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    Pulmonary Embolism and Deep Venous Thrombosis: Report by 蔡壁如 2001/9/24

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    Khaled S. Harb
    1. Pulmonary embolism (PE) and deep venous thrombosis (DVT) are caused by blood clots that form in veins. DVT typically forms in the lower extremities while PE occurs when clots break off and lodge in the lungs. 2. Risk factors for PE and DVT include prior clots, inactivity, surgery or trauma, genetic conditions, cancer, and more. Symptoms of DVT are calf pain and swelling while PE causes shortness of breath, chest pain, and cough. 3. Diagnostic tests include imaging scans, blood tests, and lung scans. Treatment involves blood thinners like heparin and warfarin to prevent clot growth and

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    Pulmonary Embolism and Deep Venous Thrombosis: Report by 蔡壁如 2001/9/24

    Uploaded by

    Khaled S. Harb
    23 views17 pages
    1. Pulmonary embolism (PE) and deep venous thrombosis (DVT) are caused by blood clots that form in veins. DVT typically forms in the lower extremities while PE occurs when clots break off and lodge in the lungs. 2. Risk factors for PE and DVT include prior clots, inactivity, surgery or trauma, genetic conditions, cancer, and more. Symptoms of DVT are calf pain and swelling while PE causes shortness of breath, chest pain, and cough. 3. Diagnostic tests include imaging scans, blood tests, and lung scans. Treatment involves blood thinners like heparin and warfarin to prevent clot growth and

    Original Description:

    Deep venous

    Original Title

    DVT and PE

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    1. Pulmonary embolism (PE) and deep venous thrombosis (DVT) are caused by blood clots that form in veins. DVT typically forms in the lower extremities while PE occurs when clots break off and lodge in the lungs. 2. Risk factors for PE and DVT include prior clots, inactivity, surgery or trauma, genetic conditions, cancer, and more. Symptoms of DVT are calf pain and swelling while PE causes shortness of breath, chest pain, and cough. 3. Diagnostic tests include imaging scans, blood tests, and lung scans. Treatment involves blood thinners like heparin and warfarin to prevent clot growth and

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    23 views17 pages

    Pulmonary Embolism and Deep Venous Thrombosis: Report by 蔡壁如 2001/9/24

    Uploaded by

    Khaled S. Harb
    1. Pulmonary embolism (PE) and deep venous thrombosis (DVT) are caused by blood clots that form in veins. DVT typically forms in the lower extremities while PE occurs when clots break off and lodge in the lungs. 2. Risk factors for PE and DVT include prior clots, inactivity, surgery or trauma, genetic conditions, cancer, and more. Symptoms of DVT are calf pain and swelling while PE causes shortness of breath, chest pain, and cough. 3. Diagnostic tests include imaging scans, blood tests, and lung scans. Treatment involves blood thinners like heparin and warfarin to prevent clot growth and

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 17

    Pulmonary Embolism and

    Deep Venous Thrombosis

    Report by 蔡壁如 2001/9/24


    DVT vs PE
    • DVT :
    – Begins in the lower extremities
    – Originate in the calf near valve cusps or bifurcuti
    – 20 ~ 30% clots popliteal, femoral, iliac
    – 10% DVT begins in the thigh
    • PE :
    – Large emboli lodge at the bifurcation
    – Smaller emboli into small arteries
    – Lower lobe > upper lobe (特別multiple emboli)
    – 10 ~ 20% emboli infarction, usually preexisting
    cardiopulmonary disease
    一、Risk factors

    1. Prior venous thromboembolism


    2. Bed rest, congestive heart failure, or inactivity
    3. Endothelial damage : lower extremity surgery or
    trauma
    4. Hypercoagulable states : prothrombin mutation,
    antithrombin III deficiency, lupus anticoagulant,
    and antiphospholipid antibody
    5. Malignancy
    二、Clinical manifestations

    • Symptoms and signs


    • Hemodynamic findings
    • Differential diagnosis
    Symptoms and sign

    DVT : calf pain, edema, venous distension,


    and pain on passive dorsiflexion of the foot
    PE :
    dyspnea, chest pain, and cough. tachypnea,
    and tachycardia, mild fever below 39℃
    hemotysis, pleuritic pain, pleural rub
    syncope, chest pain, and dyspnea, RV
    dysfunction eg ; RV heave, JV distension,
    TR
    Hemodynamic finding

    • C.O  or 
    • RV diastolic pressure 
    • RA pressure 
    • PAP 
    Differential diagnosis

    • Small pulmonary embolism :


    pneumothorax, congestive heart failure,
    hyperventilation, asthma, myocardial
    infarction
    • Massive pulmonary embolism : RV
    infarction, pericardial tamponade,
    venous air embolism
    三. Laboratory evaluation (1)
    • ECG
    – 23% normal in small to medium P.E, 6% normal in massive P.E
    • Chest X-ray
    – Elevation of hemidiaphragm, atelectasis, effusion, margin toward the
    hilum
    • Noninvasive studies for DVT
    – Color flow doppler (Duplex )
    – Impedance plethysmography (IPG) or Venous Occlusive
    Plethysmography ( VOP )
    • D-dimers
    – A level below 500 U/ml high negative predictive valve of 91%
    三. Laboratory evaluation(2)

    • Lung scintigraphy
    – 放射性同位素之閃爍造影術

    • Pulmonary angiography
    – Definitive diagnostic technique in the disease

    • Contrast CT
    • MRA
    四、Prophylaxis for DVT and PE

    • Elastic stockings and sequential


    compression boots
    • Anticoagulation : if no contraindication
    • Subcutaneous heparin : mild to moderate risk
    • Screening DVT by venous ultrasound : if
    Anticoagulation is contraindication
    五、Treatment (1) Heparin

    – Dose : bolus 75U/Kg


    • Keep 18U/Kg/hr, PTT keep 1.5~ 2.5 times
    – Duration : 5 ~ 7 days, warfarin overlap in
    5th
    – Complication :
    • hrmorrhage
    • Thrombocytopenia 3 ~ 4%
    – Contraindication :
    • Bleeding
    • Thrombocytopenia
    • Maligmant pericarditis
    五、Treatment (2)

    • Low Molecular Weight (LMW)


    – Prophylaxis
    – Subcutaneous injection
    五、Treatment (3)
    • Oral anticoagulants (Warfarin)
    – PT keep 2.5 time
    – Duration :
    • 6 week course :calf vein thrombosis
    • 3 ~ 6 m course : proximal DVT and PE
    • Life-long anticoagulation :
    – cancer
    – antiphospholipid antibody syndrome
    五、Treatment (4)
    Thrombolytic therapy
    • Indication
    – Acute massive PE with hemodynamic compromise
    • Objective
    – Accelerate clot lysis,  PAP, improve RV function, improve survival
    • Contraindication
    – Bleeding, Surgery or trauma (10天內)
    • Choice of thrombolytic agent
    • Complication
    – Bleeding
    – streptokinase : allergic , mild fever, itching, hypotension (10%)
    Thrombolytic agents
    Drug FDA approved dose Alternative dose Cost
    Streptokinase 250,000U x 20min, 1500,000 U x 1h $ 350
    100,000U/h x 24 ~72 hrs

    Urokinase 4,400 U/Kg bolus 3,000,000U x 2h $ 2000 ~


    4,400 U/Kg/h x 12h 2700

    tPA 100mg x 2h 0.6mg/kg x $2,000 ~


    3 ~ 15 min 4,200
    五、Treatment (5)

    • IVC Filters
    • Pulmonary embolectomy
    – 80% do in the first hour
    – Mortality : 57% emergency, 25% semiurgent
    Venous Study in SICU (89年)

    • Total numbers : 772人次


    • DATA :
    – Venous Occlusive Plethysmography : 199/24
    – Venous Duplex : 573/142

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