Symptomatic subsegmental versus more central pulmonary embolism: Clinical outcomes during anticoagulation.
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State: Public
Version: author
License: CC BY-NC-ND 4.0
Serval ID
serval:BIB_0CAAA6F3FFBC
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Symptomatic subsegmental versus more central pulmonary embolism: Clinical outcomes during anticoagulation.
Journal
Research and practice in thrombosis and haemostasis
Working group(s)
RIETE Investigators
Contributor(s)
Adarraga M.D., Aibar M.A., Alfonsa M., Arcelus J.I., Azcarate-Agüero P., Ballaz A., Baños P., Barba R., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Camón A.M., Chasco L., Cruz A.J., Del Pozo R., de Miguel J., Del Toro J., Díaz-Pedroche M.C., Díaz-Peromingo J.A., Escribano J.C., Falgá C., Fernández-Aracil C., Fidalgo M.A., Font C., Font L., García M.A., García-Bragado F., García-Morillo M., García-Raso A., García-Sánchez A.I., Gavín O., Gaya I., Gómez C., Gómez V., González J., Grau E., Guijarro R., Gutiérrez J., Hernández-Comes G., Hernández-Blasco L., Hernando E., Jara-Palomares L., Jaras M.J., Jiménez D., Joya M.D., Lima J., Llamas P., Lobo J.L., López-Reyes R., López-Sáez J.B., Lorente M.A., Lorenzo A., Lumbierres M., Maestre A., Marchena P.J., Martín-Martos F., Martín-Romero M., Morales M.V., Nieto J.A., Nieto S., Núñez A., Núñez M.J., Odriozola M., Olivares M.C., Otalora S., Pedrajas J.M., Pellejero G., Pérez-Ductor C., Peris M.L., Pons I., Porras J.A., Ramírez L., Reig O., Riera-Mestre A., Riesco D., Rivas A., Rodríguez-Dávila M.A., Rosa V., Ruiz-Artacho P., Sahuquillo J.C., Sala-Sainz M.C., Sampériz A., Sánchez-Martínez R., Soler S., Sopeña B., Suriñach J.M., Tolosa C., Torres M.I., Troya J., Trujillo-Santos J., Uresandi F., Valero B., Valle R., Vela J., Vela L., Vidal G., Villalobos A., Vanassche T., Vandenbriele C., Verhamme P., Yoo HHB, Wells P., Hirmerova J., Malý R., Salgado E., Bertoletti L., Bura-Riviere A., Falvo N., Farge-Bancel D., Hij A., Mahé I., Quere I., Braester A., Brenner B., Ellis M., Tzoran I., Antonucci G., Barillari G., Bilora F., Bortoluzzi C., Bucherini E., Camerota A., Cattabiani C., Dentali F., Duce R., Giorgi-Pierfranceschi M., Grandone E., Imbalzano E., Lessiani G., Maida R., Mastroiacovo D., Pace F., Pesavento R., Pesavento M., Poggio R., Prandoni P., Quintavalla R., Rocci A., Siniscalchi C., Tiraferri E., Tonello D., Visonà A., Zalunardo B., Gibietis V., Skride A., Vitola B., Alatri A., Bounameaux H., Calanca L., Mazzolai L.
ISSN
2475-0379 (Electronic)
ISSN-L
2475-0379
Publication state
Published
Issued date
01/2021
Peer-reviewed
Oui
Volume
5
Number
1
Pages
168-178
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Publication Status: epublish
Abstract
The optimal therapy of patients with acute subsegmental pulmonary embolism (PE) is controversial.
We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the rate of symptomatic PE recurrences during anticoagulation in patients with subsegmental, segmental, or more central PEs.
Among 15 963 patients with a first episode of symptomatic PE, 834 (5.2%) had subsegmental PE, 3797 (24%) segmental, and 11 332 (71%) more central PE. Most patients in all subgroups received initial therapy with low-molecular-weight heparin, and then most switched to vitamin K antagonists. Median duration of therapy was 179, 185, and 204 days, respectively. During anticoagulation, 183 patients developed PE recurrences, 131 developed deep vein thrombosis (DVT), 543 bled, and 1718 died (fatal PE, 135). The rate of PE recurrences was twofold higher in patients with subsegmental PE than in those with segmental (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.16-3.85) or more central PE (HR, 1.89; 95% CI, 1.12-3.13). On multivariable analysis, patients with subsegmental PE had a higher risk for PE recurrences than those with central PE (adjusted HR, 1.75; 95% CI, 1.02-3.03). After stratifying patients with subsegmental PE according to ultrasound imaging in the lower limbs, the rate of PE recurrences was similar in patients with DVT, in patients without DVT, and in those with no ultrasound imaging.
Our study reveals that the risk for PE recurrences in patients with segmental PE is not lower than in those with more central PE, thus suggesting that the risk of PE recurrences is not influenced by the anatomic location of PE.
We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the rate of symptomatic PE recurrences during anticoagulation in patients with subsegmental, segmental, or more central PEs.
Among 15 963 patients with a first episode of symptomatic PE, 834 (5.2%) had subsegmental PE, 3797 (24%) segmental, and 11 332 (71%) more central PE. Most patients in all subgroups received initial therapy with low-molecular-weight heparin, and then most switched to vitamin K antagonists. Median duration of therapy was 179, 185, and 204 days, respectively. During anticoagulation, 183 patients developed PE recurrences, 131 developed deep vein thrombosis (DVT), 543 bled, and 1718 died (fatal PE, 135). The rate of PE recurrences was twofold higher in patients with subsegmental PE than in those with segmental (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.16-3.85) or more central PE (HR, 1.89; 95% CI, 1.12-3.13). On multivariable analysis, patients with subsegmental PE had a higher risk for PE recurrences than those with central PE (adjusted HR, 1.75; 95% CI, 1.02-3.03). After stratifying patients with subsegmental PE according to ultrasound imaging in the lower limbs, the rate of PE recurrences was similar in patients with DVT, in patients without DVT, and in those with no ultrasound imaging.
Our study reveals that the risk for PE recurrences in patients with segmental PE is not lower than in those with more central PE, thus suggesting that the risk of PE recurrences is not influenced by the anatomic location of PE.
Keywords
anticoagulant, deep vein thrombosis, outcomes, pulmonary embolism, subsegmental
Pubmed
Web of science
Open Access
Yes
Create date
12/02/2021 14:29
Last modification date
23/05/2024 6:01
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