85 Irish Journal of Medical Science • Volume 173 • Number 2 Abstract Introduction The prevention of pulmonary embolism (PE) is an important component of medical care. Aim To examine the risk factors for venous thromboembolism in an Irish patient cohort with acute PE, and identify cases that may have been preventable. Methods Retrospective review of 60 consecutive cases of computed tomography (CT)-confirmed acute PE. Results The primary thromboembolic risk factors were elective surgery (27%), medical illness (20%), primary immobility (13%) and isolated distal lower limb fracture (7%). A significant proportion (43%) had been hospitalised within the six weeks prior to PE onset. Some patients had undergone ‘low risk’ procedures, without prophylaxis, but had other significant thromboembolic risk factors that indicated a requirement for prophylaxis. Conclusions Hospital- and ward-based thromboprophylaxis guidelines, based on certain categories of patient or procedure, need to be routinely supplemented by an individual risk factor assessment for each patient, to determine those at particularly high risk for venous thromboembolism. Risk factors for pulmonary embolism in an Irish patient cohort S Timmons, R Liston, H Kelly South Munster Geriatric Training Scheme, Tralee General Hospital, Co Kerry, Ireland Introduction Pulmonary embolism (PE) is a serious, potentially fatal disorder and is the most common preventable cause of hospital death. 1 Unfortunately, PE is often the first presentation of venous t h romboembolism (VTE) and many deaths occur before investigations or treatment can be instigated. 2 Therefore, despite advances in the diagnosis and treatment of deep venous thrombosis (DVT) and PE, prevention remains of paramount importance. Up to 25% of patients with proven PE have no identifiable risk factors for VTE 3 and others have occult risk factors that are only identified in retrospect. However, many cases occur in patients with overt pre-existing risk factors and it has been well reported that hospitalised patients at risk of VTE are under-prescribed thromboprophylaxis. 4-6 In an effort to highlight the importance of thromboembolism risk factor detection, leading to the initiation of appropriate thromboprophylaxis, this study reports the risk factors found in a cohort of Irish patients with proven acute PE. Cases where, in retrospect, thromboprophylaxis may have been indicated, are identified and discussed. Methods The results of all spiral CT examinations performed in Tralee General Hospital (TGH) over a three-year period, July 2000–June 2002, were reviewed. A consultant radiologist reviewed the films of possible or definite PE cases, to confirm the diagnosis. Sixty consecutive cases of acute PE were identified and the case notes reviewed. The risk factors for VTE and thromboprophylactic measures (compression hosiery or low molecular weight heparin [LMWH]) employed for each case were recorded. Of note, seven patients had been hospitalised elsewhere during the relevant thromboembolic risk period, with details of the thromboprophylaxis received, if any, available for only two of these patients. All statistical analysis was performed using the non-parametric Fisher’s exact test. Results The 60 cases of acute PE ranged in age from 24 to 88 years. Forty-eight per cent were female, mean age 64 years (±16 years), while males were non-significantly younger, 55 (±17) years (p<0.06). Twenty-three per cent were in-patients at the time of PE, while a further 20% had been in-patients within the preceding 6 weeks. In 15% of cases, no risk factor for VTE was ultimately identified. Thirteen per cent had two or more risk factors, while 7% had three or more (see Figure 1). The main risk factors are summarised in Table 1. Risk factor Percentage of cases Surgery 28% Current medical illness 20% Immobility* 13% Lower limb fracture 12% Previous thromboembolism 7% Others 5% (None) (15%) *Excludes immobility secondary to another risk factor. Table 1. Primary risk factors for venous thromboembolism in cases of acute pulmonary embolism Figure 1. Number of thromboembolism risk factors in each case of pulmonary embolism. Risk factors for pulmonary embolism in an Irish patient cohort