Adverse Events and Mortality in Anticoagulated Patients with Different Categories of Pulmonary Embolism
| Autor: | Danielle T. Vlazny, David O. Hodge, Elias S. Saba, David A. Froehling, Lisa G. Peterson, Ana I. Casanegra, Hector R. Villarraga, Dalene M. Bott-Kitslaar, Waldemar E. Wysokinski, Robert D. McBane, Damon E. Houghton, Julia C. Cambron |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
PESI Pulmonary Embolism Severity Index VTE venous thromboembolism 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Internal medicine medicine 030212 general & internal medicine Adverse effect Trial registration AHA American Heart Association lcsh:R5-920 business.industry DVT deep vein thrombosis Hazard ratio Cancer CRNMB clinically relevant nonmajor bleeding medicine.disease HR hazard ratio NRVD no right ventricle dysfunction Pulmonary embolism CT computed tomography RV right ventricle DVT - Deep vein thrombosis PE pulmonary embolism SSO subsegmental only Original Article business lcsh:Medicine (General) Venous thromboembolism Major bleeding |
| Zdroj: | Mayo Clinic Proceedings: Innovations, Quality & Outcomes Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 4, Iss 3, Pp 249-258 (2020) |
| ISSN: | 2542-4548 |
| Popis: | Objective To determine whether the pulmonary embolism (PE) categories of massive, submassive, PE with no right ventricle dysfunction (NRVD), and subsegmental only (SSO) adequately predict clinical outcome. Methods Patients treated for acute PE (March 1, 2013, through July 31, 2019) were followed forward prospectively to compare venous thromboembolism (VTE) recurrence, all-cause mortality, major bleeding, and clinically relevant nonmajor bleeding (CRNMB) across 4 PE categories. Results Of 2703 patients with VTE, 1188 (44%) had PE, of which 1021 (85.9%) completed at least 3 months of therapy or had clinical outcomes precluding further treatment (27 with massive, 217 submassive, 557 NRVD, and 220 SSO PE). One patient with massive, 8 with submassive, 23 with NRVD, and 5 with SSO PE had recurrent VTE (3.90, 5.33, 5.36, and 3.66 per 100 person-years, respectively; P=.84). There were 3 deaths in massive, 27 in submassive, 140 in NRVD, and 34 in SSO PE groups (11.59, 17.37, 31.74, and 24.74 per 100 person-years, respectively; P=.02); when adjusted for cancer, the relationship was no longer significant (P=.27). One patient with massive, 5 with submassive, 22 with NRVD, and 5 with SSO PE had major bleeding (3.90, 3.31, 5.24, and 3.75 per 100 person-years, respectively; P=.66). Similar cumulative rates for CRNMB were observed (P=.87). Three-month rates of VTE recurrence, death, major bleeding, and CRNMB did not differ by PE category. Conclusion In the setting of anticoagulation therapy with maximal standardization and evidence-based practice, there is no evidence of a difference between PE categories and outcomes. Trial Registration clinicaltrials.gov Identifier : NCT03504007 |
| Databáze: | OpenAIRE |
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