Triggers of acute pulmonary thromboembolism developed in hospital, with focusing on toilet activities as triggering acts

Background: The recognition of the trigger which is the action leading to the occurrence of acute pulmonary thromboembolism (APTE) is important to perform early diagnosis and early management of APTE. Methods and Results: The trigger of APTE in 138 patients who developed APTE in hospital was investigated. The triggers of APTE were specified in 57 patients. Approximately half of these patients developed APTE during toilet activities (defecation and micturition). Mortality of the patients with APTE associated with toilet activities was 33%. APTE associated with toilet activities was independently related to a recent major surgery, heart diseases and a recent angiography. Conclusions: Defecation and micturition would be common triggers of APTE after operation and angiography, especially in patients with cardiac dysfunction.