[High-risk factors and clinical pathological analysis in 21 cases of fatal pulmonary embolism].

OBJECTIVE

To explore the clinical and pathological characteristics of fatal pulmonary thromboembolism, especially the contribution of acquired and genetic risk factors of fatal pulmonary thromboembolism, so as to provide some useful information for its clinical prevention and treatment.

METHODS

The medical dispute autopsy cases performed at the Department of Pathology, School of Basic Medical Sciences, Peking University from January 1, 2002 to September 30, 2008 were retrospectively reviewed. FV ( factor V ) Leiden mutation and FII ( factor II) G20210A mutation were analyzed by using methods of PCR and restriction fragment length polymorphism (RFLP) in fatal pulmonary embolism cases and random selected control cases of adult autopsy.

RESULTS

There were 21 patients who died from fatal pulmonary thromboembolism, accounting for 12.96% (21/162) of adult autopsy cases. In these cases, there was at least one of the known risk factors in each case and more than two risk factors could be found in most cases. The acquired risk factors, such as surgery, trauma and fractures, cancer, pregnancy and puerperium, the elderly, hypertension, diabetes, infections, could be found in these patients. FV Leiden mutation and FII G20210A mutation were not detected in any of the 21 cases of fatal pulmonary thromboembolism cases and six control cases. Of all the 21 cases, quantitative D-dimer measurement was performed only in six patients and D-dime level in these six samples was all significantly increased. According to the records, there was only 1 patient treated by preventive anticoagulants in the 21 patients.

CONCLUSION

Fatal pulmonary thromboembolism is an important reason for medical dispute. Fractures and trauma, surgery and other acquired factors are the main reasons for fatal pulmonary embolism in Chinese. Genetic factors (FV Leiden and FII G20210A mutations) are not the reason for Chinese to suffer from fatal pulmonary thromboembolism. Assessment of risk factors (especially traumatic fractures and surgical intervention) of pulmonary thromboembolism may play an important role in taking appropriate preventive procedures, early diagnosis and reasonable treatment to reduce its mortality.