Russian register of acute pulmonary embolism SIRENA: characteristics of patients and in-hospital treatment

Aim. To assess the features of diagnosis, treatment and outcomes of pulmonary embolism (PE) in patients of Russian hospitals.

Material and methods. The register included all hospitalized patients with PE identified by any diagnostic method. Duration of inclusion was 12 months. In-hospital period management was assessed. Information about the included patients was provided by 20 hospitals from 15 Russian cities.

Results. For the period from April 15, 2018 to April 15, 2019, 609 patients were included in the register (women — 50,7%, mean age — 63,0±14,5 years, minimum-maximum — 19-94 years). Among the known risk factors for PE, the most common were lower limb varicose veins (31,4%), heart failure (23,3%), previous deep vein thrombosis (19,4%), cancer (17,1%). The median time from symptom onset to suspicion/confirmation of PE was 4 days (1-3 quartiles — 1-8 days). Shortness of breath, syncope/presyncope, chest pain/discomfort, cough, leg pain or lower extremity asymmetry and hemoptysis were noted in 88,7%, 30,0%, 29,8%, 17,3%, 9,4% and 8,5% of patients, respectively. Echocardiography was performed in 89,5%, and Doppler ultrasound of lower limb veins — in 85,9% of patients. Signs of venous thrombosis were found in 57,8% of patients. Computed tomographic (CT) pulmonary angiography was performed in 89,2% of patients, pulmonary scintigraphy and pulmonary angiography — 0,8% each.

Conclusion. Symptoms and main risk factors for PE in Russian patients did not fundamentally differ from those previously known. There was good adherence to modern guidelines for the diagnosis of PE, but adherence to guidelines on drug therapy met requirements only in half of the cases. There was an excessive use of TLT, as well as the use of ineffective methods of administering and monitoring anticoagulant therapy.In total, imaging technologies were used in 90,6% of patients, and signs confirming PE were found in 92,7%. Thrombolytic therapy (TLT) was performed in 25,0%; 92,0% of patients received anticoagulants. At the same time, unfractionated heparin (UFH) was injected subcutaneously in 26,3% of cases, and in one third of patients the drug was injected in doses unadjusted by body weight. In 42,7% of patients received UFH, the target activated partial thromboplastin time was not achieved. With warfarin treatment, the target international normalized ratio was achieved in only 48,4% of patients. Inferior vena cava filter placement and thrombectomy were performed in 1,3% each. During hospitalization (median — 11 days), 9,9% of patients died.

1. Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Task force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology. Eur Heart J. 2014;35(43):3033-69. doi:10.1093/eurheartj/ehu283.

2. Heit JA. The epidemiology of venous thromboembolism in the community. Arterioscler Thromb Vasc Biol. 2008;8(3):370-2. doi:10.1161/ATVBAHA.108.162545.

3. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the international cooperative pulmonary embolism registry (ICOPER). Lancet. 1999;353(9):1386-9. doi:10.1016/s0140-6736(98)07534-5.

4. Pollack CV, Schreiber D, Goldhaber SZ, et al. Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: initial report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry). J Am Coll Cardiol. 2011;57(6):700-6. doi:10.1016/j.jacc.2010.05.071.

5. Botova SN, Pochinka IG, Dvornikova MI, et al. Clinical attributes of pulmonary embolism according to the hospital register. Cardiology N. O.T. 2016;3:95-99. (In Russ.)

6. Duplyakov DV, Pavlova TV, Mullova TV, et al. Clinical presentation and patient management differences in confirmed and non-confirmed pulmonary embolism. Russ J Cardiol. 2015;(3):18-24. (In Russ.). doi:10.15829/1560-4071-2015-3-18-24.

7. Kuznetsov AB, Boyarinov GA. Early diagnosis of pulmonary artery thromboembolism (review). Sovremennye tehnologii v medicine. 2016;8(4):330-6. (In Russ.)

8. Berns SA, Shmidt EA, Nagirniyak OA. Management of patients with pulmonary embolism in the cardiac hospital from position of modern European Society Of Cardiology Guidelines. Complex Issues of Cardiovascular Diseases. 2015;4:90-6. (In Russ.). doi:10.17802/2306-1278-2015-4-90-96.

9. Konstantinides SV, Meyer G, Becattini C, et. al. Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Heart J. 2020;41(4):543-603. doi:10.1093/eurheartj/ehz405.

10. Cohen AT, Agnelli G, Anderson FA, et al; VTE Impact Assessment Group in Europe (VITAE). Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost. 2007;98:756-64.