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El tromboembolismo pulmonar (TEP) es una afección potencialmente mortal que se define como la oclusión total o parcial de la circulación pulmonar, ocasionada por un coágulo sanguíneo proveniente de la circulación venosa sistémica, incluidas las cavidades cardiacas derechas y que, dependiendo de su magnitud, puede o no originar síntomas. El tratamiento temprano es fundamental para mejorar la supervivencia y reducir el riesgo de complicaciones. Los equipos de respuesta rápida en tromboembolismo pulmonar (PERT, por sus siglas en inglés) se han convertido en una herramienta clave para lograr este objetivo.

Pulmonary embolism (PE) is a potentially fatal condition that is defined as the total or partial occlusion of the pulmonary circulation, caused by a blood clot coming from the systemic venous circulation, including the right cavities and that, depending on its magnitude, can or not cause symptoms. Early treatment is essential to improve survival and reduce the risk of complications. Pulmonary thromboembolism rapid response teams (PERT) have become a key tool to achieve this goal.

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Introduction Pulmonary thromboembolism (PTE) is the obstruction that occurs in the pulmonary artery or one of its branches due to an embolus or thrombus that predominantly originates in the lower extremities. It continues to be a frequent reason for admission to the emergency department. However, the specific clinical characteristics in the emergency department are not well described and are sometimes underdiagnosed, resulting in high mortality rates. Objective: This study aimed to describe the most common clinical characteristics of patients who present spontaneously to the emergency department of a high-complexity institution in the city of Santiago de Cali, Colombia, and are diagnosed with PTE using chest angiotomography. Materials and Methods Signs, symptoms, and risk factors were described in a descriptive case series of patients over 18 years of age who consulted the emergency department with imaging evidence of PTE. Pregnant patients and patients from services other than emergency were excluded. Bivariate analysis was performed using proportions, frequencies, means, medians, and standard deviation. This study has received ethical approval from the research ethics committee. Results and Discussion Tachycardia and tachypnea continue to be the most frequent signs for suspecting PTE, and dyspnea remains the most common symptom, along with chest pain, in the emergency department. Regarding risk factors, obesity is the most prevalent risk factor for PTE in our study, unlike deep vein thrombosis, which is the most common risk factor.

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ANTECEDENTES Y OBJETIVOS: El Tromboembolismo Venenoso, incluye la Trombosis venosa profunda y el Tromboembolismo Pulmonar. Existen múltiples factores de riesgo para su desarrollo, entre los cuales están los traumas o cirugías. En este contexto, el Departamento de Seguridad y Calidad de Atención, de la División de Gestión de la Red Asistenciales de la subsecretaría de Redes Asistenciales, solicita esta síntesis con el objetivo de actualizar la norma vigente sobre esta temática METODOLOGÍA: Se formuló una estrategia de búsqueda en las bases de datos MEDLINE y EMBASE, utilizando conceptos "practice guideline", "venous thromboembolism", "surgical procedures", con fecha del 1 al 3 de Abril del 2024 dos revisores independientes seleccionaron los estudios que respondieron a la pregunta basándose en criterios de inclusión y exclusión acordados. La extracción de cada artículo la realizó una persona. Los hallazgos fueron resumidos narrativamente RESULTADOS: Se encontraron 20 GPC sobre profilaxis en pacientes quirúrgicos. De estas 14 fueron procedimientos quirúrgicos específicos, y 16 para procedimientos quirúrgicos variados En total se contabilizaron más de 400 recomendaciones, las cuales se distinguen por tipo de profilaxis; farmacológicas, mecanismos/no farmacológicas o profilaxis conjuntas, y referentes al momento de aplicación y duración de la intervención Se encontraron recomendaciones para 10 tipos de cirugías; cirugía general y mayor, ortopédica; neurológica; urológica; cardiaca y vascular; de trauma; ginecología u obstetricia; bariátrica o gástrica; ambulatoria; de cabeza y cuello

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Objetivo: desse estudo foi descrever os mecanismos fisiopatológicos envolvidos no desenvolvimento de tromboembolismo pulmonar em pacientes com COVID-19. Métodos: Revisão de literatura, utilizando o método Scoping Review. A busca foi realizada nos bancos de dados da BVS e PubMed através dos descritores: "COVID-19", "Embolia Pulmonar", "Fisiopatologia" e "Fatores de Risco". Resultados: Seis artigos atenderam aos critérios de elegibilidade do estudo. Conclusão: Os artigos analisados demonstram que a infecção pelo Sars-Cov-2, aliada a fatores na coagulação, imunológicos e fatores de risco, desencadeia alterações endoteliais e vasculares que propiciam o tromboembolismo pulmonar. (AU)

Objective: To describe the pathophysiological mechanisms involved in the development of pulmonary thromboembolism in patients with COVID-19. Methods: Literature review, using the Scoping Review method. The search was carried out in the VHL and PubMed databases using the descriptors: "COVID-19", "Pulmonary Embolism", "Physiopathology" and "Risk Factors". Results: Six articles met the study's eligibility criteria. Conclusion: The analyzed articles demonstrate that the infection by Sars-Cov-2, combined with factors in coagulation, immunological and risk factors, triggers endothelial and vascular alterations that favor pulmonary thromboembolism. (AU)

Objective: Describir los mecanismos fisiopatológicos involucrados en el desarrollo de tromboembolismo pulmonar en pacientes con COVID-19. Métodos: Revisión de la literatura, utilizando el método Scoping Review. La búsqueda se realizó en las bases de datos de la BVS y PubMed utilizando los descriptores: "COVID-19", "Pulmonary Embolism", "Physiopathology" y "Risk Factors". Resultados: Seis artículos cumplieron con los criterios de elegibilidad del estudio. Conclusión: Los artículos analizados demuestran que la infección por Sars-Cov-2, combinada con factores de coagulación, inmunológicos y de riesgo, desencadena alteraciones endoteliales y vasculares que favorecen el tromboembolismo pulmonar. (AU)

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El sarcoma primario de arteria pulmonar es un tumor poco frecuente y con muy mal pronóstico. Su incidencia es difícil de estimar. Presenta una sintomatología inespecífica que dificulta y retrasa su diagnóstico. Presentamos un paciente de 62 años diagnostica do inicialmente de tromboembolismo pulmonar con una clínica discordante. Se decide continuar el estudio, que confirma posteriormente el diagnóstico de sarcoma primario de arteria pulmonar mediante biopsia(AU)

Primary pulmonary artery sarcoma is a rare tumor with a very poor prognosis. Its inci dence is hard to estimate. It presents with nonspecific symptoms, delaying the diagnosis and making it challenging. We present a 62-year-old patient initially diagnosed with pulmonary thromboembolism, exhibiting discordant symptoms. Further investigation was pursued, ultimately confirming the diagnosis of primary pulmonary artery sarcoma through biopsy(AU)

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El tromboembolismo pulmonar masivo es una entidad potencialmente mortal si no es tratado de forma emergente. La trombólisis sistémica es una terapéutica adecuada para estos casos cuando se presenten con datos de shock obstructivo o fracaso respiratorio agudo severo. Presentamos el caso de un varón de 69 años con antecedente de reparación programada de una hernia inguinal diez días antes del evento que acude al servicio de urgencias y emergencias por síncope. A las cuatro horas de su estancia en el hospital sufre hipotensión y desaturación brusca y es diagnosticado de tromboembolismo pulmonar masivo requiriendo la administración de fármacos fibrinolíticos. En este caso, no hubo eventos adversos hemorrágicos y la reperfusión fue completa inmediatamente después a su administración. Se adjuntan imágenes del electrocardiograma (EKG) y la tomografía computarizada (CT) con contraste previo y posterior a la administración del fibrinolítico donde se objetivan reperfusión total de la arteria pulmonar y corrección de todos los cambios eléctricos secundarios a la sobrecargar del ventrículo derecho en un plazo menor a 24 horas. El paciente fue dado de alta a medicina interna a las 72 horas.

Massive pulmonary thromboembolism is a potentially fatal entity if it is not treated immediately. Systemic thrombolysis is an adequate therapy for these cases when they present with data of obstructive shock or severe acute respiratory failure. We present the case of a 69-year-old man with a history of scheduled inguinal hernia repair ten days before the event who attended the Emergency Department due to syncope. Four hours into his hospital stay, he suffered hypotension and sudden desaturation and diagnosed with massive pulmonary thromboembolism requiring the administration of fibrinolytic drugs. In this case, there were no hemorrhagic adverse events and reperfusion was complete at once after its administration. Electrocardiogram (EKG) and computed tomography (CT) images with contrast before and after the administration of the fibrinolytic are attached, showing total reperfusion of the pulmonary artery and correction of all electrical changes secondary to right ventricular overload in less than 24 hours. The patient was discharged to Internal Medicine at 72 hours.

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ABSTRACT Introduction: Although still rare, pulmonary embolism (PE) in children has been increasing over the years. Data regarding this group of patients are still sparse, which contributes to the lack of standardized prophylaxis protocols and the misdiagnosis. This study aimed to determine the incidence of pediatric PE at a Brazilian tertiary hospital, describe clinical characteristics and identify possible risk factors. We also analyzed the diagnosis and management of PE. Methods: This was a retrospective review of tertiary Brazilian single-center data of all pediatric patients (0 - 18 years) with acute PE, diagnosed radiologically, from September 2009 to May 2019. Results: The incidence of PE was 3.3 cases per 10,000 hospitalized children. All the twenty-three cases had some risk factor identified and sixteen of them (69.5%) had more than one risk factor. The most important were central venous catheter (39.1%), malignancy (34.8%) and recent surgery (34.8%). Among the children with identifiable symptoms (69.5%), the most common was dyspnea (56.2%). Only one patient did not receive antithrombotic therapy because of the high bleeding risk and most patients (70.6%) were treated for 3 to 6 months. Among the nineteen patients alive at the end of the six-month follow-up, ten (52.6%) repeated the PE image control. Seven of them (70.0%) had complete or partial resolution of the thrombosis and none had worsening images. Conclusion: Our lower incidence than that of the current literature may reflect underdiagnosis due to low suspicion of PE. At least one risk factor was identified in all patients, which emphasizes the importance of increasing awareness of high-risk children.

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Introducción: El síndrome de May-Thurner es una enfermedad cuya prevalencia real es desconocida. Suele ser asintomática y las manifestaciones clínicas aparecen en el contexto de las complicaciones asociadas a la enfermedad. La aproximación diagnóstica se realiza por medio de imágenes, donde se identifican alteraciones patognomónicas que permiten descartar diagnósticos diferenciales. Se ha demostrado que la COVID-19 genera un estado protrombótico, que en contexto del síndrome de May-Thurner puede derivar en complicaciones tromboembólicas. Objetivo: Comparar la clínica y la posible relación de la enfermedad tromboembólica venosa en el curso de la COVID-19 en pacientes con SMT. Caso clínico: Mujer de 24 años, secretaria de profesión y residente en Bucaramanga. Presentó un cuadro clínico de 20 días de evolución que inició con rinorrea hialina, tos ocasional y mialgias; cinco días después manifestó fiebre no cuantificada y tos con expectoración hemoptoica. Conclusiones: Dentro de la fisiopatología de la infección por SARS-CoV-2 se desarrollan mecanismos procoagulantes, lo cual incrementa el riesgo de eventos trombóticos en pacientes con o sin factores de riesgo(AU)

Introduction: May-Thurner syndrome is a disease whose actual prevalence is unknown. It is usually asymptomatic and clinical manifestations appear in the context of complications associated with the disease. The diagnostic approach is performed by imaging, where pathognomonic alterations are identified to rule out differential diagnoses. It has been demonstrated that COVID-19 generates a prothrombotic state, which particularly in patients with May-Thurner syndrome would lead to thromboembolic complications. Objective: To compare the clinical and possible relationship of venous thromboembolic disease in the course of COVID-19 in patients with May-Thurner syndrome. Clinical case: 24-year-old woman, secretary by profession and resident in Bucaramanga, Colombia. She presented a clinical picture of 20 days of evolution that began with hyaline rhinorrhea, occasional cough and myalgias; five days later she manifested unquantified fever and cough with hemoptotic expectoration. Conclusions: Within the pathophysiology of SARS-CoV-2 infection, procoagulant mechanisms develop, which increases the risk of thrombotic events in patients with or without risk factors(AU)

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PURPOSE@#Static progressive stretch (SPS) can be applied to treat chronic joint stiffness. However, the impacts of subacute application of SPS to the distal lower limbs, where deep vein thrombosis (DVT) is common, on venous thromboembolism remain unclear. This study aims to explore the risk of venous thromboembolism events following subacute application of SPS.@*METHODS@#A retrospective cohort study was conducted on patients diagnosed with DVT following a lower extremity orthopedic surgery before being transferred to the rehabilitation ward from May 2017 to May 2022. Patients with unilateral lower limb comminuted para-articular fractures, transferred to rehabilitation ward for further treatment within 3 weeks after operation, followed up more than 12 weeks since initial manual physiotherapy, and diagnosed DVT by ultrasound before rehabilitation course were included in the study. Patients with polytrauma, without evidence of previous peripheral vascular disease or incompetence, had medication for thrombosis treatment or prophylaxis before the operation, detected with paralysis due to nervous system impairment, infected after operation during the regime, or with acute progression of DVT were excluded. The included patients were randomized to the standard physiotherapy and the SPS integrated groups for observation. Associated DVT and pulmonary embolism data were collected during the physiotherapy course to compare the groups. SSPS 28.0 and GraphPad Prism 9 were used for data processing. A p < 0.05 was set significant difference.@*RESULTS@#In total of 154 patients with DVT participating in this study, 75 of them were treated with additional SPS for postoperative rehabilitation. The participants in the SPS group showed improved range of motion (12.3° ± 6.7°). However, in the SPS group, there was no difference in thrombosis volume between the start and termination (p = 0.106, p = 0.787, respectively), although difference was seen intra-therapy (p < 0.001). Contingency analysis revealed the pulmonary embolism incidence (OR = 0.703) in the SPS group compared to the mean physiotherapy.@*CONCLUSION@#The SPS technique is a safe and reliable option to prevent potential joint stiffness without aggravating the risk of distal DVT for postoperative patients suffering from relevant trauma.

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OBJECTIVES@#To explore the difference in CT values between pulmonary thromboembolism and postmortem clot in postmortem CT pulmonary angiography (CTPA) to further improve the application value of virtual autopsy.@*METHODS@#Postmortem CTPA data with the definite cause of death from 2016 to 2019 were collected and divided into pulmonary thromboembolism group (n=4), postmortem clot group (n=5), and control group (n=5). CT values of pulmonary trunk and left and right pulmonary artery contents in each group were measured and analyzed statistically.@*RESULTS@#The average CT value in the pulmonary thromboembolism group and postmortem clot group were (168.4±53.8) Hu and (282.7±78.0) Hu, respectively, which were lower than those of the control group (1 193.0±82.9) Hu (P<0.05). The average CT value of the postmortem clot group was higher than that of the pulmonary thromboembolism group (P<0.05).@*CONCLUSIONS@#CT value is reliable and feasible as a relatively objective quantitative index to distinguish pulmonary thromboembolism and postmortem clot in postmortem CTPA. At the same time, it can provide a scientific basis to a certain extent for ruling out pulmonary thromboembolism deaths.

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Introduction: Pulmonary embolism is one of the complications of COVID-19, with reported incidence ranging from 3 to 33 % in non-ICU patients to as high as 40% among ICU patients. Since the clinical presentations of COVID-19 and Pulmonary embolism overlap, it is difficult to differentiate between these cases. This study aimed to assess the incidence of pulmonary embolism and associated factors among confirmed Covid-19 Patients in Ethiopia. Methods: A nested case control study was conducted among 131 patients with COVID-19 (40 COVID-19 patients with Pulmonary embolism and 91 COVID-19 patients with no PE) who were on follow up from May, 2021 to May, 2022. Data was summarized using frequencies with percentages. A chi-square test/ Fisher's exact test was run to determine the presence of a significant difference between the exposure variables and the development of PE. To identify factors associated with the development of Pulmonary embolism, a multivariable Binary Logistic Regression model with sensitivity analysis was run. Results: The incidence of PE was 30.5% (95% CI, 22.9% - 37.4%) in the cohort of patients for whom upfront CTPA was performed. The Chi-square/ Fisher's exact test results showed a significantly higher proportion of patients with PE tend to present with shortness of breath, chest pain and anosmia/ageusia than those with no PE. However, in a subsequent regression analysis, only chest pain was found to be significantly associated with the development of PE in COVID-19 patients (AOR= 3.24, 95% CI= 1.10, 9.54, p-value=0.033). Conclusion: The incidence of PE among COVID-19 patients was found to be relatively lower than reports from other countries. Having chest pain was found to be a significant factor that indicates the development of PE, implying that in a setting where performing upfront CTPA is not practical, detailed symptom inquiry could serve as an important clinical criteria.

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Décrire les aspects épidémio-cliniques des manifestations thrombotiques au cours de la COVID-19 au sein des hôpitaux militaires de Libreville et Akanda, Gabon. Méthodes : Nous avons mené une étude rétrospective et descriptive multicentrique d'une durée de 7 mois, du 01er septembre 2021 au 31 mars 2022, portant sur les patients admis dans les unités de réanimation des hôpitaux d'instruction des armées de Libreville (HIAOBO) et d'Akanda (HIAA), pour COVID-19 documentée ou suspectée. Résultats : Durant la période d'étude, 167 patients ont été́ admis pour infection à SARS-CoV-2, parmi lesquels, 18 ont présentés des manifestations thromboemboliques (10,8%). La moyenne d'âge était de 54,7±6.4 ans. Il y avait une large prédominance masculine avec un sexe ratio à 2. Nous avons noté́ 9 cas d'embolie pulmonaire (50%), 5 cas d'accidents vasculaires cérébraux ischémiques (28%), 1 cas de thrombose veineuse profonde de membre inferieur (6%), 1 cas de thrombose veineuse cérébrale (6%), 1 cas de thrombose de la veine mésentérique (6%) et 1 cas de thrombose de la veine porte (6%). Les D-dimères étaient élevés chez tous les patients. Les globules blancs étaient élevés (>10000/mm3 ) chez 12 patients (67%). Les plaquettes étaient inférieures à 150000/mm3 pour 6 patients (33%). Tous les patients avaient une pneumonie à SARS-CoV-2 et la moyenne d'atteinte deslésions pulmonaires était estimée à 45%. Neuf patients étaient décédés (50%) au cours de l'hospitalisation. Conclusion : L'infection par le SARS-CoV-2 constitue vraisemblablement une prédisposition à la survenue d'un événement thrombotique. L'incidence des manifestations thrombotiques chez les patients atteints de COVID-19 reste élevée, renforçant ainsi la prescription systématique d'une anticoagulation prophylactique

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Resumen Algunos estudios sugieren que existe una relación entre el uso de antipsicóticos y el riesgo de tromboembolismo venoso (TEV) y embolia pulmonar (EP). Sin embargo, los resultados siguen sin ser concluyentes. Se trata del caso de un Masculino de 23 años con antecedentes de Esquizofrenia y Depresión tratado quetiapina 800 mg, el cual es encontrado muerto en la cama de un hotel. En la necropsia sin lesiones traumáticas visibles, hallazgos histológicos de tromboembolismo pulmonar masivo con infartos pulmonares secundarios. Laboratorio de Toxicología detectó la presencia de quetiapina, no se detectó alcohol o drogas de abusos. Mediante el Algoritmo De Karch & Lasagna Modificado el tromboembolismo pulmonar fue una reacción adversa con una probabilidad de relación causal posible. Se han informado muchos casos de muerte súbita causada por EP con la exposición a antipsicóticos, pero la relación de su uso y el riesgo de TEV y EP sigue siendo controvertida.

Abstract Some studies suggest a relationship between antipsychotic use and the risk of venous thromboembolism (VTE) and pulmonary embolism (PE). However, the results remain inconclusive. This is the case of a 23-year-old male with a history of schizophrenia and depression treated with quetiapine 800 mg, who was found dead in a hotel bed. At necropsy with no visible traumatic lesions, histological findings of massive pulmonary thromboembolism with secondary pulmonary infarcts. Toxicology laboratory detected the presence of quetiapine, no alcohol or drugs of abuse were detected. Using the Modified Karch & Lasagna Algorithm, pulmonary thromboembolism was an adverse reaction with a probable causal relationship. Many cases of sudden death caused by PE have been reported with exposure to antipsychotics, but the relationship of their use and the risk of VTE and PE remains controversial.