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

Abstract

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.

Keywords

• pulmonary embolism
• register
• sirena
• deep vein thrombosis
• anticoagulants
• thrombolysis
• outcomes