Autopsy incidence of pulmonary embolism in tuberculosis.

Reports of the autopsy incidence of pulmonary embolism in non-surgical general hospital patients’ especially those with coronary heart disease23 have resulted in increasing use of anticoagulant therapy in “medical” patients. The autopsy incidence of pulmonary embolism in patients dying with active tuberculosis has not been stressed in comparable fashion. In a previous report4 I have discussed the necropsy incidence of active tuberculosis in a series of 634 consecutive autopsies performed over a five year period in an institution where both mental patients and general hospital patients were cared for, and where the average age at autopsy was unusually high (60 years). This same series of autopsies has also been used as a basis for reports on the incidence of pulmonary embolism due to prostatic thrombosis5 and the incidence of pulmonary embolism in coronary heart disease.6 The high incidence of pulmonary embolism and the frequent finding of active tuberculosis in the series suggested that this group of autopsies might well be analyzed from the viewpoint of the incidence of pulmonary embolism in subjects with active tuberculosis. Such an analysis should be helpful in evaluating the importance of prevention of pulmonary embolism in tuberculous patients and the possibility of the use of anticoagulant therapy in cases of tuberculosis complicated by thrombo-embolic phenomena or in certain selected cases where the possibility of thrombo-embolic complications seemed likely. In the series Of 634 consecutive autopsies, active tuberculosis was found in 111 subjects, an incidence of 17.5 per cent. These 111 cases form the basis of the present report, although it is recognized that this number is small from a statistical standpoint. Pulmonary embolism was found 27 times in these 111 autopsies (24.3 per cent). This incidence is slightly higher than the incidence of pulmonary embolism in the entire series (23.1 per cent). Four of these emboli were classed as massive (occludingone half or more of the pulmonary circulation) and 23 were classed as minor. The four massive emboli were regarded as the immediate cause