Death due to recurrent thromboembolism among younger healthier individuals hospitalized for idiopathic pulmonary embolism

2008 ◽  
Vol 99 (04) ◽  
pp. 683-690 ◽  
Author(s):  
Hong Zhou ◽  
Susan Murin ◽  
Richard White
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Fatality Rate ◽  
Thromboembolic Pulmonary Hypertension ◽  
The Mean ◽  
First Time ◽  
Acute Pe

SummaryThe incidence of death due to recurrent pulmonary embolism (PE) after a first-time idiopathic PE is not well defined. We conducted a retrospective study of patients age 18 to 56 years who had idiopathic PE between 1994–2001.The incidence and cause of death within five years was determined using linked discharge records and a master death registry. A total of 3,456 patients had a first-time idiopathic PE. The rate of recurrent VTE 0–6 months after the index event was 13.1%/year, and 2.9%/year 6–60 months after the event. During the mean follow-up of 3.2 years 118 (3.4%, 95% confidence interval [CI]=2.8–4.1%) patients died. Fifty-two (44%) deaths occurred <29 days after the index PE (case-fatality rate =1.5%,95%CI=1.1–2.0%). Among the 66 cases (1.9%) that died after 28 days, 18 (0.52%) were due to recurrent PE or its sequelae: eight had recurrent PE alone, five had recurrent PE and a serious co-morbid illness, and five had thromboembolic pulmonary hypertension with or without acute PE. The person-time rate of death (deaths per 100 patientyears) attributed to any recurrent thromboembolism 6–60 months after the event was 0.16% (95%CI=0.1–0.26%). Ten of the 18 (56%) late thromboembolic deaths reflected a first-time recurrent PE. The 28-day case-fatality rate for recurrentVTE was 2.8% (95%CI= 1.5–4.9%).In this cohort of younger patients with idiopathic PE, the rate of death due to recurrentVTE, particularly to first-time recurrent PE, was low. Among the patients who died of thromboembolism >28 days after the index PE, 28% had developed pulmonary hypertension.

P2772The rule-out criteria for chronic thromboembolic pulmonary hypertension can identify patients without haemodynamic abnormalities and functional limitation 3 and 12 months after acute PE

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Barco ◽  
A Mavromanoli ◽  
F A Klok ◽  
S V Konstantinides
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
High Probability ◽  
Acute Pulmonary Embolism ◽  
Functional Limitation ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Thromboembolic Pulmonary Hypertension ◽  
Acute Pe ◽  
Rule Out

Abstract Background Up to one-third of patients report persisting hemodynamic abnormalities and functional limitation over long-term follow-up after acute pulmonary embolism (PE). Purpose We tested whether a validated algorithm designed to rule-out chronic thromboembolic pulmonary hypertension (CTEPH) after acute PE can be used for identifying patients at lower risk of presenting with persisting symptoms and echocardiographic abnormalities. Methods The multicentre Follow-up of Acute Pulmonary Embolism (FOCUS) cohort study prospectively enrolled 1,100 consecutive patients diagnosed with acute symptomatic PE; two-year follow-up is ongoing. We focused on the scheduled visits for 3- and 12-month follow-up. The rule-out criteria are based on: the absence of ECG signs of right ventricular dysfunction and normal NT-proBNP/BNP values. Echocardiographic abnormalities were defined according to the presence of abnormal parameters indicating an intermediate/high probability of pulmonary hypertension as recommended by the 2015 ESC/ERS Society Guidelines on Pulmonary Hypertension. The presence of functional limitation was defined based on a World Health Organization classification grade ≥3, a Borg dyspnoea index ≥4, or a 6-minute walking distance <300 m. Results We included 323 patients (mean age 61 years, 58% men), of whom 255 have meanwhile completed a one-year follow-up. At 3- and 12-month follow-up, 194 (60%) and 155 (61%) of patients exhibited no abnormal echocardiographic findings or natriuretic peptide levels. The percentage of patients with echocardiographic abnormalities was 20.4% and 18.0%, respectively. The negative predictive value of the score for ruling out the combination of functional limitation and intermediate/high probability of pulmonary hypertension as recommended by the 2015 ESC/ERS Guidelines on Pulmonary Hypertension was 0.96 (95% CI 0.92–0.98) at 3 and 0.97 (0.92–0.99) at 12 months. The corresponding positive predictive values were 0.10 (0.06–0.17) and 0.09 (0.05–0.17), respectively. Conclusions The CTEPH rule-out criteria are capable of excluding functional limitation and evidence of (chronic) pulmonary hypertension 3 and 12 months after the diagnosis of acute PE. Acknowledgement/Funding The sponsor (University Medical Center of the Johannes Gutenberg University, Mainz) has obtained grants from Bayer Vital GmbH and Bayer Pharma AG

Prevalence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism

2014 ◽  
Vol 112 (09) ◽  
pp. 598-605 ◽  
Author(s):  
Laurent Guérin ◽  
Francis Couturaud ◽  
Florence Parent ◽  
Marie-Pierre Revel ◽  
Florence Gillaizeau ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Systolic Pulmonary Artery Pressure ◽  
Prospective Multicentre Study ◽  
Right Heart Catheterisation ◽  
Venous Thromboembolic Events ◽  
Thromboembolic Pulmonary Hypertension ◽  
Acute Pe

SummaryChronic thromboembolic pulmonary hypertension (CTEPH) has been estimated to occur in 0.1–0.5% of patients who survive a pulmonary embolism (PE), but more recent prospective studies suggest that its incidence may be much higher. The absence of initial haemodynamic evaluation at the time of PE should explain this discrepancy. We performed a prospective multicentre study including patients with PE in order to assess the prevalence and to describe risk factors of CTEPH. Follow-up every year included an evaluation of dyspnea and echocardiography using a predefined algorithm. In case of suspected CTEPH, the diagnosis was confirmed using right heart catheterisation (RHC). Signs of CTEPH were searched on the multidetector computed tomography (CT) and echocardiography performed at the time of PE. Of the 146 patients analysed, eight patients (5.4%) had suspected CTEPH during a median follow-up of 26 months. CTEPH was confirmed using RHC in seven cases (4.8%; 95%CI, 2.3 – 9.6) and ruled-out in one. Patients with CTEPH were older, had more frequently previous venous thromboembolic events and more proximal PE than those without CTEPH. At the time of PE diagnosis, patients with CTEPH had a higher systolic pulmonary artery pressure and at least two signs of CTEPH on the initial CT. After acute PE, the prevalence of CTEPH appears high. However, initial echocardiography and CT data at the time of the index PE suggest that a majority of patients with CTEPH had previously unknown pulmonary hypertension, indicating that a first clinical presentation of CTEPH may mimic acute PE.

scholarly journals Vena Cava Filters and In-Hospital Case Fatality Among Patients With Pulmonary Embolism: Results From a Large Population-Based Study

2019 ◽  
Vol 25 ◽  
pp. 107602961988802 ◽  
Author(s):  
Fulvio Pomero ◽  
Walter Ageno ◽  
Francesco Dentali ◽  
Luigi Fenoglio ◽  
Alessandro Squizzato ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Case Fatality Rate ◽  
Large Population ◽  
Vena Cava ◽  
Case Fatality ◽  
First Episode ◽  
Fatality Rate ◽  
Hospital Case ◽  
Vena Cava Filters ◽  
Acute Pe

In patients with venous thromboembolism (VTE), vena cava filters (VCFs) are currently only recommended when anticoagulant treatment is contraindicated or if VTE has recurred despite adequate anticoagulation. However, evidence on the efficacy of filter in patients with VTE is not compelling. We evaluated potential efficacy of VCF in reducing in-hospital mortality in a large population of patients presenting with a first episode of pulmonary embolism (PE). Patients were collected using regional hospital-discharge databases covering a population of more than 13 million of inhabitants in Northern Italy. For each year of observation, we calculated the proportion of cases with VCF among all PE incident cases. The temporal trend of VCF application during the study period was also derived. The effect of VCF use on in-hospital case-fatality rate was evaluated with a multivariate regression model and with the use of propensity score matching. During the study period (2002-2012), 60 813 patients were hospitalized for a first episode of acute PE. In-hospital case-fatality rate for PE was 13.3%. Vena cava filters were used in 745 (1.22%) patients. The annual use of VCF remained stable from 2002 to 2008, while it progressively decreased afterward. After adjustment for available confounders, case-fatality rate remained significantly lower in patients who received VCF compared to the one registered in patients who did not (odds ratio [OR] 0.46; 95% confidence interval [CI]: 0.34-0.62). Propensity score matching gave similar results (OR: 0.42; 95% CI: 0.30-0.61). Vena cava filters were infrequently used in patients with acute PE. Insertion of VCF appeared to sensibly reduce all-cause in-hospital mortality in this subgroup of patients.

scholarly journals Managing Recurrent Clozapine-Induced Constipation in a Patient with Resistant Schizophrenia

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Silviu Tomulescu ◽  
Kim Uittenhove ◽  
Reda Boukakiou
Keyword(s):  
Side Effects ◽  
Case Fatality Rate ◽  
Surgical Intervention ◽  
Case Fatality ◽  
Fatality Rate ◽  
Augmentation Strategy

Clozapine is an effective antipsychotic for the treatment of resistant schizophrenia. However, clozapine can lead to serious side effects. One of the most common side effects is constipation and in rare cases ileus, which is associated with a considerable case fatality rate. Our patient exhibited repeated episodes of ileus while being treated with clozapine. We adapted the treatment of the patient in several ways to manage these severe side effects. First, we reduced clozapine dosage by opting for an augmentation strategy of clozapine through paliperidone. Then, we added linaclotide as a nonconventional laxative. We further adapted treatment after the occurrence of a volvulus prompting surgical intervention which revealed a malformation of the intestines’ peritoneal attachment. A gastrostomy to facilitate the treatment of any further episode was performed and bethanechol was introduced alongside linaclotide. Follow-up revealed the efficacy of our strategy involving the use of linaclotide in managing the side effects of clozapine in this patient.

Impact of Vena Cava Filters on In-hospital Case Fatality Rate from Pulmonary Embolism

2012 ◽  
Vol 125 (5) ◽  
pp. 478-484 ◽  
Author(s):  
Paul D. Stein ◽  
Fadi Matta ◽  
Daniel C. Keyes ◽  
Gary L. Willyerd
Keyword(s):  
Pulmonary Embolism ◽  
Case Fatality Rate ◽  
Vena Cava ◽  
Case Fatality ◽  
Fatality Rate ◽  
Hospital Case ◽  
Vena Cava Filters

Association of digoxin therapy with case fatality rate in acute pulmonary embolism

2020 ◽  
Author(s):  
Mehmet Baran Karataş ◽  
Nizamettin Selçuk Yelgeç ◽  
Yiğit Çanga ◽  
Ahmet Zengin ◽  
Ayşe Emre
Keyword(s):  
Pulmonary Embolism ◽  
Case Fatality Rate ◽  
Acute Pulmonary Embolism ◽  
Case Fatality ◽  
Fatality Rate ◽  
Digoxin Therapy

scholarly journals Accurate and efficient non-invasive strategy for early identification of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism (InShape II study)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Klok ◽  
G.J.A.M Boon ◽  
Y.M Ende-Verhaar ◽  
R Bavalia ◽  
M Delcroix ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
Acute Pulmonary Embolism ◽  
Diagnostic Delay ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Funding Source ◽  
Total Period ◽  
Life Years ◽  
Thromboembolic Pulmonary Hypertension ◽  
Acute Pe

Abstract Background The current diagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary embolism (PE) is unacceptably long exceeding 1 year, causing loss of quality-adjusted life years and excess mortality. Validated screening strategies to diagnose CTEPH earlier are lacking. Importantly, performing echocardiography in all PE patients for this purpose has a low diagnostic yield, is associated with overdiagnosis and is not cost-effective. Moreover, expertise in performing high-quality PH-dedicated echocardiograms may not be available outside expert centers. Aim To validate a simple screening strategy aimed at identifying CTEPH early in the course after acute PE, avoiding echocardiography if possible (Figure 1). Methods In this prospective, international, multicenter management study, consecutive PE survivors were managed according to the predefined algorithm starting three months after acute PE. All were followed for a total period of two years. The study protocol was approved by all local IRBs and all patients provided informed consent. Results 424 patients were included across three European countries (Table 1). Following the algorithm, CTEPH was considered excluded in 343 (81%) patients based on clinical pre-test probability assessment by the “CTEPH prediction score”, evaluation of symptoms and application of the “CTEPH rule-out criteria” (Figure 1); only 19% was subjected to echocardiography. Only 1 of 343 patients managed without echocardiography was diagnosed with CTEPH, 10 months after initial PE, for a failure rate of 0.29% (95% CI 0–1.6%). Overall, 13 patients were diagnosed with CTEPH (incidence 3.1%), of whom 10 within 4 months after PE diagnosis. Conclusions The algorithm accurately ruled out CTEPH and avoided echocardiography in 81% of patients. The vast majority of CTEPH cases were identified early in the course of acute PE which is a considerable improvement compared to current clinical practice with an economic use of healthcare resources. Figure 1. Study flowchart Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): This study was supported by unrestricted grants from Bayer/Merck Sharp & Dohme (MSD) and Actelion Pharmaceuticals Ltd. F.A. Klok and G.J.A.M. Boon were supported by the Dutch Heart Foundation (2017T064).

scholarly journals Characteristics of COVID-19 fatality cases in East Kalimantan, Indonesia

2020 ◽  
Author(s):  
Swandari Paramita ◽  
Ronny Isnuwardana ◽  
Krispinus Duma ◽  
Rahmat Bakhtiar ◽  
Muhammad Khairul Nuryanto ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Information System ◽  
Cerebrovascular Disease ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Fatality Rate ◽  
Rt Pcr ◽  
East Kalimantan ◽  
The Mean ◽  
Underlying Diseases

Introduction. Coronavirus Disease (COVID-19) is caused by SARS-CoV-2 infection. On March 2, 2020, Indonesia announced the first confirmed cases of COVID-19 infection. East Kalimantan will play an important role as the new capital of Indonesia. There is attention to the preparedness of East Kalimantan to respond to COVID-19. We report the characteristics of COVID-19 fatality cases in here. Methods. We retrospectively analyzed the fatality cases of COVID-19 patients from the East Kalimantan Health Office information system. All patients were confirmed COVID-19 by RT-PCR examination. Results. By July 31, 2020, 31 fatality cases of patients had been identified as having confirmed COVID-19 in East Kalimantan. The mean age of the patients was 55.1 + 9.2 years. Most of the patients were men (22 [71.0%]) with age more than 60 years old (14 [45.2%]). Balikpapan has the highest number of COVID-19 fatality cases from all regencies. Hypertension was the most comorbidities in the fatality cases of COVID-19 patients in East Kalimantan. Discussion. Older age and comorbidities still contributed to the fatality cases of COVID-19 patients in East Kalimantan, Indonesia. Hypertension, diabetes, cardiovascular disease, and cerebrovascular disease were underlying conditions for increasing the risk of COVID-19 getting into a serious condition. Conclusion. Active surveillance for people older than 60 years old and having underlying diseases is needed for reducing the case fatality rate of COVID-19 in East Kalimantan. Keywords. Comorbidity, fatality cases, COVID-19, Indonesia.

scholarly journals Regional Differences in Epidemiological and Clinical Characteristics, Treatment, and Clinical Outcomes of COVID-19 in Wuhan and Remote Areas of Hubei Province

2021 ◽  
Vol 8 ◽  
Author(s):  
Honggang Ren ◽  
Xingyi Guo ◽  
Antonio Palazón-Bru ◽  
Pengcheng Yang ◽  
Nan Huo ◽  
...  
Keyword(s):  
Regional Differences ◽  
Case Fatality Rate ◽  
Clinical Characteristics ◽  
Case Fatality ◽  
Cross Sectional Study ◽  
Hubei Province ◽  
Fatality Rate ◽  
Cross Sectional ◽  
Suburban Areas

Background: The Coronavirus disease 2019 (COVID-19) pandemic has been a major threat to global health. Regional differences in epidemiological and clinical characteristics, treatment and outcomes of patients have not yet been investigated. This study was conducted to investigate these differences amongCOVID-19 patients in Hubei Province, China.Methods: This retrospective cross-sectional study analyzed data on 289 COVID-19 patients from designated hospitals in three regions:Urban (Wuhan Union West Hospital), Suburban areas of Wuhan (Hannan Hospital) and Enshi city, between February 8 and 20, 2020. The final date of follow-up was December 14th, 2020. The outcomes were case fatality rate and epidemiological and clinical data.Results: Urban Wuhan experienced a significantly higher case fatality rate (21.5%) than suburban Wuhan (5.23%) and rural area of Enshi (3.51%). Urban Wuhan had a higher proportion of patients on mechanical ventilation (24.05%) than suburban Wuhan (0%) and rural Enshi (3.57%). Treatment with glucocorticoids was equivalent in urban and suburban Wuhan (46.84 and 45.75%, respectively) and higher than Enshi (25.00%). Urban Wuhan had a higher proportion of patients with abnormal tests including liver function and serum electrolytes and a higher rate of pneumonia (p &lt; 0.01 for all). Urban Wuhan also had a higher incidence of respiratory failure, heart disease, liver disease and shock, compared with the other two regions (all p &lt; 0.05).Conclusions: Our findings revealed that there are regional differences in COVID-19. These findings provide novel insights into the distribution of appropriate resources for the prevention, control and treatment of COVID-19 for the global community.

Sign in / Sign up

Export Citation Format

Share Document