A temible complication of ischemic stroke: pulmonary embolism

Linda Iurato, Giovanna Randisi, Josita Torrisi, Roberto Grimaldi, Grazia Naso, Sara Verniccio, Clorinda Occhipinti, Michele Maria Vecchio

DOI: https://doi.org/10.7175/cmi.v9i4.1196

Abstract

Stroke is a leading cause of death and disability and is the third highest cause of death in the western world. Medical illness after ischemic stroke contribute substantially to poor stroke outcomes. The early in-hospital complications of stroke patients are mainly: pneumonia (hospital acquired pulmonary infection), increased intracranial pressure (neuroimaging evidence of cerebral edema or brain shift syndrome with clinical deterioration), urinary tract infection, intracerebral bleeding, recurrent stroke, epileptic seizures, thrombosis or pulmonary embolism. All these complications influence the patient’s outcomes and require diagnostic and therapeutic measures.

Pulmonary embolism is a major contributor to in-hospital death after stroke. Although the rate of clinically overt pulmonary embolism after stroke has been estimated to be less than 1%, pulmonary emboli account for up to 50% of early deaths after stroke. In daily practice, the clinical burden of pulmonary embolism in patient with stroke is, however, underestimated since the clinical symptoms of stroke may obscure the recognition of this complication. The aim of this article is to describe the clinical and therapeutic aspects of pulmonary embolism as complication after stroke.

Keywords

Ischemic stroke; Pulmonary embolism; Complications

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References

  • Quellette DR, Kamangar N, Harrington A. Pulmonary Embolism. Medscape. Available at http://emedicine.medscape.com/article/300901-overview (last accessed December 2015)
  • Liu LP, Zheng HG, Wang DZ, et al. Risk assessment of deep-vein thrombosis after acute stroke: a prospective study using clinical factors. CNS Neurosci Ther 2014; 20: 403-10; http://dx.doi.org/10.1111/cns.12227
  • Pongmoragot J, Rabinstein AA, Nilanont Y, et al.; Investigators of Registry of Canadian Stroke Network (RCSN) and University of Toronto Stroke Program for Stroke Outcomes Research Canada (SORCan [www.sorcan.ca]) Working Group. Pulmonary embolism in ischemic stroke: clinical presentation, risk factors, and outcome. J Am Heart Assoc 2013; 2: e000372
  • Stein PD, Beemath A, Matta F, et al. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med 2007; 120: 871-9; http://dx.doi.org/10.1016/j.amjmed.2007.03.024
  • Pelliccia F, Schiariti M, Terzano C, et al. Treatment of acute pulmonary embolism: update on newer pharmacologic and interventional strategies. Biomed Res Int 2014; 2014: 410341; http://dx.doi.org/10.1155/2014/410341
  • Torbicki A, Perrier A, Konstantinides S, et al.; ESC Committee for Practice Guidelines (CPG). Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008; 29: 2276-315; http://dx.doi.org/10.1093/eurheartj/ehn310
  • Piazza G, Goldhaber SZ. Acute pulmonary embolism: part II: treatment and prophylaxis. Circulation 2006; 114: e42-7; http://dx.doi.org/10.1161/CIRCULATIONAHA.106.620880
  • Gensini GF, Zaninelli A, Ricci S, et al. SPREAD, Stroke Prevention And Educational Awareness Diffusion, VII Edizione, Ictus cerebrale: linee guida italiane di prevenzione e trattamento. Raccomandazioni e sintesi. 14 marzo 2012. Available at http://www.siapav.it/pdf/SPREAD%202012.pdf (last accessed December 2015)
  • Regione Toscana. Linee guida per la profilassi del tromboembolismo venoso nei pazienti ospedalizzati. SNLG Regioni, 2015. Available at http://www.snlg-iss.it/cms/files/LG_Toscana_TEV.pdf (last accessed December 2015)
  • Barbar S, Noventa F, Rossetto V, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost 2010; 8: 2450-7; http://dx.doi.org/10.1111/j.1538-7836.2010.04044.x
  • Kahn SR, Lim W, Dunn AS, et al.; American College of Chest Physicians. Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 Suppl): e195S-226S
  • National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. Available at https://www.nice.org.uk/guidance/cg68 (last accessed December 2015)
  • CLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration, Dennis M, Sandercock P, et al. Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial. Lancet 2013; 382: 516-24; http://dx.doi.org/10.1016/S0140-6736(13)61050-8
  • Wells PS, Forgie MA, Rodger MA. Treatment of venous thromboembolism. JAMA 2014; 311: 717-28; http://dx.doi.org/10.1001/jama.2014.65; http://dx.doi.org/10.1001/jama.2014.6123
  • Turpie AG, Hull RD, Schellong SM, et al.; EXCLAIM Investigators. Venous thromboembolism risk in ischemic stroke patients receiving extended-duration enoxaparin prophylaxis: results from the EXCLAIM study. Stroke 2013; 44: 249-51; http://dx.doi.org/10.1161/STROKEAHA.112.659797
  • Konstantinides SV. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014; 35: 3145-6
  • Konstantinides SV, Torbicki A. Management of pulmonary embolism: recent evidence and the new European guidelines. Eur Respir J 2014; 44: 1385-90; http://dx.doi.org/10.1183/09031936.00180414
  • Doyen D, Castellani M, Moceri P, et al. Patent foramen ovale and stroke in intermediate-risk pulmonary embolism. Chest 2014; 146: 967-73; http://dx.doi.org/10.1378/chest.14-0100
  • Karlinski M, Kobayashi A, Mikulik R, et al. Intravenous Alteplase in ischemic stroke patients not fully adhering to the current drug license in Central and Eastern Europe. Int J Stroke 2012; 7: 615-22; http://dx.doi.org/10.1111/j.1747-4949.2011.00733.x
  • Condliffe R, Elliot CA, Hughes RJ, et al. Management dilemmas in acute pulmonary embolism. Thorax 2014; 69: 174-80; http://dx.doi.org/10.1136/thoraxjnl-2013-204667
  • Royal College of Physicians. National clinical guideline for stroke. September 2012, fourth edition. Available at https://www.rcplondon.ac.uk/file/1299/download?token=mcyQFjEq (last aaccessed December 2015)
  • Jauch EC, Saver JL, Adams HP, et al; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44: 870-947; http://dx.doi.org/10.1161/STR.0b013e318284056a

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