抄録
We objectively diagnosed 21 patients with symptomatic pulmonary embolism (PE) at our hospital between January 1994 and February 2003 (105, 516 in-patients) and examined risk factors and disease course in those 21 patients with symptomatic PE. From these results we administered PE prophylaxis plans according to the American College of Chest Physicians Consensus Guidelines for Venous Thromboembolism Prevention. We retrospectively evaluated the usage of our PE prophylaxis on patient charts.
Results: Underlying risk factors for PE that were common in our cases included immobility, surgery, and active cancer. The morbidity rates were 0.02% of all in-patients, 0.03% of all surgical patients and 0.5% in patients who had total hip arthroplasty. The mortality rates were 38% in patients with symptomatic PE.
Of the in-patients, 70% were classified in the low-moderate risk group, 25% in the high-risk group, and 5% in the ultra high-risk group.
Forty-one percent of high-risk in-patients and 22% of ultra high-risk in-patients were not administered PE prophylaxis. 59% of ultra high-risk in-patients underused physical therapy, but only 27% of them underused anticoagulation therapy.
We had two patients with symptomatic PE during a 10-month period after changing our approach to PE Prophylaxis.
Conclusion: The morbidity of non-prophylactic symptomatic PE in our hospital was similar to that of other Japanese hospitals. Missed opportunities for prevention tended to occur in cases of inadequate assessment of the patients' risk factors and non-surgery in our case series.
PE prophylaxis was inadequately administered, even in the ultra high-risk patient group. Education about
