Acute Pulmonary Embolism after an Earthquake in Japan

ABSTRACT

There have been no reports on acute pulmonary embolism (APE) after earthquakes. Our aim was to clarify the actual the occurrence of APE following the 2004 Mid Niigata Prefecture earthquake in Japan, and to assess the risk factors for APE after the event. We sent questionnaires to 122 hospitals in the Niigata Prefecture after the earthquake. Cities, towns, and villages in the prefecture were classified into two areas (high evacuee rate area, and low evacuee rate area) due to the mean ratio of evacuees to the overall population during 1 week immediately after the earthquake. A rate of 5% and higher was encountered for the high evacuee rate area and a rate of < 5% was encountered for the low evacuee rate area. Ten out-of-hospital cases of APE (seven in the high evacuee rate area and three in the low evacuee rate area) were diagnosed within the first month after the earthquake. The relative risk of APE was high in the high evacuee rate area (13.09; p = 0.0002) and also higher in women (8.55; p = 0.04). All patients in the high evacuee rate area had stayed in their automobiles for long periods of time, but none had done so in the low evacuee rate area (p = 0.008).

KEYWORDS

Pulmonary embolism - earthquake - gender - economy-class syndrome

REFERENCES

• 1 Simpson K. Shelter deaths from pulmonary embolism.  Lancet. 1940;  2 744
• 2 Homans J. Thrombosis of the deep leg veins due to prolonged sitting.  N Engl J Med. 1954;  250 148-149
• 3 Symington I S, Stack BHR. Pulmonary thromboembolism after travel.  Br J Dis Chest. 1977;  71 138-140
• 4 Ferrari E, Chevallier T, Chapelier A et al.. Travel as a risk for venous thromboembolic disease: a case-control study.  Chest. 1999;  115 440-444
• 5 Scurr J H, Machin S J, Bailey-King S et al.. Frequency and prevention of symptomless deep-vein thrombosis in long-haul flight: a randomized trial.  Lancet. 2001;  357 1485-1489
• 6 Hosoi Y, Geroulakos G, Belcaro G et al.. Characteristics of deep vein thrombosis associated with prolonged travel.  Eur J Vasc Endovasc Surg. 2002;  24 235-238
• 7 Lapostolle F, Surget V, Borron S W et al.. Severe pulmonary embolism associated with air travel.  N Engl J Med. 2001;  345 779-783
• 8 Belcaro G, Geroulakos G, Nicolaides A N et al.. Venous thromboembolism from air travel: the LONFLIT study.  Angiology. 2001;  52 369-374
• 9 Leor J, Poole W K, Kloner R A. Sudden cardiac death triggered by an earthquake.  N Engl J Med. 1996;  334 413-419
• 10 Suzuki S, Sakamoto S, Koide M et al.. Hanshin-Awaji earthquake as a trigger for acute myocardial infarction.  Am Heart J. 1997;  134 974-977
• 11 The Japanese Hospitals Directory .2003-2004 (Byoin Youran, 2003-2004). Tokyo; Igaku-syoin 2003
• 12 Niigata Prefecture .Available at: http://saigai.pref.niigata.jp/content/jishin/jishin_1.html Accessed: October 30, 2004
• 13 Kumasaka N, Sakuma M, Shirato K. Incidence of pulmonary thromboembolism in Japan.  Jpn Circ J. 1999;  63 439-441
• 14 Kitamukai O, Sakuma M, Takahashi T et al.. Incidence and characteristics of pulmonary thromboembolism in Japan 2000.  Intern Med. 2003;  42 1090-1094
• 15 Milne R. Venous thromboembolism and travel: is there an association?.  J R Coll Physicians Lond. 1992;  26 47-49
• 16 Eklof B, Kistner R L, Masuda E M et al.. Venous thromboembolism in association with prolonged air travel.  Dermatol Surg. 1996;  22 637-641
• 17 Nakamura M, Fujioka H, Yamada N et al.. Clinical characteristics of acute pulmonary embolism in Japan: results of a multicenter registry in Japanese Society of Pulmonary Embolism Research.  Clin Cardiol. 2001;  24 132-138
• 18 Sakuma M, Okada O, Nakamura M et al.. Recent developments in diagnostic imaging techniques and management for acute pulmonary embolism: multicenter registry by the Japanese Society of Pulmonary Embolism Research.  Intern Med. 2003;  42 470-476
• 19 Sakuma M, Nakamura M, Nakanishi N et al.. Inferior vena cava filter is a new additional therapeutic option to reduce mortality from acute pulmonary embolism.  Circ J. 2004;  68 816-821
• 20 Sakuma M, Konno Y, Shirato K. Increasing mortality from pulmonary embolism in Japan, 1951-2000.  Circ J. 2002;  66 1144-1149
• 21 Silverstein M D, Heit J A, Mohr D N et al.. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study.  Arch Intern Med. 1998;  158 585-593
• 22 Anderson F A, Wheeler H B, Goldberg R J et al.. The prevalence of risk factors for venous thromboembolism among hospital patients.  Arch Intern Med. 1992;  152 1660-1664
• 23 Rosendaal F R. Venous thrombosis: a multucausal disease.  Lancet. 1999;  353 1167-1173
• 24 Morio H. Pulmonary thromboembolism associated with air travel in Japan. In: Shirato K Venous Thromboembolism: Prevention and Treatment. Tokyo, Japan; Springer-Verlag 2005: 87-93
• 25 Belcaro G, Cesarone M R, Shah SSG et al.. Prevention of edema, flight microangiopathy and venous thrombosis in long flights with elastic stockings. A randomized trail: the LONFLIT 4 Concord Edema-SSL study.  Angiology. 2002;  53 635-645
• 26 Matsuo T, Suzuki S, Kodama K et al.. Hemostatic activation and cardiac events after the 1995 Hanshin-Awaji earthquake.  Int J Hematol. 1998;  67 123-129