Clinical characteristics of acute pulmonary thromboembolism in Japan: Results of a multicenter registry in the Japanese Society of Pulmonary EmbolismResearch

Background: Although the incidence of acute pulmonary thromboembolism (APTE ) has been increasing in Japan, patient characteristics, management strateg ies, and outcome have nut vet been assessed in large series. Hypothesis: The present study was designed to investigate the current statu s of APTE in Japan. Methods: Of a total of 533 registry patients with pulmonary thromboembolism . 309 with APTE were analyzed with respect to clinical symptoms and signs, predisposing factors, diagnostic procedures, estimation of deep Venous thro mbosis, treatment, and clinical course. Results: Main risk factors were recent major surgery, cancer; prolonged imm obilization, and obesity; only a few patients had coagulopathy and 36% were in cardiogenic shock at presentation. The majority of registry patients un derwent lung scans or pulmonary angiography; 30% were diagnosed only by lun g scanning. Venous ultrasonography was used in only 34 patients, while 188 patients underwent at least one diagnostic procedure for deep venous thromb osis. Thrombolysis was more frequently performed in patients with cardiogen ic shock, and only a few patients received thromboembolectomy. In-hospital mortality rate was 14%. In patients with cardiogenic shock, the mortality r ate was reduced by thrombolysis. The predictors of in-hospital mortality we re male gender, cardiogenic shock, cancer, and prolonged immobilization. Conclusions: The patients in this registry had almost the same findings as those in Western patients, except for some paints that had the possibility of demonstrating a difference between Westerners and Japanese in the develo pment of APTE. These results can prove especially helpful in planning prosp ective, randomized trials that will clarify the impact of widely used treat ment modalities on the outcome of patients with APTE.