José A Nieto1, Julio A Vicente2, Luis M Prieto2, David Jiménez3, Behnood Bikdeli4, Agustina Rivas5, José Antonio Porras6, Mª Del Valle Morales7, Marijan Bosevski8, Manuel Monreal9. 1. Department of Internal Medicine, Hospital Virgen de la Luz, Cuenca, Spain. Electronic address: joseanietor@gmail.com. 2. Department of Internal Medicine, Hospital Virgen de la Luz, Cuenca, Spain. 3. Respiratory Department, Hospital Ramón y Cajal and Medicine Department Universidad de Alcalá (IRYCIS), Madrid, Spain. 4. Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY, USA; Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA; Cardiovascular Research Foundation, New York, NY, USA. 5. Department of Pneumonology, Hospital Universitario Araba, Álava, Spain. 6. Department of Internal Medicine, Hospital Universitario Joan XXIII de Tarragona, Tarragona, Spain. 7. Department of Internal Medicine, Hospital del Tajo, Madrid, Spain. 8. Institute for Cardiovascular Diseases, Faculty of Medicine, Clinical Center, Skopje, Republic of Macedonia. 9. Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Universidad Católica de Murcia, Spain.
Abstract
BACKGROUND: The contemporary natural history of patients with acute pulmonary embolism (PE) not receiving (or early discontinuing) anticoagulant therapy has not been consistently evaluated. OBJECTIVE: To assess the rate of the composite outcome of PE-related death, sudden death, or recurrent thromboembolism (VTE) within 30 days in all PE patients in whom anticoagulation was not administered or discontinued prematurely (<90 days of anticoagulation). METHODS: We used the RIETE database to assess the incidence rates (per 100 person-days) of the composite outcome within the subsequent 30 days. The risk of these events was compared to PE patients who were anticoagulated for ≥90 days. RESULTS: Of 34,447 PE recruited from 2001 to 2017, 47 (0.14%) did not receive anticoagulants and 1348 (3.91%) discontinued it before 90 days. Fatal PE developed in 25 (53%) of those without any anticoagulation and in 45 (3.33%) with premature discontinuations. Sudden death or non-fatal recurrent VTE occurred in 6 (0.45%) and 24 (1.48%) patients, respectively. The incidence of the primary outcome declined logarithmically from 6.36 per 100 patient-days in untreated patients to 0.32-0.13 in those treated for 8-90 days. During the first week of follow-up, the incidence rate was 13.9 and 0.60-0.31 per 100 patient-days, respectively. The adjusted odds of the primary outcome was 27 fold higher in untreated than in treated patients, and progressively decreased to 2.5-7 fold higher in patients treated for at least 7 days. CONCLUSION: The incidence of the composite outcome was highest during the first week, and inversely and logarithmically correlated with the duration of anticoagulant therapy.
BACKGROUND: The contemporary natural history of patients with acute pulmonary embolism (PE) not receiving (or early discontinuing) anticoagulant therapy has not been consistently evaluated. OBJECTIVE: To assess the rate of the composite outcome of PE-related death, sudden death, or recurrent thromboembolism (VTE) within 30 days in all PE patients in whom anticoagulation was not administered or discontinued prematurely (<90 days of anticoagulation). METHODS: We used the RIETE database to assess the incidence rates (per 100 person-days) of the composite outcome within the subsequent 30 days. The risk of these events was compared to PE patients who were anticoagulated for ≥90 days. RESULTS: Of 34,447 PE recruited from 2001 to 2017, 47 (0.14%) did not receive anticoagulants and 1348 (3.91%) discontinued it before 90 days. Fatal PE developed in 25 (53%) of those without any anticoagulation and in 45 (3.33%) with premature discontinuations. Sudden death or non-fatal recurrent VTE occurred in 6 (0.45%) and 24 (1.48%) patients, respectively. The incidence of the primary outcome declined logarithmically from 6.36 per 100 patient-days in untreated patients to 0.32-0.13 in those treated for 8-90 days. During the first week of follow-up, the incidence rate was 13.9 and 0.60-0.31 per 100 patient-days, respectively. The adjusted odds of the primary outcome was 27 fold higher in untreated than in treated patients, and progressively decreased to 2.5-7 fold higher in patients treated for at least 7 days. CONCLUSION: The incidence of the composite outcome was highest during the first week, and inversely and logarithmically correlated with the duration of anticoagulant therapy.
Authors: Romain Le Pennec; Amir Iravani; Beverley Woon; Brieg Dissaux; Bibiche Gest; Pierre-Yves Le Floch; Pierre-Yves Salaün; Grégoire Le Gal; Michael S Hofman; Rodney J Hicks; Pierre-Yves Le Roux Journal: Front Med (Lausanne) Date: 2021-02-16
Authors: Tobias Tritschler; Nicole Langlois; Brian Hutton; Beverley J Shea; Risa Shorr; Sara Ng; Suzanne Dubois; Carol West; Alfonso Iorio; Peter Tugwell; Grégoire Le Gal Journal: BMJ Open Date: 2020-12-07 Impact factor: 2.692