Your browser doesn't support javascript.
loading
Quality of initial anticoagulant treatment and risk of CTEPH after acute pulmonary embolism.
Boon, Gudula J A M; van Rein, Nienke; Bogaard, Harm Jan; Ende-Verhaar, Yvonne M; Huisman, Menno V; Kroft, Lucia J M; van der Meer, Felix J M; Meijboom, Lilian J; Symersky, Petr; Vonk Noordegraaf, Anton; Klok, Frederikus A.
Afiliación
  • Boon GJAM; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
  • van Rein N; Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands.
  • Bogaard HJ; Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
  • Ende-Verhaar YM; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
  • Huisman MV; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
  • Kroft LJM; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
  • van der Meer FJM; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
  • Meijboom LJ; Department of Radiology and Nuclear medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
  • Symersky P; Department of Cardiac Surgery, VU University Medical Center, Amsterdam, The Netherlands.
  • Vonk Noordegraaf A; Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
  • Klok FA; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
PLoS One ; 15(4): e0232354, 2020.
Article en En | MEDLINE | ID: mdl-32343741
BACKGROUND: The pathophysiology of chronic thromboembolic pulmonary hypertension (CTEPH) is not fully understood. Poor-quality anticoagulation may contribute to a higher risk of CTEPH after acute pulmonary embolism (PE), partly explaining the transition from acute PE to CTEPH. We assessed the association between the time in therapeutic range (TTR) of vitamin-K antagonist (VKA) treatment and incidence of CTEPH after a PE diagnosis. METHODS: Case-control study in which the time spent in, under and above therapeutic range was calculated in 44 PE patients who were subsequently diagnosed with CTEPH (cases). Controls comprised 150 consecutive PE patients in whom echocardiograms two years later did not show pulmonary hypertension. All patients were treated with VKA for at least 6 months after the PE diagnosis. Time in (TTR), under and above range were calculated. Mean differences between cases and controls were estimated by linear regression. RESULTS: Mean TTR during the initial 6-month treatment period was 72% in cases versus 78% in controls (mean difference -6%, 95%CI -12 to -0.1), mainly explained by more time above the therapeutic range in the cases. Mean difference of time under range was 0% (95%CI -6 to 7) and 2% (95CI% -3 to 7) during the first 3 and 6 months, respectively. In a multivariable model, adjusted odds ratios (ORs) for CTEPH were around unity considering different thresholds for 'poor anticoagulation', i.e. TTR <50%, <60% and <70%. CONCLUSION: Subtherapeutic initial anticoagulation was not more prevalent among PE patients diagnosed with CTEPH than in those who did not develop CTEPH.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Embolia Pulmonar / Hipertensión Pulmonar / Anticoagulantes Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: PLoS One Asunto de la revista: CIENCIA / MEDICINA Año: 2020 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Embolia Pulmonar / Hipertensión Pulmonar / Anticoagulantes Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: PLoS One Asunto de la revista: CIENCIA / MEDICINA Año: 2020 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Estados Unidos