ABSTRACT
Abstract: Introduction: Pulmonary thromboembolism (PTE) is a cardiovascular emergency threatening life. It is classified at low, intermediate and high risk of mortality. By the above, it allows to establishing conservative treatment for low-intermediate risk PTE and more intense treatment for high risk PTE. Objective: To report the number of cases of acute PTE, risk stratification and prognosis in those treated with adherence to clinical guidelines. Material and methods: Review of clinical records with a diagnosis of acute PTE by confirmatory diagnostic test. The type of treatment was determined by: oral anticoagulation (OAC) or parenteral anticoagulation (PAC), percutaneous thrombectomy, supraselective thrombolysis, systemic thrombolysis, surgical thrombectomy or combinations. The type of initial anticoagulation and maintenance therapy. Hard results: TIMI major bleeding, re-thrombosis, death and brain stroke (BS). Normality was verified by Kolmogorov-Smirnov test. Then was compared with Student t or U Mann-Whitney. Results: A sample of 36 patients was obtained, the mean age was 67.24 ± 18.83 years, 62.2% were females. The 29.7% were low-risk PTE, 51.4% were intermediate risk and 18.9% were high risk. The 70.3% received OAC, 8.1% percutaneous trombectomy, 8.1% systemic thrombolysis, 10.8% systemic thrombolysis + percutaneous thrombolysis, 2.7% percutaneous trombectomy + supraselective thrombolysis. There is increased risk of death in this group OR = 2.63 (95% CI 0.45-16.08) but not significant (p = 0.255). Conclusions: Lack of adherence to clinical guidelines confers increased risk of death in patients with acute PTE, this difference is not statistically significant.
Resumen: Introducción: La tromboembolia pulmonar (TEP) es una urgencia cardiovascular que pone en riesgo la vida. Se cataloga en riesgo bajo de mortalidad, intermedio y alto. Lo anterior permite establecer estrategias terapéuticas conservadoras para la TEP de riesgo bajo-intermedio y más intensas para alto riesgo. Objetivo: Reportar el número de casos de TEP aguda, la estratificación de riesgo y el pronóstico en quienes recibieron tratamiento con apego a guías clínicas. Material y métodos: Revisión de expedientes clínicos con diagnóstico de TEP aguda, mediante prueba diagnóstica confirmatoria. Se determinó el tipo de tratamiento: anticoagulación (ACO), oral o parenteral (ACP), trombectomía percutánea(TBTP), trombolisis supraselectiva (TBLSU), trombolisis sistémica (TBLSIS), trombectomía quirúrgica (TBTQ) o sus combinaciones. El tipo de anticoagulación inicial y de mantenimiento. Los resultados duros: sangrado TIMI mayor, retrombosis, muerte y evento vascular cerebral (EVC). Se verificó la normalidad mediante prueba de Kolmogorov-Smirnov. Posteriormente se comparó con t Student o U de Mann-Whitney. Resultados: Se obtuvo una muestra de 36 pacientes, la edad media fue 67.24 ± 18.83 años, el 62.2% fueron del género femenino. El 29.7% correspondía a TEP de riesgo bajo, 51.4% riesgo intermedio y 18.9% a riesgo alto. El 70.3% se dio ACO y ACP, 8.1% TBTP, 8.1% TBLSIS, 10.8% TBLSIS + TBTP y 2.7% TBTP + TBLSU. Existe mayor riesgo de muerte en el grupo de falta de apego a guías OR = 2.63 (IC 95% 0.45-16.08), sin embargo, no es significativo (p= 0.255). Conclusiones: La falta de apego a guías clínicas confiere mayor riesgo de muerte en pacientes con TEP aguda, esta diferencia no es estadísticamente significativa.