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New Insight Into Lung Clot Treatment Found

Breaking News - January 2006 - Week 4

(Jan 25, 2006)

Healthcare in  the News

-- Ten simple risk factors can help doctors identify the best treatment for patients with a clot in the lungs, a new study finds.

Picture of a female nurse with a patient

These risk markers can help physicians identify which patients with a pulmonary embolism are at low risk of short-term death and are good candidates for outpatient treatment, concludes the study in the Archives of Internal Medicine.

A pulmonary (lung)embolism (PE) is a blood clot that develops in a blood vessel elsewhere in the body (most commonly from the leg), then travels to an artery in the lung, forming a suddenocclusion (blockage) of the artery.

An embolism to the lung may cause serious life-threatening consequences and, potentially, death.

Most commonly, a PE is the result of a condition called deep vein thrombosis (blood clot in the deep veins of the leg).

These types of clots can be fatal and cause more than 100,000 hospitalizations in the US each year, according to the researchers.

Risk Factors Identified

Dr. Drahomir Aujesky of the University of Lausanne, Switzerland, and colleagues evaluated 15,531 hospitalized patients who received a discharge diagnosis of PE from 186 Pennsylvania hospitals.

The researchers concentrated on over 10,000 pulmonary embolism patients and identified 10 risk factors that indicated a greater risk of short-term death (within 30 days).

The risk factors identified by Dr. Aujesky's team include: an age of 70 years or older; a history of cancer, heart failure, chronic lung disease, or chronic kidney disease; cardiovascular disease; altered mental status; high pulse rate; low systolic blood pressure; and reduced oxygen saturation in arterial blood.

Patients without any of these risk factors are considered to be at low risk for short-term death and eligible for outpatient treatment, the study concludes.

Low-Risk Patients May Receive Out-Patient Treatment

The researchers noted that if 20 percent of people with pulmonary embolism received outpatient treatment instead of inpatient care, this would result in health-care savings of up to $91 million a year in the US.

However, "outpatient treatment for nonmassive PE is not widely accepted because no explicit clinical criteria exist to accurately identify patients with PE who are at low risk of adverse outcomes," the researchers state in the study.

Because of this, Dr. Aujesky and colleagues attempted to develop an objective and easily-applied clinical prediction rule to identify patients with PE at low risk of short-term death and other complications who would be candidates for outpatient treatment.

In an accompanying editorial, Dr. Lisa K. Moores, of Walter Reed Army Medical Center in Washington, D.C., calls the study "exciting because it is the first to combine several factors into a score that can be used to determine the appropriate treatment setting."

"Perhaps more importantly, the risk score can be calculated quickly and reliably with clinical data easily obtained in the initial history review and physical examination," Dr. Moores notes.

Always consult your physician for more information.

For more information on health and wellness, please visit health information modules on this Web site.

Causes of Pulmonary Embolism

Blood clotting is a normal process that occurs in the body to prevent bleeding. The body makes blood clots and then breaks them down.

Under certain circumstances, the body may be unable to break down a clot, which may result in a serious health condition.

Abnormal blood clotting in the veins is related to a combination of several problems such as "sluggish" blood flow through the veins, an over-increase in clot forming factors, and/or an injury to the blood vessel wall.

Blood clots can form in arteries and/or veins.

Clots formed in veins are called venous clots. Veins of the legs can be classified as superficial veins (close to the surface of the skin) or deep veins (located near the bone and surrounded by muscle).

Venous clots most often occur in the deep veins of the legs. This condition is called deep vein thrombosis (DVT), or deep vein clot.

Once a clot has formed in the deep veins of the leg, there is a potential for part of the clot to break off and travel (embolize) through the bloodstream to another area of the body.

Deep vein thrombosis is the most common cause of a pulmonary embolism. Therefore, the term venous thromboembolism (VTE) may refer to deep vein thrombosis and/or the complication, pulmonary embolism.

Other less frequent sources of pulmonary embolism are a fat embolus, amniotic fluid embolus, air bubbles, and a deep vein thrombosis in the upper body.

Clots may also form on the end of an indwelling intravenous (IV) catheter, break off, and travel to the lungs.

In order to prevent pulmonary embolism, the only effective way is to prevent deep vein thrombosis.

Always consult your physician for a diagnosis.

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