Original communication| Volume 29, ISSUE 1, P24-43, January 1951

Venous thrombosis analysis of 580 cases

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      • 1.
        1. The present study is based on 580 cases of venous thrombosis encountered at Charity Hospital during the 7 year period, 1941 to 1948; of these, 316 were complicated by pulmonary embolism, 203 of which ended fatally.
      • 2.
        2. The incidence of thromboembolism is increasing in spite of measures which have been instituted to prevent its development. In the 5 year period, 1941 to 1946, there were 332 cases, and in the subsequent 2 year period, 1947 and 1948, there were 248 cases, or an increase in the rate per hundred thousand admissions of 56 per cent. There was an even greater increase in the incidence of fatal pulmonary embolism in the last 2 years, the corresponding percentage being 111.
      • 3.
        3. Thromboembolism occurred more frequently in white people than in colored and more often in females than in males. Embolism, however, affected men more often than women.
      • 4.
        4. The age incidence of fatal embolism followed rather closely the curve for the age distribution of thrombosis. When compared with the curve for the age distribution of all fatalities in the hospital, there appeared to be a tendency for pulmonary embolism to occur at a slightly earlier age.
      • 5.
        5. There was no significant variation in the seasonal incidence.
      • 6.
        6. The incidence of thromboembolism for the individual services corresponded to that for all hospital admissions with the exception of the obstetric and gynecologic services. Whereas 20 per cent of all admissions were to the obstetric service, only 9.8 per cent of cases of thromboembolism were on this service. Of all cases admitted to the hospital, 8.7 per cent were on the gynecologic service, and 18.1 per cent of cases of thromboembolism were observed on this service. Tuberculosis was associated with a low incidence of thromboembolism.
      • 7.
        7. Whereas only slightly more than one-fourth of all the cases of thromboembolism were on the medical service, approximately one-half of the fatal cases of pulmonary embolism occurred on this service. This is probably due to the fact that the majority of these patients had serious cardiac disorders. Although 10 per cent of all cases of thromboembolism occurred on the obstetric service, only 2 per cent had fatal pulmonary emboli.
        Approximately one-fourth of the cases of thromboembolism occurred postoperatively. The next largest number occurred in association with heart disease. In the postoperative group, the relative frequency of pulmonary embolism was approximately that of thrombosis, whereas in the cardiac group the frequency of pulmonary embolism was far greater. Eight per cent of all cases of thromboembolism occurred spontaneously.
      • 8.
        8. The deaths from pulmonary embolism paralleled generally the curve of the deaths for all hospital services with the exception of the gynecologic obstetric, and tuberculosis services. In gyneeology the proportion of deaths from pulmonary embolism was significantly greater in relation to all cases of pulmonary embolism than was the proportion of gynecologic deaths in relation to all hospital deaths (13.8 per cent and 1.9 per cent, respectively). This is probably due to the large number of patients with postabortal sepsis treated on the gynecologic service. In the obstetric group the number of fatalities was low. In tuberculosis the relative number of deaths from thromboembolism was much lower than the tuberculosis death rate.
      • 9.
        9. Of the 580 cases of pulmonary embolism, 203 (35 per cent) were fatal. The highest mortality rates (63.5 per cent) occurred in patients with medical conditions; the lowest were on the surgical and obstetric services. With the exception of the cardiac cases, a number of the fatalities from pulmonary embolism might have been prevented by ligation of the femoral vein. Of the entire group of 580 cases, 15.7 per cent had venous ligation. However, in 43.3 per cent of the fatal cases of pulmonary embolism not associated with heart disease there was no clinical evidence of phlebothrombosis. This emphasizes the difficulty of making this diagnosis.
      • 10.
        10. On the basis of certain studies on blood coagulation, it is believed that the relating proportions of antithrombin and blood thrombin levels of the blood constitute significant factors. These studies suggest that the circulating antithrombin may be alpha tocopherol phosphate, which is normally present in the alpha globulin and gamma globulin fractions of the blood. Whereas venous thrombosis does not develop in every case with antithrombin deficiency, a low antithrombin level in a patient whose prothrombin level is normal is indicative that thrombosis is likely and steps should be taken to prevent the development of an intravascular clot.
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