2 | Special Topic Supplement: VENOUS THROMBOEMBOLISM
ike a scene from the movies, a fainting spell can
be brought on by sudden emotional distress.
Sometimes, severe dehydration or standing still
for too long can lead to a blackout.
But when unexplained fainting leads to
hospitalization, blood clots in the lungs may be the reason far
more often than doctors realize, according to a new study.
Italian researchers found that such potentially deadly lung
clots — known as pulmonary embolisms — were found
in about 17 percent of the elderly patients they examined.
That’s about one out of every six patients.
The study’s findings, published last October in the New
England Journal of Medicine, could prompt doctors to start
screening patients for something that normally isn’t on their
checklist. They also led the American Heart Association to
rank the study among its top 10 heart and stroke science
advances of 2016.
Researchers in the Pulmonary Embolism in Syncope
Italian Trial screened 560 patients admitted to 11 hospitals for
first-time episodes of fainting, also known as syncope. The
average patient age was 76.
The lead researcher, Paolo Prandoni, M.D., Ph.D., said the
findings could have a lifesaving impact by helping to identify
a very treatable condition. “Whenever a patient with a first
episode of syncope is admitted to a hospital ward, unless he
or she is already on anticoagulation medicine, a pulmonary
embolism should be suspected,” he said.
A pulmonary embolism is a clot that breaks free from a
vein, usually in the leg, and travels to the lung, where it gets
stuck and blocks some or all of the blood supply. Every
year, an estimated 300,000 to 600,000 Americans either get
pulmonary embolisms, deep vein thrombosis (blood clots
in their legs), or both, according to government figures. An
estimated 60,000 to 100,000 will die from them.
If doctors believe a lung clot may be behind the
fainting spell, the study suggested that additional
screenings be conducted, such as a blood test known as
a D-dimer that can help rule out a lung clot, and a specific
assessment that estimates pretest clinical probability
based on various factors.
Those results can determine whether more tests, such
as a CT scan, are warranted and, if so, “a therapeutic dose
of an anticoagulant drug should be promptly administered
while awaiting the imaging tests, according to the available
recommendations delivered by all major international
guidelines for patients with a high probability of pulmonary
embolism,” Prandoni said.
In his study, Prandoni and fellow researchers noted that
while checking for blood clots is included in most textbooks
for diagnosing fainting spells, current international guidelines
“pay little attention” to that possibility.
“Hence, when a patient is admitted to a hospital for an
episode of syncope, pulmonary embolism — a potentially
fatal disease that can be effectively treated — is rarely
BLOOD CLOTS IN LUNG
BIGGER FACTOR IN SERIOUS
FAINTING SPELLS THAN
By American Heart Association News