CLINICAL PRESENTATION AND PATIENT MANAGEMENT DIFFERENCES IN CONFIRMED AND NON-CONFIRMED PULMONARY THROMBOEMBOLISM

Aim. to study differences in clinical course and patient management in patients with confirmed and non-confirmed thromboemboly of pulmonary artery. Material and methods. An analysis of the data from 321 patients was performed, those consequently hospitalized with suspected PE from 03.10.2010 to 17.07.2013. Patients with further ruled out PE consisted the I group (n=65, 32M), mean age 53,1±14,34. group II included 256 patients (128М) with PE confirmed by investigations, mean age 58,3±13,5. the anamnesis analyzed, clinical and physical signs, laboratory, functional-diagnostic, ultrasound, x-ray and other (totally 60) parameters. Results.  the groups significantly differed only by the prevalence of clinical susceptibility of PE by the Wells and  geneva scores — 20% and 3,85%, resp. (p<0,01). Risk factors of venous thromboembolism: acute thrombosis of lower extremities veins and postthromboflebitic disease were significantly more common in II group. ECg analysis showed that in the I group the classic pattern Mcginn-White (sI-qIII) was found in 19 patients (29,2%), but in the II group — in 106 patients (41,4%), (p=0,072). By EchoCg, the enlargement of RV was found in 27 (42,2%) patients having the signs of pulmonary hypertension due to other diseases. In the II group the increase of RV was significantly more common — in 175 (70%) patients (p<0,0001).  the level of systolic pressure in pulmonary artery was significantly higher in the II group (62,02±23,7 vs. 45,3±20,6 mmhg in patients of I group; р<0,0001). In the I group the d-dimer level was higher in 43 patients (70,5%), as in the II group — in 226 patients (92,2%). Visualization (MdCt , APg) in the I group was done for 23 patients (35,4%) that helped to rule out PE diagnosis. In the II group these studies were done for 173 (77,6%) patients of whom in 139 (80%) there were signs of pulmonary artery thrombosis. Conclusion. the obtained data confirmed the meaning of nonspecificity of clinical presentation and laboratory and most instrumental methods in patients with suspected PE. By this reason the key point in management of patients should be strict following the recommended stages of diagnostics and treatment.

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