Acute pulmonary embolism (APE) is a serious cardiovascular disease. In recent years, there has been an increasing detection rate of patients with APE accompanied by thrombocytopenia, presenting a dual challenge of thrombosis and bleeding. Current research is mainly based on successful case reports, with a certain research gap in clinical evaluation and treatment options.

To explore the clinical characteristics and prognosis of APE patients complicated with thrombocytopenia, so as to provide a basis for clinical diagnosis and treatment.

A total of 21 patients with APE accompanied by thrombocytopenia who were admitted to the Emergency Department, Peking University People's Hospital from January 2015 to January 2020 were included as the study subjects and categorized into the severe bleeding group (n=7) and mild/no bleeding group (n=14) based on their bleeding conditions; as well as the multiple-site thrombosis group (n=7) and pulmonary artery thrombosis groups (n=14) based on the presence of thrombosis at sites other than the pulmonary artery; and into the death group (n=5) and survived group (n=16) based on their survival status. Clinical data were collected and compared between groups.

A total of 21 APE patients with thrombocytopenia were included in this study, involving 7 males and 14 females, with an average age of (63.2±18.9) years. The etiologies included immune thrombocytopenic purpura (5 cases), antiphospholipid syndrome (4 cases), eosinophilia (3 cases), drug-related thrombocytopenia (2 cases), systemic lupus erythematosus (2 cases), cancer-associated thrombocytopenia (2 cases), and 3 cases of unknown etiology. Nineteen patients received anticoagulant therapy. Fibrinogen and fibrinogen/albumin ratios were higher in the pulmonary artery thrombosis group than in the multi-site thrombosis group (P<0.05). The proportion of males and mean platelet volume were lower in the severe bleeding group than in the mild/no bleeding group, and the proportion of multi-site thrombus and centrocyte/lymphocyte ratio were higher than the mild/no bleeding group (P<0.05). The proportion of anticoagulation therapy and platelet count in the death group were lower than those in the survival group, and the proportion of heart rate, mean platelet volume/platelet ratio, and cancer-associated thrombocytopenia were higher than those in the survival group (P<0.05) .

APE patients with thrombocytopenia are at risk for multiple thrombotic events. Anticoagulant therapy contributes to improved clinical prognosis. Anticoagulation therapy based on platelet count is not significantly associated with serious bleeding events. Platelet count, platelet-related parameters, and other coagulation-related parameters contribute to the interpretation of thrombotic burden, bleeding risk, and clinical prognosis.