Quality of initial anticoagulant treatment and risk of CTEPH after acute pulmonary embolism.

Autor: Boon GJAM; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands., van Rein N; Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands., Bogaard HJ; Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands., Ende-Verhaar YM; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands., Huisman MV; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands., Kroft LJM; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands., van der Meer FJM; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands., Meijboom LJ; Department of Radiology and Nuclear medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands., Symersky P; Department of Cardiac Surgery, VU University Medical Center, Amsterdam, The Netherlands., Vonk Noordegraaf A; Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands., Klok FA; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 Apr 28; Vol. 15 (4), pp. e0232354. Date of Electronic Publication: 2020 Apr 28 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0232354
Abstrakt: Background: The pathophysiology of chronic thromboembolic pulmonary hypertension (CTEPH) is not fully understood. Poor-quality anticoagulation may contribute to a higher risk of CTEPH after acute pulmonary embolism (PE), partly explaining the transition from acute PE to CTEPH. We assessed the association between the time in therapeutic range (TTR) of vitamin-K antagonist (VKA) treatment and incidence of CTEPH after a PE diagnosis.
Methods: Case-control study in which the time spent in, under and above therapeutic range was calculated in 44 PE patients who were subsequently diagnosed with CTEPH (cases). Controls comprised 150 consecutive PE patients in whom echocardiograms two years later did not show pulmonary hypertension. All patients were treated with VKA for at least 6 months after the PE diagnosis. Time in (TTR), under and above range were calculated. Mean differences between cases and controls were estimated by linear regression.
Results: Mean TTR during the initial 6-month treatment period was 72% in cases versus 78% in controls (mean difference -6%, 95%CI -12 to -0.1), mainly explained by more time above the therapeutic range in the cases. Mean difference of time under range was 0% (95%CI -6 to 7) and 2% (95CI% -3 to 7) during the first 3 and 6 months, respectively. In a multivariable model, adjusted odds ratios (ORs) for CTEPH were around unity considering different thresholds for 'poor anticoagulation', i.e. TTR <50%, <60% and <70%.
Conclusion: Subtherapeutic initial anticoagulation was not more prevalent among PE patients diagnosed with CTEPH than in those who did not develop CTEPH.
Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: G.J.A.M. Boon and F.A. Klok were supported by the Dutch Heart Foundation (2017T064). F.A. Klok reports research grants from Bayer, Bristol-Myers Squibb, Boehringer-Ingelheim, Daiichi Sankyo, MSD and Actelion, and the Netherlands Thrombosis Foundation. M.V. Huisman reports grants from ZonMW Dutch Healthcare Fund, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Pfizer-BMS, grants and personal fees from Bayer Health Care, grants from Aspen, grants and personal fees from Daiichi-Sankyo, outside the submitted work. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Databáze: MEDLINE
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