scholarly journals Sex Differences in Risk Factors, Clinical Presentation, Treatment and Outcomes of Patients Presenting with Acute Pulmonary Embolism

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2429-2429
Author(s):  
Rachel P Rosovsky ◽  
Islam Y Elgendy ◽  
Suzanne C Cannegieter ◽  
Menno V Huisman ◽  
David Jimenez ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Sex Differences ◽  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Research Funding ◽  
Clinical Presentation ◽  
The United States ◽  
Categorical Variables ◽  
All Cause Mortality ◽  
Acute Pe

Background Pulmonary embolism (PE) is a major cause of morbidity and mortality in both the United States and worldwide. There is a paucity of contemporary clinical registry data regarding sex differences in the clinical presentation, treatment and outcomes of patients with acute PE. Methods Patients with PE from the RIETE (Registro Informatizado Enfermedad Trombo Embólica), a multicenter international prospective registry of patients with venous thromboembolism, were included. Patient characteristics between groups were compared using t-tests for continuous variables and chi-square tests for categorical variables. Multivariable logistic regression adjusting for baseline characteristics, clinical presentation and therapies was used to compare outcomes between both sexes. Outcomes included all-cause mortality, recurrent venous thromboembolism (VTE), and major bleeding through 30 days after initiation of PE treatment as well as all-cause mortality through 90 days. Results From January 2001 through June 2019, 41,477 patients with an acute PE were enrolled, of whom 22,057 (53%) were women. Women were older (mean age +/- standard deviation: 69 +/- 18 years versus 65 +/- 16 years), had higher body mass index (BMI) and were less likely to have cancer than men (Table 1). Women were also less likely to have prior VTE, chronic lung disease, history of MI or angina or an unprovoked PE but more likely to have recent immobilization, chronic heart failure, arterial hypertension, leg varicosities and depression. Women smoked less and fewer women tested positive for an inherited thrombophilia compared to men. Initial presentation: Women presented more frequently with hypotension, tachycardia, dyspnea, syncope and altered mental status than men but women reported less frequently hemoptysis, cough or chest pain. The location of PE was similar between the sexes. Similarly, there was no difference in the initial medical treatment such as unfractionated heparin (UFH) between men and women. However, more men underwent embolectomy and had inferior vena cava filters (IVCF) placed. During the course of anticoagulation (mean duration: 311 days for women and 315 days for men), women received a higher mean dose of low molecular weight heparin (181 [+/-41] International Units (IU)/kilogram (kg)/day versus 178 [+/-40] IU/kg/day, p <0.001) compared to men. For the long-term therapy, women were less likely to receive a direct oral anticoagulant (DOAC). Follow up: Women were less likely to die at 30-days (OR 0.81; 95% CI 0.67-0.97, p <0.05) and 90-days, (OR 0.83; 95% CI 0.74-0.94, p <0.01) and less likely to have recurrent DVT (OR 0.61; 95% CI 0.41-0.91, p <0.05), but more likely to suffer from major bleeding (OR 1.31; 95% CI 1.07-1.61, p <0.01) compared with men. There was no difference in the rates of recurrent PE (OR 1.16; 95% CI 0.83-1.61; Table 2). Conclusion In this international multicenter registry including >40,000 patients with an acute PE, we found that despite presenting with more signs and symptoms of severe PE, women were more likely to be alive at 30 and 90 days and had fewer DVT recurrences but more major bleeds than men. Disclosures Rosovsky: Dova Pharmaceuticals: Consultancy; Bristol-Myers Squibb: Research Funding; Janssen Pharmaceuticals: Consultancy, Research Funding.

Subgroup Analysis of Patients with Cancer in Xalia - a Non-Interventional Study of Rivaroxaban in Routine Treatment of Deep Vein Thrombosis

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1438-1438 ◽  
Author(s):  
Alexander G G Turpie ◽  
Lorenzo G Mantovani ◽  
Sylvia Haas ◽  
Reinhold Kreutz ◽  
Danja Monje ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Research Funding ◽  
Incidence Rates ◽  
Vein Thrombosis ◽  
All Cause Mortality ◽  
Recurrent Vte ◽  
Deep Vein ◽  
Active Cancer

Abstract Background: XALIA is a prospective, non-interventional study of rivaroxaban in the treatment of acute deep vein thrombosis. The overall XALIA results showed that rivaroxaban was associated with similarly low rates of major bleeding and symptomatic recurrent venous thromboembolism (VTE) as standard anticoagulation. A subset of patients in XALIA had active cancer at the time of enrolment into the study. Purpose: To describe the demographics, clinical characteristics, treatment strategies and outcomes of patients in XALIA with cancer and VTE. The primary outcomes were major bleeding, recurrent VTE and all-cause mortality. Methods: Patients with deep vein thrombosis with or without concomitant pulmonary embolism aged ≥18 years who had active cancer and were scheduled to receive ≥3 months of anticoagulation with rivaroxaban or standard therapy were eligible. Therapy type, dose and duration were at the physician's discretion. For the purpose of this substudy, we defined the following treatment cohorts: rivaroxaban cohort (patients treated with rivaroxaban alone or who received heparin/fondaparinux for ≤48 hours before switching to rivaroxaban); early switchers cohort (patients treated with rivaroxaban who received heparin/fondaparinux for >48 hours-14 days and/or a vitamin K antagonist [VKA] for 1-14 days before changing to rivaroxaban); standard anticoagulation cohort (patients treated with heparin/fondaparinux and a VKA or a VKA only); and heparin/fondaparinux cohort (patients treated with heparin/fondaparinux alone). Results: Of 5136 patients in XALIA who received study medication, 587 (11.4%) had active cancer at baseline. Of these, 146 (24.9%) received rivaroxaban, 30 (5.1%) were early switchers, 167 (28.4%) received standard anticoagulation (of which 26 [4.4%] received a VKA only) and 244 (41.6%) received heparin/fondaparinux only, of whom 223 (38.0%) received low molecular weight heparin and the remainder other heparins or fondaparinux. Demographics are shown in Table 1. The most common type of active cancer at baseline in all cohorts was genitourinary, with the exception of the heparin/fondaparinux cohort where gastrointestinal cancer was the most common type (Table 2). The incidence rates for the primary outcomes for each cohort are shown in Figure 1. The rates of major bleeding were highest in the standard anticoagulation cohort (n=8 [4.8%]) and lowest in the early switchers (no major bleeding events occurred). The rates of recurrent VTE were similar in the in the rivaroxaban, early switcher and standard anticoagulation cohorts (n=5 [3.4%], n=1 [3.3%] and n=6 [3.6%], respectively) and were highest in the heparin/fondaparinux cohort (n=12 [4.9%]). All-cause mortality was highest in the heparin/fondaparinux cohort (n=61 [25.0%]) and lowest in the early switchers (no deaths occurred). Conclusions: In the real-world XALIA study, 38.0% of patients with cancer received treatment with low molecular weight heparin, which was in line with guidelines. The remaining patients received rivaroxaban, standard anticoagulation or were early switchers. For the three primary outcomes, the lowest incidence rates were observed in the early switcher cohort. The highest rates were in the standard anticoagulation cohort for major bleeding and the heparin/fondaparinux cohort for recurrent VTE and all-cause mortality; rates for all three primary outcomes were low in the rivaroxaban cohort, suggesting that rivaroxaban may be a safe and effective treatment option for patients with VTE and active cancer. Figure 1 Primary outcomes in patients with active cancer at baseline by treatment group. VTE, venous thromboembolism. Figure 1. Primary outcomes in patients with active cancer at baseline by treatment group. / VTE, venous thromboembolism. Disclosures Turpie: Janssen Research & Development, LLC: Consultancy, Honoraria; Bayer Pharma AG: Consultancy, Honoraria. Mantovani:Janssen-Cilag Ltd: Research Funding; Boehringer Ingelheim: Research Funding; Daiichi Sankyo: Consultancy; Bayer Pharma AG: Consultancy; Pfizer Inc: Research Funding. Haas:Sanofi SA: Consultancy; Pfizer Inc: Consultancy; Daiichi Sankyo: Consultancy; Bristol-Myers Squibb: Consultancy; Bayer Pharma AG: Consultancy; Aspen Pharmacare: Consultancy. Kreutz:Bayer Pharma AG: Honoraria; Servier Laboratories Ltd: Consultancy; Lundbeck Ltd: Consultancy; Daiichi Sankyo: Consultancy; Berlin-Chemie Menarini: Consultancy; Bayer Pharma AG: Consultancy; Bristol-Myers Squibb: Honoraria; Daiichi Sankyo: Honoraria. Monje:Bayer Pharma AG: Employment. Schneider:Bayer Pharma AG: Employment. van Eickels:Bayer Pharma AG: Employment. Gebel:Bayer Pharma AG: Employment. Ageno:Boehringer Ingelheim: Consultancy, Honoraria; Bristol-Myers Squibb: Consultancy, Honoraria; Bayer Pharmaceuticals: Research Funding; Daiichi Sankyo: Consultancy, Honoraria; Bayer Pharma AG: Consultancy, Honoraria.

scholarly journals Predictive Value of Cellular Blood Indices for All-Cause Mortality in Acute Pulmonary Embolism

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2103-2103
Author(s):  
Brett Slajus ◽  
Yevgeniy Brailovsky ◽  
Trung Phan ◽  
Iman Darwish ◽  
Jawed Fareed ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Predictive Value ◽  
Thrombotic Event ◽  
The United States ◽  
Predictive Values ◽  
Blood Indices ◽  
Lymphocyte Ratio ◽  
Chronic Inflammatory Condition ◽  
All Cause Mortality ◽  
Acute Pe

Introduction: Pulmonary embolism (PE) contributes to more than 100,000 annual deaths in the United States and is the third most common cause of cardiovascular death. Short-term all-cause mortality rates differ widely, from 2% among low risk normotensive patients to 95% among those experiencing cardiac arrest. Prognostic models for PE help clinicians facilitate decision making but have suboptimal predictive values. The most widely used tool is the simplified Pulmonary Embolism Severity Index (sPESI) - a scoring system which utilizes 6 clinical variables to predict death. Cellular indices, like platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR), have been shown to be markers of systemic inflammation and are associated with worsened prognosis in acute PE. Other ratios, such as lymphocyte-monocyte ratio (LMR) and platelet-neutrophil ratio (PNR), have not been fully explored. Given the need to further improve sPESI to better manage PE patients, we sought to determine the association of PLR, NLR, LMR, and PNR with all-cause mortality in patients presenting with acute PE. We also evaluated the additive effect of these cellular indices on the predictive value of sPESI. Methods: We retrospectively investigated patients who were consecutively diagnosed and treated between March 2016 and June 2019 at Loyola Medical Center in Maywood, Illinois and Gottlieb Memorial Hospital in Melrose Park, Illinois. Diagnosis of PE was made using CT pulmonary angiography or ventilation perfusion (VQ) scan. Patients were excluded if there was presence of infection, sepsis, ongoing cancer treatment, or a chronic inflammatory condition at the time of PE diagnosis. Clinical characteristics were collected using the electronic medical record system. Differential complete blood count data was collected within 24 hours prior to PE diagnosis. Mann Whitney U and Chi-Square tests were used to determine associations between all-cause mortality and clinical data. ROC curves were constructed to illustrate the sensitivity and specificity of cellular indices to predict all-cause mortality. Optimal ratio cutoffs were determined using Youden J Index. A composite sPESI score was created using cellular blood indices cutoff values. One point was added to the sPESI score for every additional condition met. Results: Among the 228 PE patients, 48 (21%) were non-survivors with median follow up period of 56 days (IQR: 17-182). Elevated PLR and NLR, as well as decreased LMR, were associated with all-cause mortality (all p < 0.01). PNR was not associated with all-cause mortality (p > 0.62). PLR > 256.7 was predictive of mortality (p < 0.01) with sensitivity 54.2% and specificity 85.6%. NLR > 5.5 was predictive of mortality (p < 0.01) with sensitivity 66.7% and specificity 68.3%. LMR < 1.6 was predictive of mortality (p < 0.01) with sensitivity 66.7% and specificity 70.8%. sPESI was predictive of mortality (p < 0.01) with sensitivity 72.9% and specificity 64.0%. A composite model including sPESI, PLR, NLR, and LMR had further improved predictive abilities for all-cause mortality with sensitivity 85.4% and specificity 66.3% as compared to sPESI alone (AUC: 0.82, 95% CI: 0.76-0.89 vs AUC 0.75, 95% CI: 0.68-0.83). Conclusion: This study demonstrated an association between PLR, NLR, and LMR and all-cause mortality in PE patients. Our findings were consistent with past literature and contribute to the argument that these routine laboratory tests can supplement existing risk prediction models. Lymphopenia as well as elevated neutrophil count are associated with pro-inflammatory states during cardiopulmonary events, which may increase risk for thrombotic events. Platelets, a key component of thrombosis, are significantly decreased immediately after a thrombotic event. The composite sPESI model, including PLR, NLR, and LMR exhibited higher sensitivity which allows for improved detection of patients who are at high risk for death. Future studies are required to assess the predictive value of other routine blood tests on all-cause mortality in this patient population to further optimize sPESI and other predictive tools. Disclosures No relevant conflicts of interest to declare.

External Validation of a Clinical and Claims-Based Approach for Predicting 90-Day Post-Pulmonary Embolism Outcomes Among US Veterans

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 533-533
Author(s):  
Neela K Kumar ◽  
Erin R Weeda ◽  
Philip S Wells ◽  
Frank Peacock ◽  
Gregory J Fermann ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Hospital Mortality ◽  
Major Bleeding ◽  
Predictive Value ◽  
Research Funding ◽  
Claims Data ◽  
Severity Index ◽  
Low Risk ◽  
Equity Ownership

Abstract Background: Both the simplified Pulmonary Embolism Severity Index (sPESI) and the multivariable In-hospital Mortality for Pulmonary embolism using Claims daTa (IMPACT) rule classify patients' risk of early post-pulmonary embolism (PE) complications. Objective: To externally validate sPESI and IMPACT for predicting 90-day all-cause mortality and readmission rates among PE patients treated within the Veterans Health Administration (VHA). Methods: We used VHA data from 10/1/2010-9/30/2015 to identify adult patients with: (1) ≥1 inpatient diagnosis for acute PE (International Classification of Diseases-9th Revision-Clinical Modification codes=415.1x), (2) continuous medical and pharmacy enrollment for ≥12-months prior to the index PE (baseline period), (3) a minimum of 90-days of post-event follow-up or until death (whichever came first), and (4) ≥1 claim for an anticoagulant during the index PE stay. Patients were excluded if they had a claim for PE or an anticoagulant during the baseline period. We classified patients as low-risk for early post-PE complications if their sPESI score=0 or their absolute in-hospital mortality risk estimated by IMPACT was <1.5% (the latter calculated using the formula: 1/(1 + exp(-x); where x = −5.833 + [0.026*age] + [0.402*myocardial infarction] + [0.368*chronic lung disease] + [0.464*stroke] + [0.638*prior major bleeding] + [0.298*atrial fibrillation] + [1.06 1*cognitive impairment] + [0.554*heart failure] + [0.364*renal failure] + [0.484*liver disease] + [0.523*coagulopathy] + [1.068*cancer]). Sensitivity, specificity, negative and positive predictive value (NPV and PPV) for all-cause mortality, all-cause readmission, and readmission for recurrent venous thromboembolism (VTE) or major bleeding at 90-days were reported with 95% confidence intervals (CIs) for sPESI and IMPACT tools. Results: Of6,746 eligible PE patients, 851 (12.6%) died and 1,359 (20.1%) were readmitted for any reason within 90-days. Hospitalization for recurrent VTE and major bleeding occurred in 375 (5.6%) and 116 (1.7%), respectively.sPESI classified 1,918 (28.4%) as low-risk, while 1,024 (15.2%) were low-risk per IMPACT. Both tools displayed sensitivity >90% and NPVs >96% for all-cause 90-day mortality, but low specificity and PPVs (Table). IMPACT's sensitivity for all-cause readmission was numerically higher than sPESI, but both had comparable NPVs. Similar trends were observed for accuracy in predicting readmissions due to recurrent VTE or major bleeding. Conclusion: In this external validation study utilizing VHA data, IMPACT classified patients for 90-day post-PE outcomes with similar accuracy as sPESI. While not recommended for prospective clinical decision-making, IMPACT appears useful for identification of PE patients at low-risk for early mortality or readmission in retrospective claims-based studies. Table. Test characteristics for sPESI and IMPACT for 90-day post-pulmonary embolism outcomes CI= confidence interval; IMPACT=In-hospital Mortality for Pulmonary embolism using Claims data; NPV=negative predictive value; PPV=positive predictive value; sPESI=simplified Pulmonary Embolism Severity Index; VTE=venous thromboembolism Table. Test characteristics for sPESI and IMPACT for 90-day post-pulmonary embolism outcomes CI= confidence interval; IMPACT=In-hospital Mortality for Pulmonary embolism using Claims data; NPV=negative predictive value; PPV=positive predictive value; sPESI=simplified Pulmonary Embolism Severity Index; VTE=venous thromboembolism Disclosures Kumar: Johnson & Johnson: Employment. Wells:Itreas: Other: Served on a Writing Committee; Janssen Pharmaceuticals: Consultancy; Bayer Healthcare: Other: Speaker Fees and Advisory Board; BMS/Pfizer: Research Funding. Peacock:Comprehensive Research Associates LLC: Equity Ownership; Cardiorentis: Consultancy, Research Funding; The Medicine's Company: Consultancy, Research Funding; Banyan: Research Funding; Emergencies in Medicine LLC: Equity Ownership; Abbott: Research Funding; Alere: Consultancy, Research Funding; Prevencio: Consultancy; Janssen: Consultancy, Research Funding; Portola: Consultancy, Research Funding; Pfizer: Research Funding; Roche: Research Funding; ZS Pharma: Consultancy, Research Funding; Ischemia Care: Consultancy; Phillips: Consultancy. Fermann:Janssen Pharmaceuticals: Other: Advisory Board, Speakers Bureau; Pfizer: Research Funding. Wang:Janssen Pharmaceuticals: Research Funding. Baser:Janssen Pharmaceuticals: Research Funding. Schein:Johnson & Johnson: Employment, Equity Ownership, Other: Own in excess of $10,000 of J&J stock. Crivera:Johnson & Johnson: Employment, Equity Ownership, Other: Owns excess of $10,000 in stock. Coleman:Boehringer-Ingelheim Pharmaceuticals, inc.: Consultancy, Research Funding; Bayer Pharmaceuticals AG: Consultancy, Research Funding; Janssen Pharmaceuticals: Consultancy, Research Funding.

Safety of Outpatient Treatment In Acute Pulmonary Embolism.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3796-3796
Author(s):  
Petra MG Erkens ◽  
Esteban Gandara ◽  
Phil Wells ◽  
Alex Yi-Hao Shen ◽  
Gauruv Bose ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Outpatient Treatment ◽  
Research Funding ◽  
Low Molecular Weight ◽  
Ottawa Hospital ◽  
Bleeding Episodes ◽  
Acute Pe

Abstract Abstract 3796 Introduction: Systematic reviews have shown that subcutaneous low molecular weight heparins (LMWH) are at least as safe and effective in the treatment of venous thromboembolism (VTE) as intravenous unfractionated heparin (UFH). LMWH allows patients with VTE to be treated as outpatients. However, patients with pulmonary embolism (PE) are still systematically admitted to the hospital for a few days to avoid potential complications. Physicians are reluctant to discharge patients due to insufficient data supporting the safety of outpatient management of PE. This study evaluates the safety of outpatient treatment of acute PE at the Ottawa Hospital. Methods: This is a retrospective cohort study of consecutive patients presenting at the Ottawa Hospital with acute PE diagnosed between January 1, 2007 and December 31, 2008. PE was defined as an arterial filling defect on CTPA or a high probability V/Q scan. Patients diagnosed with PE during hospitalization, patients with chronic PE and patients in whom anticoagulation treatment was not initiated (e.g. palliative care patients, small clinical non-significant PE) were excluded from the analyses. Patients were managed as outpatients if they were hemodynamically stable, did not require supplemental oxygenation and did not have contraindications to low molecular weight heparin therapy. Results: In this cohort of 473 patients with acute PE, 260 (55.0%) were treated as outpatients and 213 (45.0%) were admitted to the hospital. The majority of the patients were admitted because of severe comorbidities (45.5%) or hypoxia (22.1%).No outpatient died of fatal PE during the 3 month follow-up period. At the end of follow-up, the overall mortality was 5.0% (95% CI: 2.7 to 8.4%). The rates of recurrent venous thromboembolism (VTE) in the outpatient group were 0.4% (95% CI: 0.0 to 2.1%) and 3.8% (95% CI: 1.9 to 7.0%) within 14 days and 3 months, respectively. The rates of major bleeding episodes were 0% (95% CI: 0 to 1.4%) and 1.5% (95% CI: 0.4 to 3.9%) within 14 days and 3 months, respectively. Four (1.5%) outpatients were admitted to hospital within the first 14 days because of progressive shortness of breath and pain, a pre-syncopal episode or heparin induced thrombocytopenia. Conclusion: A majority of patients with acute PE can be managed as outpatients with a low risk of mortality, recurrent VTE and major bleeding episodes. Outpatient treatment in PE is feasible and safe in uncomplicated patients. Disclosures: Rodger: Pfizer: Research Funding; Leo Pharma: Research Funding; Sanofi Aventis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Canadian Institutes of Health Research: Research Funding; Heart and Stroke Foundation: Research Funding.

Acute Treatment Of Pulmonary Embolism With Rivaroxaban - Real Life Data From The Prospective Dresden Noac Registry (NCT01588119)

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2380-2380
Author(s):  
Christina Köhler ◽  
Sebastian Werth ◽  
Luise Tittl ◽  
Jan Beyer-Westendorf
Keyword(s):  
Pulmonary Embolism ◽  
Major Bleeding ◽  
Research Funding ◽  
Bleeding Complications ◽  
Daily Care ◽  
Study Results ◽  
Bayer Healthcare ◽  
Recurrent Vte ◽  
Acute Pe

Abstract Background and Objectives In the EINSTEIN PE study rivaroxaban (RX) was found to be as effective as warfarin in the treatment of acute pulmonary embolism (PE) with superior safety. However, study results need to be confirmed in unselected PE patients in daily care. Patients and Methods Using prospectively collected data from a large regional registry of patients treated with novel direct oral anticoagulants (NOAC) in the district of Saxony, Germany, we evaluated the rate of recurrent VTE, other cardiovascular complications and bleeding events in patients receiving rivaroxaban for acute PE. In this ongoing registry, a network of 239 physicians enrols up to 2500 daily care NOAC patients who receive central prospective follow up (FU) by the registry office at day 30 day and quarterly thereafter to collect efficacy and safety data. All outcome events are centrally adjudicated using standard scientific definitions. Results Until July 31th 2013, 2249 patients were enrolled. Of these, 72 patients received RX for acute PE treatment (demographic data in table 1). Registry patients were older than the EINSTEIN PE population (67.3 vs. 55.8 years), 55.6% were female and 23.6% were treated for a recurrent VTE. During follow-up, unplanned rivaroxaban discontinuation rates were low (around 5%; table 1). So far, only one recurrent VTE event occurred (1.7 events per 100 patient years). One patient experienced non-fatal ischaemic stroke within 4 weeks after PE diagnosis (1.7 events per 100 patient years). Bleeding complications were frequent but only 2 major bleeding (non-fatal vaginal bleeds) occurred (3.3 events per 100 patient years). During follow-up three patients died of underlying diseases but none of these deaths were related to VTE or bleeding complications. Conclusion Acute PE treatment with rivaroxaban in daily care is effective, safe and well tolerated with low rates of unplanned treatment discontinuation. Thromboembolic and major bleeding complications are rare and seem to occur predominantly in the early phase of PE treatment. At ASH, updated results from our registry will be presented Disclosures: Werth: Bayer Healthcare: Honoraria. Beyer-Westendorf:Pfizer: Research Funding, Speakers Bureau; Boehringer Ingelheim: Research Funding, Speakers Bureau; Bayer Healthcare: Research Funding, Speakers Bureau.

scholarly journals Computed Tomography Pulmonary Perfusion for Prediction of Short-Term Clinical Outcome in Acute Pulmonary Embolism

TH Open ◽  
2021 ◽  
Vol 05 (01) ◽  
pp. e66-e72
Author(s):  
Lisette F. van Dam ◽  
Lucia J. M. Kroft ◽  
Menno V. Huisman ◽  
Maarten K. Ninaber ◽  
Frederikus A. Klok
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Predictive Value ◽  
Acute Pulmonary Embolism ◽  
Clinical Presentation ◽  
Reperfusion Therapy ◽  
Pulmonary Perfusion ◽  
Short Term ◽  
Acute Pe ◽  
Related Mortality

Abstract Background Computed tomography pulmonary angiography (CTPA) is the imaging modality of choice for the diagnosis of acute pulmonary embolism (PE). With computed tomography pulmonary perfusion (CTPP) additional information on lung perfusion can be assessed, but its value in PE risk stratification is unknown. We aimed to evaluate the correlation between CTPP-assessed perfusion defect score (PDS) and clinical presentation and its predictive value for adverse short-term outcome of acute PE. Patients and Methods This was an exploratory, observational study in 100 hemodynamically stable patients with CTPA-confirmed acute PE in whom CTPP was performed as part of routine clinical practice. We calculated the difference between the mean PDS in patients with versus without chest pain, dyspnea, and hemoptysis and 7-day adverse outcome. Multivariable logistic regression analysis and likelihood-ratio test were used to assess the added predictive value of PDS to CTPA parameters of right ventricle dysfunction and total thrombus load, for intensive care unit admission, reperfusion therapy and PE-related death. Results We found no correlation between PDS and clinical symptoms. PDS was correlated to reperfusion therapy (n = 4 with 16% higher PDS, 95% confidence interval [CI]: 3.5–28%) and PE-related mortality (n = 2 with 22% higher PDS, 95% CI: 4.9–38). Moreover, PDS had an added predictive value to CTPA assessment for PE-related mortality (from Chi-square 14 to 19, p = 0.02). Conclusion CTPP-assessed PDS was not correlated to clinical presentation of acute PE. However, PDS was correlated to reperfusion therapy and PE-related mortality and had an added predictive value to CTPA-reading for PE-related mortality; this added value needs to be demonstrated in larger studies.

Venous Thromboembolism

2017 ◽  
Author(s):  
Guillermo A. Escobar ◽  
Peter K. Henke ◽  
Thomas W. Wakefield
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Lower Extremity ◽  
The United States ◽  
Laboratory Evaluation ◽  
Individual Risk ◽  
Vein Thrombosis ◽  
Clinical Scenarios ◽  
Deep Vein

Deep vein thrombosis (DVT) and pulmonary embolism (PE) comprise venous thromboembolism (VTE). Together, they comprise a serious health problem as there are over 275,000 new VTE cases per year in the United States, resulting in a prevalence of one to two per 1,000 individuals, with some studies suggesting that the incidence may even be double that. This review covers assessment of a VTE event, initial evaluation of a patient suspected of having VTE, medical history, clinical presentation of VTE, physical examination, laboratory evaluation, imaging, prophylaxis against perioperative VTE, indications for immediate intervention (threat to life or limb), indications for urgent intervention, and management of nonemergent VTE. Figures show a modified Caprini score questionnaire used at the University of Michigan to determine individual risk of VTE and the indicated prophylaxis regimen; Wells criteria for DVT and PE; phlegmasia cerulea dolens secondary to acute left iliofemoral DVT after thigh trauma; compression duplex ultrasonography of lower extremity veins; computed tomographic angiogram of the chest demonstrating a thrombus in the pulmonary artery, with extension into the right main pulmonary; management of PE according to Wells criteria findings; management of PE with right heart strain in cases of massive or submassive PE; treatment of DVT according to clinical scenario; a lower extremity venogram of a patient with May-Thurner syndrome and its subsequent endovascular treatment; and various examples of retrievable vena cava filters (not drawn to scale). Tables list initial clinical assessment for VTE, clinical scenarios possibly benefiting from prolonged anticoagulation after VTE, indications for laboratory investigation of secondary thrombophilia, venous thromboembolic risk accorded to hypercoagulable states, and Pulmonary Embolism Rule-out Criteria Score to avoid the need for D-dimer in patients suspected of having PE.   This review contains 11 highly rendered figures, 5 tables, and 167 references. Key words: anticoagulation; deep vein thrombosis; postthrombotic syndrome; pulmonary embolism; recurrent venous thromboembolism; thrombophilia; venous thromboembolism; PE; VTE; DVT 

The Diagnostic Assessment of Suspected Pulmonary Embolism on the Acute Medical Take: An Evidence Based Guide

2007 ◽  
Vol 6 (1) ◽  
pp. 20-26
Author(s):  
Alastair Proudfoot ◽  
◽  
Derek Bell ◽  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Clinical Presentation ◽  
Diagnostic Assessment ◽  
Evidence Based ◽  
Suspected Pulmonary Embolism ◽  
The Subject ◽  
Adjusted Incidence ◽  
Age And Sex

Pulmonary Embolism is a common cardiopulmonary illness with an age and sex adjusted incidence of around 117 cases per 100 000 person years. The clinical presentation is extremely heterogeneous and non specific. Risk factors for venous thromboembolism are well established. When combined with presenting features and investigations. a multimodality algorithm has led to significant changes in the diagnostic approach of suspected PE. While the best combination of tests for any individual patient remains the subject of controversy this article aims to rationalise the acute physician’s approach to diagnosis and use of available investigations.

Abstract 12901: Novel Oral Anticoagulants Are Associated With Decreased Recurrence of Venous Thromboembolism in Patients With Cancer: An Updated Meta-Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sunil Upadhaya ◽  
Seetharamprasad Madala ◽  
Sunil Badami
Keyword(s):  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Novel Oral Anticoagulants ◽  
P Value ◽  
Patients With Cancer ◽  
Randomized Controlled ◽  
All Cause Mortality ◽  
Recurrent Vte

Introduction: Patients with cancer are at high risk for recurrent thromboembolic phenomenon. Use of novel oral anticoagulants (NOAC) for treatment of venous thromboembolism (VTE) in such patients is controversial. We conducted this updated meta-analysis to evaluate the pooled efficacy and safety of NOAC in patients with cancer. Methods: We did systematic search of PubMed and Cochrane library databases for randomized controlled trials comparing NOAC with low molecular weight heparin (LMWH) for VTE treatment in cancer patients till April 2020. The efficacy outcomes were recurrent VTE and all-cause mortality rates, and the primary safety outcome was incidence of major bleeding rate. Results: Four randomized controlled studies comparing NOAC with LMWH (1446 patients in NOAC group and 1448 patients in LMWH group) were included in our study. Use of NOAC lead to significant reduction in recurrent VTE rate (odds ratio (OR): 0.55 [0.36-0.84], I 2 = 45 %, p value = 0.006) (Figure 1). However, we did not find any significant difference in rate of major bleeding (OR: 1.30 [0.76-2.23], I 2 = 35%, p value = 0.34) (Figure 2) and all-cause mortality (OR: 1 [0.80 - 1.26], I 2 = 33%, p value = 0.98). Conclusions: This updated meta-analysis showed comparatively lower pooled recurrent VTE rate in patient being treated with NOAC, whereas similar rates of major bleeding and all-cause death. NOAC are more efficacious and has similar safety profile compared with LMWH.

Sign in / Sign up

Export Citation Format

Share Document