Bakulina L.A. Chief: M.D. Shepet`ko M.N. PULMONARY THROMBOEMBOLISM IN CANCER PATIENTSAFTER SURGERY

1. Belarusian State Medical University
PULMONARY
THROMBOEMBOLISM IN
CANCER PATIENTS
AFTER SURGERY
Bakulina L.A.,516 group, general medicine
faculty
Chief: M.D. Shepet`ko M.N.
Minsk 2013

2. PE – thrombotic occlusion of the main trunk of the
pulmonary artery or its branches of various calibers.
PE is one of the most
formidable postop
complication. It is
hardly diagnosed
because of no
specific
manifestations,
leading to high
mortality.

3. The goal and objectives of the
study
The Goal: To identify the most significant cause of blood clots
in the pulmonary artery in cancer patients after surgery
The Objectives:
1. Retrospectively assess the group of patients, depending
on:
o diagnosis
o Body Mass Index (BMI)
o TNM classification
o probability of pulmonary embolism
o type of performed surgeries
o prescription of anticoagulant
o postoperative ECG changes
2. Evaluate the results

4. Materials and methods
The work is based on the retrospective analysis of the
case histories of the patients who were treated at the
Minsk city clinical oncocenter from 2008 to 2012.
Over this period 53 patients died of PE

5. The distribution of data

6. The age structure of patients
Average age 67,4±1,4

7. ИМТ
BMI
Body mass
index
The correlatiopne between the weight of the person and his
growth
16 and less Expressed mass deficiency
16—18,5 The lack (deficiency) of body weight
18,5—25 Normal weight
25—30 Overweight (pre-obese)
30—35 first degree obesity
35—40 second degree obesity
40 and more third degree obesity

8. Localization of tumor

9. The distribution of patients
according to the TNM classification

10. Preliminary assessment of the
probability of PE

11. The results
11 (20,7%) patients died suddenly in the hospital.
42 (79,3%) patients were operated on.
Postoperative complications were observed in 13 (24.5%) patients.
The duration of the procedure
0,00%
10,00%
20,00%
30,00%
40,00%
50,00%
0-59 60-119 120-179 180-239 240-319 320-379 380-439

12. Indicators of
coagulation
There is an inverse correlation between PTT,
PTI and the number of past days

13. Anticoagulation therapy
The maximum life span:
With the appointment of an anticoagulant - 45 days
Without an appointment - 41 days

14. Electrocardiography
Specific changes
for PE:
-EOS-deviation to the right
-high-peaked P wave in II,
III standard leads
-ST elevation up to III,
avR, V1-V2
-high-R wave in avR
- TIII, avF, V1-2 and
deprtession in I, II, avL
and V5-6
displacement of the
transition zone to V4-V5
-RBBB, LBBB
RBBB & LBBB were
revealed in 12
(22,6%) patients

15. Evaluation of hypoxia
Sp O2 during the surgery: 97±0,5 %

16. Hypercapnia

17. Conclusions:
1. Most of the patients who died of PE suffered from
tumor process in an advanced stage (M1, T4, T3).
2. Hypercoagulation is a significant risk factor that
provokes the development of PE.
3. One of the main factors in the development of PE is a
postoperative hypoxia and hypercapnia.
4. The ongoing anticoagulation therapy is reasonable,
but does not always lead to the desired effect - a
significant reduction in thromboembolic
complications, an increase of the life expectancy.
5. The risk of PE was higher in the group of patients
with a BMI> 25, and the duration of surgery> 120
minutes.

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