scholarly journals Acute Pulmonary Embolism in Women: Focus on Estrogen Therapy as a Predisposing Factor

2021 ◽  
Author(s):  
Hassan Aghajani ◽  
Mahboobeh Aghajani ◽  
Saeed Ghodsi ◽  
Yaser Jenab ◽  
Azita Hajhossein Talasaz ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Prognostic Significance ◽  
Estrogen Therapy ◽  
Clinical Findings ◽  
Recent History ◽  
Predisposing Factor ◽  
Mortality And Morbidity ◽  
History Of

Acute pulmonary embolism (APE) is a potentially fatal disorder. The literature shows that estrogen therapy is correlated with an increase in mortality and morbidity. Accordingly, the purpose of the present study was to investigate the prevalence and prognostic significance of the recent history of estrogen therapy in women with APE. This study was conducted on female patients admitted to our hospital between January 2008 and January 2016. A total of 276 patients (mean age=62.66±08 y) with confirmed APE were divided into groups with and without recent estrogen therapy. The relationships between estrogen and clinical findings, risk factors, imaging findings, and in-hospital mortality were analyzed. Among the 276 women with APE at presentation, 37 (13.4%) patients had a recent history of estrogen therapy. The estrogen group had a lower frequency of hypertension (21.6% vs49.8%; P< .001), immobilization of at least 3 days (16.2% vs 33.5%; P= .035), and pleural effusion (0% vs16.7%; P= .007) than the group without recent estrogen use. Among the 276 patients, the rate of 1 year’s mortality was 15.8% for the group without recent estrogen therapy. No death occurred in the estrogen group. Older age, tachycardia, tachypnea, malignancy, and lack of obesity were the predictors of 1 year’s mortality. Among the patients with APE in our study, 13.4% had a history of recent estrogen therapy. No death occurred during the 1-year follow-up of these patients.

Syncope in relation to pulmonary arterial obstructive burden, hemodynamic status and short- and long-term outcome in patients with acute pulmonary embolism

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Keskin ◽  
H.C Tokgoz ◽  
O.Y Akbal ◽  
A Hakgor ◽  
S Tanyeri ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Right Atrial ◽  
Term Outcome ◽  
Risk Status ◽  
Long Term Outcome ◽  
Short And Long Term ◽  
Severity Indexes

Abstract Background and aims Although syncope (S) has been reported as one of the presenting findings in patients (pts) with acute pulmonary embolism (APE), its clinical and haemodynamic correlates and impacts on the long-term outcome in this setting remains to be determined. In this single-centre study we evaluated the clinical and haemodynamic significance of S in APE in initial asessment, and during short- and long-term follow-up period. Methods Our study was based on the retrospective and prospective analysis of the overall 641 pts (age 65 (51–74 IQR) yrs, 56.2% female) with diagnosis of documented APE who underwent anticoagulant (n=207), thrombolytic (n=164), utrasound-facilitated thrombolysis (UFT) (n=218) or rheolytic thrombectomy (RT) (n=52). The systematic work- up including multidetector computed tomography (MDCT), Echo, biomarkers, and PE severity indexes were performed in all pts, and Qanadli score (QS) was used as the measure of the thrombotic burden in the pulmonary arteries (PA). Results The S as the presenting symptom In 30.2% of pts with APE. At baseline assessment, S(+) vs S(−) APE subgroups had a significantly shorter symptom-diagnosis interval, a higher risk status according to the significant elevations in troponin T, D-dimer, the higher PE severity indexes, a more deteriorated right ventricle/left ventricle ratio (RV/LV r), right atrial/left atrial ratio (LA/RAr) and RV longitudinal function indexes including tricuspid annular planary excursion (TAPSE) and tissue velocity (St), a significantly higher PA obstructive burden as assessed by QS and PA pressures. Thrombolytic therapy (36.2% vs 21%, p&lt;0.001) and RT (11.9% vs 6.47%, p=0.037) were more frequently utilized S(+) as compared to S(−) group. However, all these differences between two subgroups were found to disappear after evidence-based APE treatments. In-hospital mortality (IHM) (12.95% vs 6%, p=0.007) and minor bleeding (10.36% vs 2.9%, p&lt;0.001) were significantly higher in S(+) pts as compared to those in S(−) subgroup. Binominal logistic regression analysis revealed that PESI score and RV/LVr independently associated with S while IHM was only predicted by age and heart rate. The COX proportional hazard method showed that RV/LVr at discharge and malignancy were independently associated with cumulative mortality during follow-up duration of 620 (200–1170 IQ) days. Conclusions The presence of S in pts with APE was found to be asociated with a higher PA obstructive burden, a more deteriorated RV function and haemodynamics and higher risk status which may need more agressive reperfusion treatments. However, in the presence of the optimal treatments, S did not predict neither in-hospital outcome, nor long-term mortality. Funding Acknowledgement Type of funding source: None

Functional outcomes and quality of life during long-term follow-up after acute pulmonary embolism: analysis of the prospective multicentre FOCUS study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Barco ◽  
L Valerio ◽  
M Jankowski ◽  
M.M Hoeper ◽  
F.A Klok ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Medical Center ◽  
Combination Group ◽  
Funding Source ◽  
Median Score ◽  
Persistent Symptoms

Abstract Background It is unclear to which extent persistence of symptoms and/or residual haemodynamic impairment clinical course of pulmonary embolism are associated with worse quality of life (QoL). Aims To study the correlation between symptoms and haemodynamic impairment with QoL during the first year after acute pulmonary embolism (PE). Methods The Follow-Up after acute pulmonary embolism (FOCUS) study prospectively enrolled and followed consecutive adult patients diagnosed with acute symptomatic objectively diagnosed PE. In the present analysis, we considered patients who completed the Pulmonary Embolism QoL (PEmb-QoL) Questionnaire at predefined visits 3 and 12 months after acute PE. The PEmb-QoL score ranges from 0% (best QoL) to 100% (worst QoL). We evaluated at these two time points the correlation between persisting symptoms (group: symptoms), elevation of natriuretic peptides or residual right ventricular dysfunction (group: RVD), or their combination (group: symptoms + RVD) and QoL. Results A total of 617 patients were included; their median age was 62 years, 44% were women; 8% had active cancer, and 21% previous venous thromboembolism. At 3 months, patients with neither symptoms nor RVD (n=302) had the highest quality of life (median score 18%, 25th–75th percentile: 8%–34%), followed by those without symptoms but with RVD (n=255; median score 19%, 25th–75th percentile: 7%–34%), and by those with symptoms only (n=131; median PEmb-QoL 31%, 25th–75th percentile: 18%–49%). Patients with both symptoms and RVD (n=170) had the worst quality of life (median score 38%, 25th–75th percentile: 19%–53%); Figure 1A. At 12 months, we found an overall improvement of PEmb-QoL score. The degree of this QoL improvement varied across groups, being largest for patients who recovered from having symptoms + RVD at 3 months to normalization of at least one at 12 months. The change in QoL from 3 to 12 months was smaller both in patients who had neither symptoms nor RVD and in patients who had no recovery in either symptoms or RVD; Figure 1B. Conclusions Persistent symptoms after PE, especially in patients with elevated biomarkers or residual echocardiographic dysfunction, were the main drivers of QoL at 3 months as well as of the course of QoL over time. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): University Medical Center of the Johannes Gutenberg University, Mainz, Germany; German Federal Ministry of Education and Research

Increased Brain Natriuretic Peptide as a Marker for Right Ventricular Dysfunction in Acute Pulmonary Embolism

2001 ◽  
Vol 86 (11) ◽  
pp. 1193-1196 ◽  
Author(s):  
Igor Tulevski ◽  
Alexander Hirsch ◽  
Bernd-Jan Sanson ◽  
Hans Romkes ◽  
Ernst van der Wall ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Brain Natriuretic Peptide ◽  
Right Ventricular ◽  
Natriuretic Peptide ◽  
Acute Pulmonary Embolism ◽  
Prognostic Significance ◽  
Systolic Pressure ◽  
Clinical Importance ◽  
Acute Pe ◽  
Rv Function

SummaryRight ventricular (RV) function is of major prognostic significance in patients with acute pulmonary embolism (PE). The aim of the present study was to evaluate the role of neurohormone plasma brain natriuretic peptide (BNP) in assessing RV function in patients with acute PE.BNP levels were measured in 16 consecutive patients with acute PE as diagnosed by high probability lung scintigraphy or pulmonary angiography. Twelve healthy age-matched volunteers served as controls. All 16 patients underwent standard echocardiography and blood tests during the first hour of presentation. In the patient group, survival was studied for a period of 30 days. Plasma BNP levels in patients with acute PE were higher than in controls (7.2 [95% CI 0.4 to 144.6] versus 1.4[95% CI 0.4 to 4.6] pmol/L, p = 0.0008). Plasma BNP was significantly higher in 5 patients with RV dysfunction compared to 11 patients with normal RV function (40.2 [95% CI 7.5 to 214.9] versus 3.3 [95% CI 0.4 to 24.9] pmol/L, p = 0.0003). RV systolic pressure was not significantly correlated with BNP (r = 0.42, p = ns).In conclusion, plasma BNP neurohormone levels might be of clinical importance as a supplementary tool for assessment of RV function in patients with acute PE.

scholarly journals Sequential Therapy of LMWH and Rivaroxaban in the Initial Treatment of Patients With Acute Pulmonary Embolism

2021 ◽  
Author(s):  
Wei Xiong ◽  
Yunfeng Zhao ◽  
He Du ◽  
Yanmin Wang ◽  
Xuejun Guo ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Initial Treatment ◽  
Acute Pulmonary Embolism ◽  
Sequential Therapy ◽  
Hemodynamic Instability ◽  
Efficacy And Safety ◽  
Bleeding Events ◽  
Once Daily ◽  
Number Of Patients

Abstract Background: Sequential low molecular weight heparin(LMWH) plus warfarin, LMWH plus edoxaban as well as LMWH plus dabigatran regimens have already showed efficacy and safety in the treatment of acute pulmonary embolism(PE). The efficacy and safety of sequential LMWH plus rivaroxaban regimen in the treatment of PE has been understudied. Methods: A retrospective study was performed to explore the efficacy and safety of sequential therapy regimens of subcutaneous LMWH( nadroparin 4100 IU every 12 hours for a week) followed by oral rivaroxaban(20mg once daily for 3 months) in the management of patients with established acute PE without hemodynamic instability, compared with those of LMWH plus dabigatran as well as LMWH plus warfarin.Results: The number of patients with total resolution of PE were 238(80.1%), 220(78.0%) and 166(62.6%), in the LMWH+rivaroxaban, LMWH+dabigatran, and LMWH+warfarin groups, respectively. (P=0.001) The prevalence of DVT at the 3-month follow-up visit were 18(6.1%), 14(5.0%) and 11(4.2%), in the aforementioned three groups, respectively.(P=0.559) The NT-proBNP level (pg/mL) at the 3-month follow-up visit were 122.5(97.4-158.9) , 131.7(102.2-166.3), and 357.8(275.4-433.2) in three groups, respectively.(P=0.001) The D-dimer level (ng/mL) at the 3-month follow-up visit were 387.3(310.9-465.2) , 432.5(382.4-489.6), and 854.0(721.5-993.7) in three groups, respectively.(P<0.001) The number of patients with major bleeding events were 3(0.9%), 6(1.8%), and 18(5.5%) in three groups, respectively. (P<0.001)Conclusions: The regimen of sequential subcutaneous LMWH for a week followed by oral rivaroxaban at a dose of 20mg once daily for three months is effective and safe in the initial treatment of patients with acute pulmonary embolism.

Family history of venous thromboembolism predicts the diagnosis of acute pulmonary embolism in the emergency department

2018 ◽  
Vol 36 (9) ◽  
pp. 1550-1554 ◽  
Author(s):  
Christopher Kelly ◽  
Chad Agy ◽  
Margaret Carlson ◽  
Jacob Steenblik ◽  
Joseph Bledsoe ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Family History ◽  
Acute Pulmonary Embolism ◽  
History Of

Abstract 14499: Impact of Pre-existing and New Incident Atrial Fibrillation on Outcomes of Patients With Acute Pulmonary Embolism: Findings From an International Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Behnood Bikdeli ◽  
David Jimenez ◽  
Jorg Del Toro ◽  
Gregory Piazza ◽  
Augussina Rivas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Embolism ◽  
Ischemic Stroke ◽  
Acute Pulmonary Embolism ◽  
Adverse Outcomes ◽  
Risk Of Mortality ◽  
Patient Groups ◽  
The Impact ◽  
Related Mortality

Background: Atrial fibrillation (AF) may occur prior to or early in the course of acute pulmonary embolism (PE). The impact of AF on outcomes of patients with PE remains uncertain. Methods: Using the data from a large prospective multicenter registry of patients with objectively-confirmed PE (04/2014 to 01/2020), we identified three patient groups: 1) those with pre-existing AF 2) patients with newly identified AF within 2 days from the index PE (incident AF) and 3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, in unadjusted and multivariable adjusted models considering those without AF as referent. Results: Among 16,497 patients with PE, 792 had pre-existing AF. Compared with those without AF, patients with pre-existing AF, had increased odds of 90-day all-cause (Odds ratio [OR]: 2.81 (95% confidence interval [CI]: 2.33-3.38) and PE-related mortality (OR: 2.38, 95% CI: 1.37-4.14). After multivariable adjustment, pre-existing AF significantly increased the odds of all-cause mortality (OR: 1.91, 95% CI: 1.57-2.32) but not PE-related mortality (OR: 1.50; 95% CI: 0.85-2.66). Pre-existing AF was associated with increased hazard for ischemic stroke at 1-year follow-up (hazard ratio [HR]: 5.48; 95% CI: 3.10-9.69). Among 16,497 patients with PE, 445 developed incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR: 2.28; 95% CI: 1.75-2.97) and PE-related (OR: 3.64; 95% CI: 2.01-6.59) mortality. Findings were similar in multivariable analyses and at 1-year follow-up (Figure). No patients with incident AF developed ischemic stroke. Conclusion: In patients with acute symptomatic PE, both pre-existing AF and incident AF predict an adverse clinical course, although the type of adverse outcomes may be different depending on the timing of AF onset.

Abstract 17285: Trends and Outcomes of Fibrinolytic Therapy in Patients With Pulmonary Embolism and Metastatic Cancer

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Gbolahan O Ogunbayo ◽  
Robert Pecha ◽  
Naoki Misumida ◽  
Karam Ayoub ◽  
Dustin Hillerson ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Metastatic Cancer ◽  
Temporal Trends ◽  
Multivariable Analysis ◽  
Fibrinolytic Therapy ◽  
Primary Diagnosis ◽  
Predictors Of Mortality ◽  
History Of ◽  
Baseline Characteristics

Introduction: Pulmonary embolism in the setting of cancer portends a poor prognosis. There is limited data on the use and outcomes of fibrinolytic therapy (FT) in this subgroup of patients. This study describes temporal trends and outcomes of the use of FT among these patients. Hypothesis: The use of FT in patients with metastatic cancer and acute pulmonary embolism is associated with higher mortality Methods: Using the NIS database, we extracted patients with metastatic cancer admitted with a primary diagnosis of acute pulmonary embolism from January 2010 to December 2014. Using weighted data we analyzed the trends of FT in these patients. For analysis of outcomes, we performed a propensity score matching (match tolerance.01) of patients with PE and FT. After matching, we compared baseline characteristics and inpatient outcomes of patients with PE who underwent FT with those that did not. Or primary outcome was mortality. We performed a multivariable regression analysis with mortality as our outcome. We also described predictors of mortality in patients that underwent FT. Results: Of the 65,882 patients with metastatic cancer admitted with a primary diagnosis of PE, 946 (1.4%) underwent fibrinolytic therapy. There was a significant trends of increase in the use of FT in this cohort of patients, increasing from 0.9% in 2010 to 2.1% in 2014. After exclusions 666 were included in the propensity match and all were matched. Both groups were well matched with regards to baseline characteristics. Patients with FT were less likely to be Caucasian or have anemia. The use of FT was more common in teaching hospitals. Patients in the FT arm were more likely to have cardiac arrest, respiratory failure and acute renal failure. There was no difference in rates of bleeding or blood transfusion. Mortality was significantly higher in the FT arm (24% vs. 1.6%, p<.01). In multivariable analysis, FT was independently associated with mortality (OR 8.35, 95% CI 2.2-32.94; p<.01). Among patients with metastatic cancer and acute PE that underwent FT, independent predictors of mortality were Obesity (OR 4.51, 95% CI 1.35-15.03; p=.02), history of coagulopathy (OR 6.71, 95% CI 1.35-33.46; p=.02), current tobacco abuse (OR 3.26, 95% CI 1.04-10.21; p=.04) and a history of anticoagulant use (OR 2.21, 95% CI 1.02-4.82; p=.046). Conclusions: Fibrinolytic therapy in patients with metastatic cancer and acute pulmonary embolism is associated with increase mortality. The clinical benefits expected from the use fibrinolytic therapy in these patients should be weighed against the risks.

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