Thirty-day outcomes in patients with acute pulmonary embolism who discontinued anticoagulant therapy before 90 days
Por:
Nieto, JA, Vicente, JA, Prieto, LM, Jimenez, D, Bikdeli, B, Rivas, A, Parras, JA, Morales, MD, Bosevski, M and Monreal, M
Publicada:
1 dic 2018
Categoría:
Cardiology and cardiovascular medicine
Resumen:
Background The contemporary natural history of patients with acute pulmonary embolism (PE) not receiving (or early discontinuing) anticoagulant therapy has not been consistently evaluated.
Objective To assess the rate of the composite outcome of PE-related death, sudden death, or recurrent thromboembolism (VTE) within 30 days in all PE patients in whom anticoagulation was not administered or discontinued prematurely (< 90 days of anticoagulation).
Methods We used the RIETE database to assess the incidence rates (per 100 person-days) of the composite outcome within the subsequent 30 days. The risk of these events was compared to PE patients who were anticoagulated for >= 90 days.
Results Of 34,447 PE recruited from 2001 to 2017, 47 (0.14%) did not receive anticoagulants and 1348 (3.91%) discontinued it before 90 days. Fatal PE developed in 25 (53%) of those without any anticoagulation and in 45 (3.33%) with premature discontinuations. Sudden death or non-fatal recurrent VTE occurred in 6 (0.45%) and 24 (1.48%) patients, respectively. The incidence of the primary outcome declined logarithmically from 6.36 per 100 patient-days in untreated patients to 0.32-0.13 in those treated for 8-90 days. During the first week of follow-up, the incidence rate was 13.9 and 0.60-0.31 per 100 patient-days, respectively. The adjusted odds of the primary outcome was 27 fold higher in untreated than in treated patients, and progressively decreased to 2.5-7 fold higher in patients treated for at least 7 days.
Conclusion The incidence of the composite outcome was highest during the first week, and inversely and logarithmically correlated with the duration of anticoagulant therapy.
Filiaciones:
Nieto, JA:
Hosp Virgen de la Luz, Dept Internal Med, Cuenca, Spain
Vicente, JA:
Hosp Virgen de la Luz, Dept Internal Med, Cuenca, Spain
Prieto, LM:
Hosp Virgen de la Luz, Dept Internal Med, Cuenca, Spain
Jimenez, D:
Hosp Ramon & Cajal, Resp Dept, Madrid, Spain
Univ Alcala IRYCIS, Med Dept, Madrid, Spain
Bikdeli, B:
Columbia Univ, Med Ctr, New York Presbyterian Hosp, New York, NY USA
CORE, New Haven, CT USA
Cardiovasc Res Fdn, New York, NY USA
Rivas, A:
Hosp Univ Araba, Dept Pneumonol, Alava, Spain
Parras, JA:
Hosp Univ Joan XXIII Tarragona, Dept Internal Med, Tarragona, Spain
Morales, MD:
Hosp Tajo, Dept Internal Med, Madrid, Spain
Bosevski, M:
Fac Med, Clin Ctr, Inst Cardiovasc Dis, Skopje, Macedonia
:
Univ Catolica Murcia, Dept Internal Med, Hosp Germans Trias & Pujol, Barcelona, Spain
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