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DOI: 10.1160/TH10-07-0480
Effect of the time of diagnosis on outcome in patients with acute venous thromboembolism
Findings from the RIETE RegistryFinancial support: This project has been partially supported by the Plan Nacional de I+D+I 2008–2011 and the ISCIII-Subdirección General de Evaluación y Fomento de la Investigación (Reference number: PI080902).
Publication History
Received:
26 July 2010
Accepted after major revision:
23 September 2010
Publication Date:
22 November 2017 (online)
Summary
The influence of the day of diagnosis (weekends vs. weekdays) on outcome in patients with acute venous thromboembolism (VTE) has not been thoroughly studied. We used the RIETE database to compare the clinical characteristics, treatment details, and mortality rate at 7 and 30 days, of all patients diagnosed with acute VTE on weekends versus those diagnosed on weekdays. Up to January 2010, 30,394 patients were included in RIETE, of whom 5,479 (18%) were diagnosed on weekends. Most clinical characteristics were similar in both groups, but patients diagnosed on weekends had less often cancer (20% vs. 22%; p=0.004), and presented more likely with pulmonary embolism (PE) than those diagnosed on weekdays (52% vs. 47%; p <0.001). Most patients in both groups received initial therapy with low-molecular-weight heparin (90% and 91%, respectively; p=0.01), then switched to vitamin K antagonists (72% and 71%, respectively; p=0.007). The 7-day mortality rate in patients presenting with PE was 2.75% in those diagnosed on weekends versus 3.00% in those diagnosed on weekdays (p=0.49). At 30 days, the mortality rate was 6.51% versus 6.06%, respectively (p=0.38). In patients presenting with deep vein thrombosis alone, the 7-day mortality rate in those diagnosed on weekends was 1.04% versuss 0.66% in those diagnosed on weekdays (p=0.053). The mortality rate at 30 days was of 3.41% versus 2.88% (p=0.14), respectively. In RIETE, the clinical characteristics, treatment strategies, and 7– and 30-day mortality rates of patients diagnosed on weekends were similar to those in patients diagnosed on weekdays.
* A full list of RIETE investigators is given in the Appendix.
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References
- 1 Konstantinides S. Acute pulmonary embolism. N Engl J Med 2008; 359: 2804-2813.
- 2 Baglin T. What happens after venous thromboembolism?. J Thromb Haemost 2009; 07 (Suppl. 01) 287-290.
- 3 Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med 2001; 345: 663-668.
- 4 Aujesky D, Jiménez D, Mor MK. et al. Weekend versus weekday admission and mortality after acute pulmonary embolism. Circulation 2009; 119: 962-968.
- 5 Monreal M, Falgá C, Valle R. et al. Venous thromboembolism in patients with renal insufficiency. Findings from the RIETE Registry. Am J Med 2006; 119: 1073-1079.
- 6 Blanco-Molina A, Trujillo-Santos J, Tirado R. et al. RIETE Investigators.. Venous thromboembolism in women using hormonal contraceptives. Findings from the RIETE Registry. Thromb Haemost 2009; 101: 478-482.
- 7 Vasco B, Villalba JC, López-Jiménez L. et al. for the RIETE Investigators.. Venous thromboembolism in nonagenarians. Findings from the RIETE Registry. Thromb Haemost 2009; 1112-1118.
- 8 Laporte S, Mismetti P, Décousus H. et al. Clinical predictors for fatal pulmonary embolism in 15520 patients with venous thromboembolism: Findings from the Registro Informatizado de la Enfermedad TromboEmbólica venosa (RIETE) Registry. Circulation 2008; 117: 1711-1716.
- 9 Redelmeier DA, Bell CM. Weekend worries. N Engl J Med 2007; 356: 1164-1165.
- 10 Kostis WJ, Demissie K, Marcella SW. et al. for the Myocardial Infarction Data Acquisition System (MIDAS 10) Study Group. Weekend versus weekday admission and mortality from myocardial infarction. N Engl J Med 2007; 356: 1099-1109.
- 11 Saposnik G, Baibergenova A, Bayer N. et al. Weekends: a dangerous time for having a stroke?. Stroke 2007; 38: 1211-1215.
- 12 Fonarow GC, Abraham WT, Albert NM. et al. Day of admission and clinical outcomes for patients hospitalizaed for heart failure: findings from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF). Circ Heart Fail 2008; 01: 50-57.
- 13 Wilop S, Galm O, Thompson L. et al. Friday Leukemia: myth or reality?. Blood 2010; 115: 912.
- 14 Wunsch H, Mapstone J, Brady T. et al. Hospital mortality associated with day and time of admission to intensive care units. Intensive Care Med 2004; 30: 895-901.
- 15 Dabbagh O, Adams L, Haddadin S. et al. Effect of time of admission on compliance with deep vein thrombosis prophylaxis in a tertiary medical intensive care unit. J Thromb Haemost 2009; 07: 950-954.
- 16 Marco J, Barba R, Plaza S. et al. Analysis of the mortality of patients admitted to Internal Medicine wards over the weekend. Am J Med Qual 2010; 25: 312-318.
- 17 Barba R, Losa JE, Velasco M. et al. Mortality among adult patients admitted to the hospital on weekends. Eur J Intern Med 2006; 17: 322-324.
- 18 Spencer FA, Emery C, Joffe SW. et al. Incidence rates, clinical profile, and outcomes of patients with venous thromboembolism. The Worcester VTE study. J Thromb Thrombolysis 2009; 28: 401-409.
- 19 Van Dongen CJ, Van den Belt AG, Prins MH. et al. Fixed dose subcutaneous low molecular weight heparin versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst Rev 2004; 18: CD001100.
- 20 Gómez-Outes A, Lecumberri R, Lafuente-Guijosa A. et al. Correlation between thrombus regression and recurrent venous thromboembolism. Examining veno-graphic and clinical effects of low molecular weight heparins: a meta-analysis. J Thromb Haemost 2004; 02: 1581-1587.
- 21 Conget F, Otero R, Jiménez D. et al. Short-term clinical outcome after acute symptomatic pulmonary embolism. Thromb Haemost 2008; 100: 937-942.
- 22 Spencer FA, Goldberg RJ, Lessard D. et al. Factors associated with adverse outcomes in outpatients presenting with pulmonary embolism: the Worcester Venous Thromboembolism Study. Circ Cardiovasc Qual Outcomes 2010; 03: 390-394.
- 23 Sevestre MA, Quashié C, Genty C. et al. for the Optimev Study Investigators. Clinical presentation and mortality in pulmonary embolism: The Optimev study. J Mal Vasc 2010; 35: 242-249.
- 24 Erkens PM, Gandara E, Wells P. et al. Safety of outpatient treatment in acute pulmonary embolism. J Thromb Haemost. 2010 Epub ahead of print.
- 25 Park B, Messina L, Dargon P. et al. Recent trends in clinical outcomes and resource utilization for pulmonary embolism in the United Sates. Findings from the Nationwide Inpatient Sample. Chest 2009; 136: 983-990.
- 26 Donzé J, Le Gal G, Fine MJ. et al. Prospective validation of the Pulmonary Embolism Severity Index. A clinical prognostic model for pulmonary embolism. Thromb Haemost 2008; 100: 943-948.