RESUMO
This study generated evidence to guide anticoagulation in patients with VTE after vaccination for COVID-19. We provided data on the low recurrence rate after cessation of anticoagulant therapy and the findings for this study offer timely insights into the management of a potentially vaccine-related adverse event.
RESUMO
BACKGROUND: The natural history of patients with a pacemaker-related upper-extremity deep vein thrombosis (UEDVT) has not been consistently studied. METHODS: We used the RIETE registry data to compare the outcomes during anticoagulation and after its discontinuation in noncancer patients with symptomatic UEDVT associated with a pacemaker, other catheters, or no catheter. The major outcome was the composite of symptomatic pulmonary embolism or recurrent DVT. RESULTS: As of February 2022, 2578 patients with UEDVT were included: 156 had a pacemaker-related UEDVT, 557 had other catheters, and 1865 had no catheter. During anticoagulation, 61 patients (2.3%) developed recurrent VTE, 38 had major bleeding (1.4%), and 90 died (3.4%). After its discontinuation, 52 patients (4.4%) had recurrent acute venous thromboembolism (VTE) and six had major bleeding (0.5%). On multivariable analysis, there were no differences among subgroups in the rates of VTE recurrences or major bleeding during anticoagulation. After its discontinuation, patients with a pacemaker-related UEDVT had a higher risk for VTE recurrences than those with no catheter (adjusted OR: 4.59; 95% CI: 1.98-10.6). CONCLUSIONS: Patients with pacemaker-related UEDVT are at increased risk for VTE recurrences after discontinuing anticoagulation. If our findings are validated in adequately designed trials, this may justify changes in the current recommendations on the duration of anticoagulation.
Assuntos
Neoplasias , Embolia Pulmonar , Trombose Venosa Profunda de Membros Superiores , Tromboembolia Venosa , Trombose Venosa , Humanos , Tromboembolia Venosa/etiologia , Fatores de Risco , Trombose Venosa Profunda de Membros Superiores/diagnóstico por imagem , Trombose Venosa Profunda de Membros Superiores/etiologia , Trombose Venosa/diagnóstico , Trombose Venosa/tratamento farmacológico , Trombose Venosa/induzido quimicamente , Embolia Pulmonar/induzido quimicamente , Hemorragia/induzido quimicamente , Neoplasias/complicações , Neoplasias/diagnóstico , Anticoagulantes/efeitos adversos , Recidiva , ExtremidadesAssuntos
Anemia Hemolítica Congênita/prevenção & controle , Autoanticorpos/sangue , Transfusão de Sangue Autóloga , Imunoglobulina G/sangue , Complicações Hematológicas na Gravidez/imunologia , Complicações Hematológicas na Gravidez/terapia , Adulto , População Negra , Feminino , Humanos , Gravidez , Complicações Hematológicas na Gravidez/etnologiaRESUMO
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