Short-term clinical outcome after acute symptomatic pulmonary embolism

Francisco Conget; Remedios Otero; David Jiménez; David Martí; Carlos Escobar; Consolación Rodríguez; Fernando Uresandi; Miguel Angel Cabezudo; Dolores Nauffal; Mikel Oribe; Roger Yusen

doi:10.1160/TH08-02-0065

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2008; 100(05): 937-942
DOI: 10.1160/TH08-02-0065

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

Short-term clinical outcome after acute symptomatic pulmonary embolism

Authors

Francisco Conget

¹Department of Medicine, Psychiatry and Dermatology, Lozano Blesa Hospital and Zaragoza University, Zaragoza, Spain
Remedios Otero

²Respiratory Department, Virgen del Rocío Hospital, Sevilla, Spain
David Jiménez

³Respiratory Department, Ramón y Cajal Hospital, Madrid, Spain; Department of Medicine. Alcalá de Henares University
David Martí

³Respiratory Department, Ramón y Cajal Hospital, Madrid, Spain; Department of Medicine. Alcalá de Henares University
Carlos Escobar

³Respiratory Department, Ramón y Cajal Hospital, Madrid, Spain; Department of Medicine. Alcalá de Henares University
Consolación Rodríguez

²Respiratory Department, Virgen del Rocío Hospital, Sevilla, Spain
Fernando Uresandi

⁴Respiratory Department, Cruces Hospital, Bizkaia, Spain
Miguel Angel Cabezudo

⁵Respiratory Department, Oviedo Hospital, Oviedo, Spain
Dolores Nauffal

⁶Respiratory Department, La Fe Hospital, Valencia, Spain
Mikel Oribe

⁷Respiratory Department, Galdakao Hospital, Galdakao, Spain
Roger Yusen

⁸Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA

Abstract

Summary

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.

Keywords

Pulmonary embolism - prognosis - adverse events

Full Text

References

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