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Gulseren Sagcan,1 Zeki Dogan,2 Hafize Uzun,3 Caglar Cuhadaroglu,1 Gulfer Okumus,4 Orhan Arseven4 1Department of Chest Diseases, Faculty of Medicine, Acıbadem University, İstanbul, Turkey; 2Department of Cardiology, Faculty of Medicine, Istanbul Atlas University, Istanbul, Turkey; 3Department of Medical Biochemistry, Faculty of Medicine, Istanbul Atlas University, Istanbul, Turkey; 4Department of Chest Diseases, Faculty of Medicine, Istanbul University, İstanbul, TurkeyCorrespondence: Gulseren Sagcan, Department of Chest Diseases, Faculty of Medicine, Acıbadem University, İstanbul, Turkey, Tel +902166495751 ; +905323637953, Fax +902166495373, Email gulserensagcan@yahoo.comBackground: Acute pulmonary embolism (APE) is a common clinical condition. Its severity ranges from asymptomatic radiological findings to fatal obstructive shock. The potential circulating biomarkers have been studied to predict APE outcomes. This study aimed to explore their predictive power on prognosis in APE.Material and Method: It was a prospective observational study between March 2008 and April 2010. All consecutive patients diagnosed with APE were categorized as massive/high-risk, submassive/moderate-risk, and non-massive/low-risk. Cardiac troponin T (cTnT), myoglobin, N-terminal pro-brain natriuretic peptide (NT-proBNP), heart-type fatty acid-binding protein (H-FABP), growth differentiation factor-15 (GDF-15), and D-dimer levels were measured.Results: Of these patients, 14 (29.8%), 16 (34.0%), and 17 (36.2%) patients were categorized as low-risk, moderate-risk, and high risk-patients, respectively. There was no significant difference between the patient groups categorized based on the risk stratification in terms of demographic and clinical characteristics. The cTnT, myoglobin, HFABP, and D-dimer levels have also not differed significantly between the groups. There was a significant difference between the groups in respect of NT-proBNP and GDF-15 levels (p=0.009 and p=0.037, respectively). Nine (19.1%) patients had died by the 3rd-month follow-up. Adverse events were seen in 26 (55.3%) patients. GDF-15 had the highest area under the curve (AUC) value for predicting any adverse event (cut-off value=9.3 ng/mL, AUC=0.796, CI (confidence interval) 95%: 0.653– 0.899). NT-ProBNP was determined as the best predictor for mortality (cut-off value=229.2 pg/mL, AUC=0.889, CI 95%: 0.756– 0.964).Conclusion: Higher levels of NT-proBNP and GDF-15 were found to be associated with more severe APE, worse outcomes, and mortality.Keywords: pulmonary embolism, biomarkers, adverse clinical outcome, natriuretic peptides, growth differentiation factor-15

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Copyright of Turkish Thoracic Journal / Turk Toraks Dergisi is the property of Aves Yayincilik Ltd. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Heparin induced thrombocytopenia (HIT) is an important complication of heparin treatment. In this article, we presented a case of HIT who was treated with fondaparinux, which is the only alternative anticoagulant agent in our country. A 48 year-old male patient was referred to our clinic when bilateral main pulmonary arterial thromboses were detected by spiral computerized tomography after he sought consultation for chest pain, dyspnea and presyncope of 3 days duration. In the physical examination, tachypnea, tachycardia, cyanosis, hypotension, neck vein distention, hepatomegaly and hepatojugular reflux were recorded. After the diagnosis of massive PTE, unfractionated heparin (UFH) infusion was started following the treatment with r-tPA. UFH was stopped due to the rapid fall in thrombocyte count (39000/mm[3]) on the second. day of treatment. PF4-heparin antibodies detected by ELISA were positive. Anticogulant therapy was followed with fondaparinux. Oral anticoagulant therapy was started when the thrombocyt count reached >100000/mm[3] on the sixth day of treatment. [ABSTRACT FROM AUTHOR]