Cardiovascular diseases are the leading cause of death worldwide [1]. They are responsible for approximately 17.5 million deaths, i.e. overall mortality estimated at 31%, of which more than 75% concerns middle- or low-income countries [2]. Venous thromboembolic disease (VTE) is the third leading cause of cardiovascular disease and is associated with mortality and high social cost, especially in resource-limited countries [3] [4]. VTE is a clinical entity that includes deep vein thrombosis (DVT) and pulmonary embolism (PE). It is a common condition, and its incidence increases with age [5]. Hospital studies carried out in 2015 in Mali and Cameroon reported 4.02% and 1.6%, respectively [6] [7].

Although their clinical presentations are described in the literature, the particularities of the sub-Saharan context are rarely specified. Indeed, VTE is a multifactorial entity resulting from an interaction between genetic predisposition and acquired factors [8] [9]. In addition, factors such as late consultation are specific to the context of developing countries and can lead to unclassical clinical presentations. The rapid identification of these presentations is essential for good management [10].

This study aimed to describe the management of VTE disease in the Yaoundé Emergency Center (CURY), mainly the frequency of the use of thrombolysis.

To describe the therapeutic modalities of VTE in an emergency center in Yaoundé, Cameroon, we conducted a cross-sectional study at the Yaoundé Emergency Center.

Swelling and pain in the lower limb were the main signs of DVT, while dyspnea and tachycardia were the most common signs of PE. Walbane et al. in Mali in 2015 found similar results for PE with tachycardia and dyspnea found respectively in 100% and 95.24% of patients [6].

The main cardiovascular risk factors identified were arterial hypertension, overweight, and type 2 diabetes. Prolonged bed rest was the most found risk factor for VTE. A study conducted in the intensive care unit of the Yaoundé Central Hospital by Etoundi et al. in 2015 found that cardiovascular risk factors, particularly hypertension, were the most frequent and found in 54.43% of patients [7]. These factors lead to vascular fragility and/or stasis, which promote thrombosis formation [11].

The prominent electrical abnormalities found were the S1Q3 aspect and the right bundle branch block. Coulibaly and al. found comparable results in Mali, with the S1Q3 appearance and right bundle branch block found in 18.91% and 14.8% of patients, respectively [12]. These results show the interest of the ECG, a simple and accessible means of diagnosis, in the diagnostic approach of pulmonary embolism. On transthoracic ultrasound, right cavitary dilatation and pulmonary arterial hypertension were the preeminent abnormalities, present in 60% and 77.1%, respectively, of patients with PE. Soumaoro and al., in a study conducted in Mali in 2006, found right cavitary dilatation in 40.8% of cases [7]. Indeed, the presence of a clot in the pulmonary arterial territory leads to an increase in pulmonary arterial pressure and, therefore, in the afterload in the right cavities, resulting in the dilation of these cavities [13].

In our study, isolated PE (73.6%) was the dominant type of VTE, followed by DVT (17%), the two being associated in 9.4% of patients. These results agreed with those found by Coulibaly et al., i.e. 60.9% isolated PE, 37.9% isolated DVT and in disagreement with the results of Etoundi et al., where isolated DVT was predominant [7] [12] [14]. The place of our study can explain this difference, and it is a reference hospital center for the management of emergencies in Yaoundé. It, therefore, mainly receives patients with serious pathologies, with life-threatening consequences such as PE.

PE was bilateral in the majority of our patients, as in the work of Walbane and al., who found 61.9% of bilateral PE [6]. In agreement with the literature, the lower limb was the prominent localization of DVT, i.e. 92.9% against 7.1% for the upper limb. Involvement of the upper limb is rarer in DVT, representing approximately 10% of cases [15] [16].

Regarding VTE management, LMWH was used in almost all cases, mainly relay oral anticoagulants. Similarly, for Coulibaly and al., heparin therapy was the most used therapeutic means found in 98.8% of patients [12]. These results are explained by the availability of heparin and the difficulties of access to other modalities such as thrombolysis in low-income countries such as sub-Saharan African countries [17] [18]. A retrospective study from 2006 to 2016 on VTE at the Abidjan Cardiology Institute found that VKAs (89%) were the most prescribed therapeutic class to patients after VTE [19]. This difference observed in our study is explained by the fact that oral anticoagulants are recent molecules increasingly prescribed in our countries. Indeed, unlike vitamin K antagonists, the latter does not require regular monitoring of the INR. Thus, their prescription has increased for several years [20].

Thrombolysis was administered in 7.5% of patients. The only molecule used was Streptokinase. This rate is lower than that found by Pessinaba and al. in 2018 in a cardiology department in Togo, which had shown a rate of administration of thrombolysis of 21.6%, all based on Streptokinase [21]. This difference could be explained by the recent commissioning of the Yaoundé emergency center, which dates from 2015, and the cost (38.000FCFA ≈ 57.93USD for one dose) and relative availability of Streptokinase. The factors associated with the performance of thrombolysis were arterial hypotension and the presence of a massive PE, following the recommendations on the indications for thrombolysis [22]. The evolution after thrombolysis was favorable, returning home in 87.5% of patients. The mortality rate was 12.5%, similar to that found by Pessinaba and al. and caused mainly by the persistence of the state of shock after thrombolysis [21].

This study has some limitations. The main weakness of this study is its small sample size. Nevertheless, our study has the advantage of being one of the pioneers aiming to evaluate the management of VTE in our context, especially the use of thrombolysis.

Management of venous thromboembolic disease in the Yaoundé Emergency Center is mainly based on low molecular weight heparin administration. Thrombolysis is achieved in only 7.5% of cases, particularly in patients with hypotension or massive pulmonary embolism.

The authors would like to thank Dr Louis Bitang, Dr Sandrine Edie, and the staffs of Yaoundé Emergency Center.

Conception and design: Chris Nadège Nganou-Gnindjio, Jacqueline Ze Minkande.

Data collection: Chris Nadège Nganou-Gnindjio, Ludovic Kadji.

Data analysis and interpretation: Ludovic Kadji, Daryl Tcheutchoua Nzokou.

Manuscript drafting: Chris Nadège Nganou-Gnindjio, Daryl Tcheutchoua Nzokou.

Manuscript revision: Honoré Kemnang Yemele, Chris Nadège Nganou-Gnindjio.

Approval of the final manuscript: All the authors.

The datasets used for this study are available from the corresponding author on request.

The study was approved by the Institutional Ethical Review Board of the University Yaoundé I (Cameroon). All the participants read and signed informed consent before their inclusion in the study.

The authors declare that they have no competing interests.

Nganou-Gnindjio, C.N., Hamadou, B., Kadji, L., Elong, J.T., Nzokou, D.T., Yemele, H.K., Menanga, A.P., Kingue, S. and Minkande, J.Z. (2022) Venous Thromboembolic Disease and Thrombolysis at the Yaoundé Emergency Center during the Past Five Years, Cameroon. World Journal of Cardiovascular Diseases, 12, 199-208. https://doi.org/10.4236/wjcd.2022.124020