The origin of fatal pulmonary emboli: a postmortem analysis of 500 deaths from pulmonary embolism in trauma, surgical, and medical patients

Tadlock, Matthew D.; Chouliaras, Konstantinos; Kennedy, Martina; Talving, Peep; Okoye, Obi; Aksoy, Hande; Karamanos, Efstathios; Zheng, Ling; Grabo, Daniel; Rogers, Christopher J.; Noguchi, Thomas T.; Inaba, Kenji; Δημητριάδης, Δημήτριος

doi:10.1016/j.amjsurg.2014.09.027

Cited by 40 publications

(27 citation statements)

References 15 publications

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“…It is interesting to note that the high rate (85.7%) of de novo PE observed in our case series stands in striking contrast to the frequency of PE without DVT (3 of 26 cases, 11.5%) among all noninfluenza patients with PE, admitted during the same time period to our hospital, as well as to the incidence of de novo PE previously reported in the literature (ranging from 0% to 22.6%), with the highest incidence reported in an autopsy study of 500 trauma, surgical, and medical patients with fatal pulmonary emboli [10, 11]. Our clinical observation further supports the results of another autopsy study [8], reporting higher incidence (62.5%) of peripherally distributed pulmonary thrombi among 8 patients with fatal pH1N1 infection, compared with the corresponding rate (37.5%) of peripheral pulmonary thrombi observed in a control group of 8 noninfluenza-related autopsy cases, suggesting the possibility of de novo formation—instead of an embolic migration—of thrombi among pH1N1-infected individuals.…”

Section: Discussioncontrasting

confidence: 65%

H1N1-Induced Venous Thromboembolic Events? Results of a Single-Institution Case Series

Dimakakos¹,

Grapsa²,

Vathiotis³

et al. 2016

Open Forum Infectious Diseases

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We describe the clinical and imaging characteristics of 7 cases with polymerase chain reaction-confirmed novel influenza A H1N1 virus (pH1N1) infection who developed venous thromboembolic events (VTEs) while being hospitalized for influenza pneumonia. Pulmonary embolism (PE) without deep vein thrombosis (DVT) was observed in 6 of 7 cases (85.7%); PE with underlying DVT was found in 1 patient (14.3%).

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Section: Discussioncontrasting

confidence: 65%

H1N1-Induced Venous Thromboembolic Events? Results of a Single-Institution Case Series

Dimakakos¹,

Grapsa²,

Vathiotis³

et al. 2016

Open Forum Infectious Diseases

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“…Based on the results of postmortem autopsy, the source of PE could not be detected in 28% of patients who died after emergency surgery and in 30% of patients after elective surgery [ 4 ]. Among patients who died in the non-surgical departments, thrombosis of the PA without DVT was found in 20.9% [ 4 ]. The data were obtained from the findings of autopsies of 500 patients with PE being a confirmed cause of death.…”

Section: Clinical Aspects Of Pulmonary Thrombosismentioning

confidence: 99%

“…The data were obtained from the findings of autopsies of 500 patients with PE being a confirmed cause of death. After excluding all cases where the source of embolism was identified, the cases were designated as PE with no primary source [ 4 ].…”

Section: Clinical Aspects Of Pulmonary Thrombosismentioning

confidence: 99%

“…This mechanistic approach is still dominant in clinical practice. However, concurrent with the accumulation of clinical data on VTE complications, the idea of embolism from thrombotic masses in the venous system as the only source of emboli in the branches of the PA started to become doubtful, since no initial thrombus was found in a large number of patients [ 3 , 4 ]. Cases of thrombi discovered in the branches of the PA in the absence of concomitant deep vein thrombosis (DVT) cannot be justified only by the drawbacks of evaluation techniques that are used to diagnose thrombosis.…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary Artery Thrombosis: A Diagnosis That Strives for Its Independence

Porembskaya

Toropova

Tomson

et al. 2020

IJMS

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According to a widespread theory, thrombotic masses are not formed in the pulmonary artery (PA) but result from migration of blood clots from the venous system. This concept has prevailed in clinical practice for more than a century. However, a new technologic era has brought forth more diagnostic possibilities, and it has been shown that thrombotic masses in the PA could, in many cases, be found without any obvious source of emboli. Chronic obstructive pulmonary disease, asthma, sickle cell anemia, emergency and elective surgery, viral pneumonia, and other conditions could be complicated by PA thrombosis development without concomitant deep vein thrombosis (DVT). Different pathologies have different causes for local PA thrombotic process. As evidenced by experimental results and clinical observations, endothelial and platelet activation are the crucial mechanisms of this process. Endothelial dysfunction can impair antithrombotic function of the arterial wall through downregulation of endothelial nitric oxide synthase (eNOS) or via stimulation of adhesion receptor expression. Hypoxia, proinflammatory cytokines, or genetic mutations may underlie the procoagulant phenotype of the PA endothelium. Both endotheliocytes and platelets could be activated by protease mediated receptor (PAR)- and receptors for advanced glycation end (RAGE)-dependent mechanisms. Hypoxia, in particular induced by high altitudes, could play a role in thrombotic complications as a trigger of platelet activity. In this review, we discuss potential mechanisms of PA thrombosis in situ.

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“…3,4 A postmortem study of PE deaths in trauma patients found that 71% of pulmonary emboli originated from the lower extremity and only 1.1% from the upper extremity. 5 Post-thrombotic syndrome following UEDVT is estimated at 7% to 46% of patients, but these studies use variable definitions across diverse patient populations and do not evaluate catheter-associated (CA) UEDVT specifically. 6 Although the body of literature is growing, current recommendations are largely based on extrapolations of LEDVT data.…”

mentioning

confidence: 99%