename: S R
authors.initials: SR
authors.lastname: Evans
authors.forename: R J
authors.initials: RJ
authors.lastname: Nauta
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors