THE CLINICAL IMPACT OF RISK FACTOR-ANALYSIS AND PROPHYLAXIS ON PULMONARY-EMBOLISM

Pulmonary emboli cause 50,000 deaths annually despite recognized risk factors and methods of prophylaxis. To determine the impact of risk fa ctor analysis and the use of prophylaxis, a retrospective chart review of patients suffering pulmonary embolism (PE) at Georgetown Universit y Hospital was performed. During a fifty-month period, 25,000 surgical and 36,000 nonsurgical admissions included 171 cases of PE. The incid ence of PE among surgical patients was 0.24% (n=61) and was 0.30% (n=1 10) among nonsurgical patients as confirmed in 82% by pulmonary angiog raphy or high-probability ventilation/perfusion scans. PE prophylaxis included pneumatic stockings, low-dose heparin, combination low-dose h eparin/stockings, and coumarin. However, prophylactic measures were ab sent in 23% of the surgical and in all the nonsurgical patients suffer ing PE. On the basis of established criteria (SVS/ISCVS), 57% of surgi cal patients suffering PE were considered at high risk as compared wit h 13% of nonsurgical patients. Conversely, 54% of nonsurgical patients suffering a PE were considered to be at low risk. Standard treatment modalities were instituted after nonfatal PE: anticoagulation (61%), i nferior vena cava filter (14%), and anticoagulation/filter (6%). While risk factor analysis identifies high-risk surgical patients, it may b e less effective in identifying nonsurgical patients at increased risk for PE.