Pulmonary embolism case study

Tamoxifen users present also a doubling incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) (118 vs. 62 cases). This increase is similar to that seen with HRT. There are some aspects of this side effect that should be commented on to improve the management of women eligible for tamoxifen treatment and at risk for DVT (Goldhaber 2005). In the subanalysis of the Italian study (Decensi et al. 2005), the venous thromboembolism definition included DVT, PE, and superficial phlebitis. Most of the VTE that the authors reported were, in fact, cases of superficial phlebitis, whereas the admitted definition of venous thromboembolism excludes this entity. Such conceptual differences, together with differences in age and background characteristics between the four studies, can explain the diversity in the incidences observed. 

There is other evidence that transdermal estrogen replacement therapy has relatively little effect on hemostasis. In a case control study, 155 consecutive patients with a first documented episode of idiopathic venous thromboembolism, 92 of whom had had a pulmonary embolism and 63 a deep venous thrombosis, were compared with 381 healthy matched controls (88). Overall, 32 (21%) of the cases and 27 (7%) of the controls were current users of oral estrogen replacement therapy, whereas 30 (19%) cases and 93 (24%) controls were current users of transdermal estrogen replacement therapy. After adjustment for potential confounding variables, the odds ratios for venous thromboembolism in current users of oral and transdermal estrogen replacement therapy compared with non-users were 3.5 (95% Cl = 1.8, 6.8) and 0.9 (0.5, 1.6) respectively. Estimated risk for venous thromboembolism in current users of oral estrogen replacement therapy compared with transdermal users was 4.0 (1.9, 8.3). 

In a placebo-controlled study of severely anemic patients with low-grade non-Hodgkin s lymphoma, chronic lymphocytic leukemia, or multiple myeloma, a fatal case of pulmonary embolism was thought to have been related to treatment with epoetin beta (95). Thrombotic events, such as vascular access thrombosis, venous thrombosis, and pulmonary embolism, have occurred after treatment with epoetin or darbepoetin alfa (96). It is therefore recommended that a rapid rise in the hemoglobin concentration be avoided and that care should be taken that the hemoglobin concentration does not exceed 12.1 g/dl (7.5 mmol/1) (97). 

Heit JA, Sdverstein MD, Mohr DN, Petterson TM, O Fallon WM, Melton LJ. Risk factors for deep vein thrombosis and pulmonary embolism a population-based case-control study. Arch Intern Med 2000 160 809-15. 

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