Factors Associated with Pulmonary Embolism Recurrence and the Benefits of Long-term Anticoagulant Therapy.
Cardiovasc Hematol Disord Drug Targets
; 17(3): 205-211, 2017.
Article
em En
| MEDLINE
| ID: mdl-28925904
ABSTRACT
BACKGROUND:
Venous thromboemboli tend to recur. However, the causative factors underlying pulmonary embolism recurrence are not well defined.AIMS:
To explore the factors associated with pulmonary embolism recurrence. PATIENTS ANDMETHODS:
Patients diagnosed with pulmonary emboli between 2004 and 2013 at our institution were enrolled. Duration of anticoagulant therapy, new episodes of venous thromboembolism, and deaths were recorded.RESULTS:
Pulmonary embolism was diagnosed in 528 patients (median age 76 years, interquartile range [IQR] 16; male 45%). The median follow-up time was 34 months (IQR 52). In total, 477 patients completed ≥3 months of anticoagulation therapy. Permanent anticoagulation was indicated in 217 (45%) patients, and therapy was discontinued in 260 (55%) patients. Overall, 79 patients experienced a recurrence (5.6 per patient-year). Recurrence was significantly associated with anticoagulation discontinuation (4% vs. 27% of patients who maintained or discontinued therapy, respectively; P<0.001; 95% confidence interval -0.95, -0.86). The median duration between anticoagulation withdrawal and recurrence was 6.5 months (IQR 23.25). Factors associated with recurrence were unprovoked pulmonary embolism (odds ratio [OR] 0.45), a greater degree of pulmonary arterial obstruction (OR 2.5), a delay in initiation of anticoagulation (OR 3), and higher plasma D-dimer levels during treatment (OR 2.3). Survival rates were improved for patients who maintained anticoagulation therapy relative to those who discontinued.CONCLUSION:
Pulmonary embolism has a high recurrence rate. Permanent anticoagulant therapy should be considered for patients with idiopathic pulmonary embolism, a high thrombotic burden, and persistently elevated D-dimer levels during treatment, and for patients where therapy was initially delayed.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Embolia Pulmonar
/
Anticoagulantes
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article