Pulmonary embolism in stroke patients: autopsy results study

Abstract

Background: Pulmonary embolism is a major contributor to in-hospital mortality after stroke and accounts for up to 50% of early deaths. The clinical picture could be unremarkable, so the complication is not recognized in a timely manner. The purpose of the study was to analyze the missed cases of pulmonary embolism after stroke. Material and methods: A retrospective analysis of autopsy protocols from 2017 till 2020 was performed and 13 cases of thromboembolism clinically unidentified but detected at necropsy were selected. Results: The study sample consists of 5 men (38.5%) and 8 women (61.5%) aged 47 – 83 years. By CT were confirmed as ischemic stroke 6 pts (46.8%), hemorrhagic stroke – 4 pts (30.1%) one of them underwent surgery (7.69%), ischemic stroke with hemorrhagic transformation – 3 pts (23.1%). It was the first event for 11 pts (84.61%) and 2 pts (15.4%) with recurrent stroke. Major cardiovascular risk factors were: hypertension – 2 pts (92.3%), obesity – 8 pts (61.5%), diabetes mellitus – 5 pts (38.46%), atrial fibrillation – 5 pts (38.46%), 1 patient (7.69%) with thrombosis in other areas. Autopsy results indicate pulmonary embolism as the direct cause of death in all patients, but just 2 pts (15.38%) presented suggestive clinical signs. Conclusions: Patients with stroke are at higher risk of pulmonary embolism due to bed rest, limb paralysis and predisposing risk factors but just a small number of patients are recognized timely to act, that’s why it is important to establish strict protocols and high awareness.