Venous thromboembolism: acute diagnostic assessment and follow-up
Year: 2014
Type: dissertation
Study design: Observational Study
Abstract: Venous thromboembolism (VTE) presents clinically as deep venous thrombosis (DVT) and pulmonary embolism (PE). PE is the third most common cause of death from cardiovascular disease. VTE can lead to complications as post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension. The main purpose of this study was to determine the easiest way to diagnose right ventricular dysfunction in emergency department with acute non-high-risk patients and to identify those patients likely to benefit from follow-up. A further aim was to evaluate the long-term clinical outcome of patients with earlier PE or DVT. This thesis consists of four projects and includes a sample of VTE patients who underwent clinical, radiological, or biochemistry evaluation over the course of their illness. Healthy volunteers were also included. The study consists of non-high-risk APE patients (n=63) whose right ventricular dysfunction (RVD) was assessed at admission to the emergency department of Helsinki University Central Hospital by computed tomography (CT) , transthoracic echocardiography, NT-proBNP, cardiac troponin T, blood gas, electrocardiogram, and clinical evaluation. The 7-month follow-up visit was performed. The extent of PE was assessed by scoring mass of embolism of patients with acute non-high-risk PE (n=47). Lung function measurements were performed at the acute event and 7 months later. Patients with ileofemoral DVT treated with either systemic or catheter-directed thrombolysis (n=37) were evaluated 2-3 years after the thrombotic event (CEAP-classification, color duplex ultrasound and questionnaire form). Furthermore the samples of patients (n= 525) were obtained to develop a simple and rapid immunoassay point-of-care testing for D-dimer. The results of this dissertation show that CT is a practical and valuable imaging method for detection of RVD in non-high-risk APE patients. Normal RV findings in CT and normal NT-proBNP level (<350 ng/l) excluded RVD both in the acute phase and at the 7-month follow-up. All patients found to have RVD at the 7-month follow-up had RVD also in the acute-phase CT. According to study results, a follow-up protocol is suggested: Patients with RVD on admission CT should be rescreened with natriuretic peptide assessment at follow-up and if elevated an echocardiography is recommended. The data provide new knowledge of the consequences of PE on lung function and also indicate that sustained reduction of diffusing capacity may remain despite treatment of PE according to current guidelines. Catheter-directed thrombolysis for DVT at the acute event reduced both deep and superficial reflux at the 2- to 3-year follow-up. By reducing the incidence of venous reflux, the likelihood of developing post-thrombotic syndrome might diminish as well. Furthermore the rapid and sensitive 10-min D-dimer assay could be suitable for exclusion of VTE in outpatients.
Source: Työväentutkimus Vuosikirja
Author: Mia Laiho
Language: English
Subfield: Internal Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1954761544