Management of life-threatening haemoptysis in an area of high tuberculosis incidence
OBJECTIVE: To prospectively evaluate risk factors for recurrence as selection criteria for surgery following embolisation: lack of complete cessation of haemoptysis, need for blood transfusion, presence of aspergilloma and absence of active TB.
DESIGN: Prospective interventional study with 1-year follow-up.
RESULTS: Within a 7-month period, 101 consecutive patients were admitted. Seven were excluded and 12 died shortly after admission. Haemoptysis ceased on medical treatment alone within 24 h in 21 of the remaining 82 patients. Their 1-year mortality was 10%. Eleven of 61 patients referred for emergency embolisation died before discharge. Of the 50 patients remaining at risk of recurrence, 38 (76%) were at low risk and 12 (24%) at high risk. Five of these patients (10% of those at risk) underwent surgery. Patients at low risk and operated patients had an uneventful course over 1 year, but two deaths occurred among the seven inoperable patients at high risk.
CONCLUSION: Lung resection surgery following successful BAE for life-threatening haemoptysis can safely be avoided in patients at low risk of recurrence.
Document Type: Regular Paper
Affiliations: 1: Department of Medicine, Tygerberg Academic Hospital and University of Stellenbosch, Cape Town, South Africa 2: Department of Biomedical Sciences, Tygerberg Academic Hospital and University of Stellenbosch, Cape Town, South Africa 3: Department of Radiology, Tygerberg Academic Hospital and University of Stellenbosch, Cape Town, South Africa 4: Department of Surgery, Tygerberg Academic Hospital and University of Stellenbosch, Cape Town, South Africa
Publication date: 2009-07-01
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