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Short-term clinical outcome after acute symptomatic pulmonary embolismFinancial support: D. Jiménez, R. Otero, F . Uresandi, D. Nauffal, C. Rodríguez, F . Conget, M.Oribe, and MA Cabezudo are investigators in the “Cooperative study for the ambulatory treatment of patients with pulmonary embolism” research study group.
03 February 2008
Accepted after major revision 09 August 2008
22 November 2017 (online)
Though studies have identified clinical variables that predict adverse events in patients with acute pulmonary embolism (PE), they have typically not differentiated short-term from long-term predictors.This multicenter prospective cohort study included consecutive outpatients with objectively confirmed symptomatic acute PE.We analyzed the incidence and time course of death, venous thromboembolism (VTE) recurrence, and major bleeding, and we compared event rates during short-term (first week) and long-term (3 months) follow-up after the diagnosis of PE.We also assessed risk factors for short-term mortality. During the first three months after diagnosis of PE, 142 of 1,338 (10.6%) patients died.Thirty-six deaths (2.7%) occurred during the first week after diagnosis of PE,and 61.1% of these were due to PE.Thirty-eight patients (2.8%) had recurrent VTE during the three-month follow-up, though none of the recurrences occurred during the first week after diagnosis of PE. During the three-month follow-up, major bleeding occurred in 48 patients (3.6%). Twenty-one (1.6%) major bleeds occurred during the first week of follow-up,and nine of these were fatal. Short-term mortality was significantly increased in patients who initially presented with systolic arterial hypotension (odds ratio [OR] 3.35; 95% CI, 1.51-5.41) or immobilization due to a medical illness (OR 2.89; 95% confidence interval [CI], 1.31-6.39).In con-clusion,during the first week after the diagnosis of PE, death and major bleeding occur more frequently than recurrent VTE. Patients with systolic arterial hypotension and immobilization at the time of PE diagnosis had an increased isk of short-term mortality.
- 1 Levine M, Gent M, Hirsh J. et al. A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deepvein thrombosis. N Engl J Med 1996; 334: 677-681.
- 2 Koopman M, Prandoni P, Piovella F. et al. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. N Engl J Med 1996; 334: 682-687.
- 3 The Columbus Investigators. Low-molecular-weight heparin in the treatment of patients with venous thromboembolism. N EnglJ Med 1997; 337: 657-662.
- 4 Büller HR, Davidson BL, Decousus H. et al. Subcutaneous fondaparinux versus intravenous unfractionated heparin in the initial treatment of pulmonary embolism. N Engl J Med 2003; 349: 1695-1702.
- 5 Wells PS, Kovacs MJ, Bormanis J. et al. Expanding eligibility for outpatient treatment of deep venous thrombosis and pulmonary embolism with low-molecular-weight heparin. Arch Intern Med 1998; 158: 1809-1812.
- 6 Kovacs MJ, Anderson D, Morrow B. et al. Outpatients treatment of pulmonary embolism with dalte-parin. Thromb Haemost 2000; 83: 209-211.
- 7 Davies CWH, Wimperis J, Green ES. et al. Early discharge of patients with pulmonary embolism: a two-phase observational study. Eur Respir J 2007; 30: 708-714.
- 8 Wicki J, Perrier A, Perneger TV. et al. Predicting adverse outcome in patients with acute pulmonary embol-ism:A risk score. Thromb Haemost 2000; 84: 548-552.
- 9 Nendaz MR, Bandelier P, Aujesky D. et al. Validation of a risk score identifying patients with acute pulmonary embolism, who are at low risk of clinical adverse outcome. Thromb Haemost 2004; 91: 1232-1236.
- 10 Aujesky D, Obrosky DS, Stone RA. et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med 2005; 172: 1041-1046.
- 11 Aujesky D, Roy PM, Le Manach CP. et al. Validation of a model to predict adverse outcomes in patients with pulmonary embolism. Eur Heart J 2006; 27: 476-481.
- 12 Jiménez D, Yusen R, Otero R. et al. Prognostic models for selecting patients with acute pulmonary embolism for initial outpatient treatment. Chest 2007; 132: 24-30.
- 13 Jiménez D, Yusen RD. Prognostic models for selecting patients with acute pulmonary embolism for initial outpatient treatment. Curr Opin Pulm Med 2008; 14: 414-421.
- 14 PIOPED investigators. Value of ventilation/perfusion scan in acute pulmonary embolism: results of the prospective investigation of the pulmonary embolism diagnosis (PIOPED). J Am Med Assoc 1990; 263: 2753-2759.
- 15 Turkstra F, Kiujer PM, van Beek E. et al. Diagnostic utility of ultrasonography of leg veins in patients suspected of having pulmonary embolism. Ann Intern Med 1997; 126: 775-781.
- 16 Remy-Jardin M, Remy J, Wattinne L. et al. Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with the single-breath-hold-technique-comparison with pulmonary angiography. Radiology 1992; 185: 381-387.
- 17 Prandoni P, Cogo A, Bernardi E. et al. A simple approach for detection of recurrent proximal vein thrombosis. Circulation 1993; 88: 1730-1735.
- 18 Konstantinides S, Geibel A, Olschewsky M. et al. Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism: results of multicenter registry. Circulation 1997; 96: 882-888.
- 19 Kasper W, Konstantinides S, Geibel A. et al. Prognostic significance of right ventricular afterload stress detected by echocardiography in patients with clinically suspected pulmonary embolism. Heart 1997; 77: 346-349.
- 20 Grifoni S, Olivotto I, Cecchini P. et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation 2000; 101: 2817-2822.
- 21 Aujesky D, Smith KJ, Cornuz J. et al. Cost-effectiveness of low-molecular-weight heparin for treatment of pulmonary embolism. Chest 2005; 128: 1601-1610.
- 22 Nijkeuter M, Söhne M, Tick LW. et al. The natural course of hemodynamically stable pulmonary embolism. Chest 2007; 131: 517-523.
- 23 Douketis J, Foster GA, Crowther M. et al. Clinical risk factors and timing of recurrent venous throm-boembolism during the initial 3 months of anticoagulant therapy. Arch Intern Med 2000; 160: 3431-3436.
- 24 Urokinase Pulmonary Embolism Trial. Phase I results: a cooperative study. J Am Med Assoc 1970; 214: 2163-2172.
- 25 Alpert JS, Smith R, Carlson J. et al. Mortality in patients treated for pulmonary embolism. J Am Med Assoc 1976; 236: 1477-1480.
- 26 Goldhaber SZ, Visana L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999; 353: 1386-1389.
- 27 Prandoni P, Lensing AW, Cogo A. et al. The long-term clinical course of acute deep vein thrombosis. An Intern Med 1996; 125: 1-7.
- 28 Carson JL, Kelley MA, Duff A. et al. The clinical course of pulmonary embolism. N Engl J Med 1992; 326: 1240-1245.
- 29 Cushman M, Heckbert SR, White RH. et al. Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. Am J Med 2004; 117: 19-25.
- 30 Jiménez D, Díaz G, Molina J. et al. Troponin I and risk stratification of patients with acute non massive pulmonary embolism. Eur Respir J 2008; 31: 847-853.