• Users Online: 20
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
Year : 2020  |  Volume : 5  |  Issue : 2  |  Page : 38-42

Acute venous thromboembolism in a limited resource healthcare system: Mitigating management challenges

1 Dr. Joe Nwiloh Heart Center, St. Joseph's Hospital, Adazi-Nnukwu, Nigeria
2 Department of Internal Medicine, Cardiology Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
3 Federal Medical Center, Pediatric Cardiology Unit, Asaba, Delta State, Nigeria
4 Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria

Correspondence Address:
Dr. Jonathan Nwiloh
Dr. Joe Nwiloh Heart Center, St. Joseph's Hospital, Adazi-Nnukwu, Anambra State
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/njct.njct_12_21

Rights and Permissions

Objective: The study's aim was to categorize patients' risk profiles, management options, and strategies to mitigate clinical practice challenges in a limited resource setting. Materials and Methods: We retrospectively reviewed the medical records of patients with acute venous thromboembolism (VTE) entered in a prospective database at our center from August 2014 to July 2021. Results: Twenty-two of 708 admitted patients were diagnosed with VTE for an incidence of 3.1%. The mean age was 63.7 ΁ 14.7, range 30-89, mean body mass index 31.5 ΁ 6.7 and 54.5% were female. Six (27.3%) patients had deep-vein thrombosis (DVT), 14 (63.6%) pulmonary embolism (PE) and 2 (9.1%) DVT/ PE. Dyspnea (68.2%) and leg swelling (63.6%) were the most frequent presenting symptoms. Hypoxemia with oxygen saturation <90 and cardiogenic shock was present in 27.3% and 13.6%, respectively. Due to limited access to computer tomography pulmonary angiogram (CTPA), transthoracic echocardiogram (TTE) was utilized to aide diagnosis and was performed in 14 (87.5%) patients with PE. All 14 patients showed evidence of right ventricular dysfunction, 78.5% had moderate-to-severe pulmonary hypertension and 57.1% right heart thrombus. 4 patients with DVT were treated as outpatients. All inpatients were anticoagulated with either unfractionated heparin or low-molecular-weight heparin and transitioned to Vitamin K antagonist or direct oral anticoagulant. The primary treatment duration was 3-6 months. The mean duration of follow-up was 17.5 ΁ 14.7 months. Hospital mortality was 16.7% (3/18), 30 days mortality 18.2% (4/22) and 6 months all-cause mortality 31.8% (7/22). All patients with late deaths had moderate-to-severe pulmonary hypertension. Conclusion: TTE in the absence of CTPA is a useful alternative diagnostic tool in the management of acute PE in limited-resource settings. It may also aid prognostication through estimation of pulmonary artery pressure.

Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)

 Article Access Statistics
    PDF Downloaded2    
    Comments [Add]    

Recommend this journal