Bobby Gouin1, Marc Blondon2, David Jiménez3, Carmen Fernández-Capitán4, Henri Bounameaux2, Silvia Soler5, Rita Duce6, Joan Carles Sahuquillo7, Nuria Ruiz-Giménez8, Manuel Monreal9. 1. Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Division of General Internal Medicine, Université de Sherbrooke, Sherbrooke, Canada (on leave). Electronic address: bobby.gouin@usherbrooke.ca. 2. Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 3. Respiratory Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain. 4. Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain. 5. Department of Internal Medicine, Hospital Olot i Comarcal de la Garrotxa, Gerona, Spain. 6. Department of Laboratory of Analysis, Ospedale Galliera, Genoa, Italy. 7. Department of Internal Medicine, Hospital Municipal de Badalona, Barcelona, Spain. 8. Department of Internal Medicine, Hospital Universitario de La Princesa, Madrid, Spain. 9. Department of Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Barcelona, Spain, and Universidad Católica de Murcia, Murcia, Spain.
Abstract
BACKGROUND: Whether the localization of nonmassive pulmonary embolism (PE) is associated with the short-term and long-term prognosis of patients remains unknown. Our aim was to characterize associations of nonmassive PE localization with risks of recurrent VTE, major bleeding, and mortality during and after anticoagulation. METHODS: Among participants of the Registro Informatizado de la Enfermedad ThromboEmbòlica (RIETE) registry with incident symptomatic nonmassive PE diagnosed by CT scan, we compared risks of recurrent VTE, major bleeding, and mortality during and after anticoagulation between central PE (main pulmonary artery) and noncentral PE (more peripheral arteries) using Cox proportional hazard-adjusted models. RESULTS: Of the 6,674 participants, patients with central PE (40.5%) had age (mean 66 years), sex (46.9% male sex), and proportion of idiopathic (45.0%) and cancer-related (22.3%) PE that were similar to those of patients with noncentral PE. During anticoagulation (5,256.1 patient-years), the risk of recurrent VTE was similar between the two groups (2.5 vs 2.1 per 100 patient-years; adjusted hazard ratio [aHR], 1.32; 95% CI, 0.91-1.90), as were risks of major bleeding and mortality. After anticoagulation was discontinued (2,175.4 patient-years), participants with central PE had a borderline greater risk of recurrent VTE than did participants with noncentral PE (11.0 vs 8.0 per 100 patient-years; aHR, 1.34; 95% CI, 1.01-1.78) but not when restricted to participants after unprovoked PE (13.8 vs 11.9 per 100 patient-years; aHR, 1.15; 95% CI, 0.79-1.68; P = .48). Risks of major bleeding and mortality were similar. CONCLUSIONS: In nonmassive PE, central localization of PE is associated with greater risk of recurrent VTE after anticoagulation cessation. However, the low magnitude of this association and the absence of association after unprovoked PE suggest that the clinical relevance of this finding is limited and that the duration of anticoagulation should not be tailored to PE localization after nonmassive unprovoked PE.
BACKGROUND: Whether the localization of nonmassive pulmonary embolism (PE) is associated with the short-term and long-term prognosis of patients remains unknown. Our aim was to characterize associations of nonmassive PE localization with risks of recurrent VTE, major bleeding, and mortality during and after anticoagulation. METHODS: Among participants of the Registro Informatizado de la Enfermedad ThromboEmbòlica (RIETE) registry with incident symptomatic nonmassive PE diagnosed by CT scan, we compared risks of recurrent VTE, major bleeding, and mortality during and after anticoagulation between central PE (main pulmonary artery) and noncentral PE (more peripheral arteries) using Cox proportional hazard-adjusted models. RESULTS: Of the 6,674 participants, patients with central PE (40.5%) had age (mean 66 years), sex (46.9% male sex), and proportion of idiopathic (45.0%) and cancer-related (22.3%) PE that were similar to those of patients with noncentral PE. During anticoagulation (5,256.1 patient-years), the risk of recurrent VTE was similar between the two groups (2.5 vs 2.1 per 100 patient-years; adjusted hazard ratio [aHR], 1.32; 95% CI, 0.91-1.90), as were risks of major bleeding and mortality. After anticoagulation was discontinued (2,175.4 patient-years), participants with central PE had a borderline greater risk of recurrent VTE than did participants with noncentral PE (11.0 vs 8.0 per 100 patient-years; aHR, 1.34; 95% CI, 1.01-1.78) but not when restricted to participants after unprovoked PE (13.8 vs 11.9 per 100 patient-years; aHR, 1.15; 95% CI, 0.79-1.68; P = .48). Risks of major bleeding and mortality were similar. CONCLUSIONS: In nonmassive PE, central localization of PE is associated with greater risk of recurrent VTE after anticoagulation cessation. However, the low magnitude of this association and the absence of association after unprovoked PE suggest that the clinical relevance of this finding is limited and that the duration of anticoagulation should not be tailored to PE localization after nonmassive unprovoked PE.
Authors: Sonja Kroep; Ling-Hsiang Chuang; Alexander Cohen; Pearl Gumbs; Ben van Hout; Manuel Monreal; Stefan N Willich; Anselm Gitt; Rupert Bauersachs; Giancarlo Agnelli Journal: J Thromb Thrombolysis Date: 2018-11 Impact factor: 2.300
Authors: Carmen Fernández-Capitán; Ana Rodriguez Cobo; David Jiménez; Olga Madridano; Maurizio Ciammaichella; Esther Usandizaga; Remedios Otero; Pierpaolo Di Micco; Farès Moustafa; Manuel Monreal Journal: Res Pract Thromb Haemost Date: 2020-11-18
Authors: Christopher Kabrhel; David R Vinson; Alice Marina Mitchell; Rachel P Rosovsky; Anna Marie Chang; Jackeline Hernandez-Nino; Stephen J Wolf Journal: J Am Coll Emerg Physicians Open Date: 2021-12-15