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ORIGINAL ARTICLE
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
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njct.njct_12_21

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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.


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