[Diagnostic and therapeutic features of pulmonary embolism in elderly patients].

BACKGROUND

Pulmonary embolism (PE) is often underdiagnosed in the elderly for nonspecificity and atypicity of presentation. The aim of this study was to evidence, retrospectively, the clinical, instrumental and laboratory aspects in the diagnosis of elderly patients with suspected PE and to observe the antithrombotic primary prophylaxis, acute antithrombotic treatment and its hemorrhagic side effects in patients with confirmed PE (CPE).

METHODS

We conducted an observational, retrospective, study on 118 hospitalized patients > or = 65 years (49 males and 69 females, mean age 77.76 +/- 7.17 years) during a 5-year period who underwent a scintigraphic lung scan for suspected PE. Clinical, instrumental and laboratory findings of 75 patients with CPE were compared with 43 patients with unconfirmed PE (UCPE).

RESULTS

Symptoms of dyspnea and chest pain and all the considered signs, except tachycardia, were significantly more frequent in the CPE group. Bed rest > 4 days, venous insufficiency, deep vein thrombosis, obesity and stroke were the risk factors significantly more frequent in the CPE group. Sinus tachycardia, incomplete right bundle branch block, ST-T alterations were significantly more present in the CPE group. Cardiomegaly was the only significant more frequent chest X-ray finding in the CPE group, while echocardiography showed a significant involvement of the right ventricle in the CPE group. Plasma D-dimer levels were significantly higher in the CPE group but the mean values were > 500 micrograms/l in both groups. In arterial blood gas analysis we found more severe hypoxemia, arterial hyposaturation and higher alveolar-oxygen gradient in the CPE group, while we did not find a more frequent respiratory alkalosis in this group. Heart failure, ischemic heart disease and chronic obstructive pulmonary disease were the more frequent diagnoses in the UCPE group. None of the patients received thrombolysis. Seventy percent of the CPE patients received intravenous heparin; 9 hemorrhagic side effects occurred, 3 of them being major with one fatal in one patient treated with subcutaneous unfractionated heparin.

CONCLUSIONS

Our study shows the diagnostic difficulties of PE in the elderly because of nonspecifcity of clinical, instrumental and laboratory aspects. Although many of these aspects are significantly more frequent in the CPE group, the same are often the main aspects also in the UCPE group. Moreover, our study reveals the low utilization of antithrombotic primary prophylaxis and high risk of hemorrhagic side effects of heparin in this subgroup of patients.