The Impact of Pulmonary Vascular Obstruction on the Risk of Recurrence of Pulmonary Embolism: A French Prospective Cohort.
Adult
Aged
Angiography
Anticoagulants
/ pharmacology
Cohort Studies
Female
Follow-Up Studies
France
Humans
Male
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Prospective Studies
Pulmonary Embolism
/ complications
Recurrence
Risk Factors
Treatment Outcome
Venous Thromboembolism
/ complications
Journal
Thrombosis and haemostasis
ISSN: 2567-689X
Titre abrégé: Thromb Haemost
Pays: Germany
ID NLM: 7608063
Informations de publication
Date de publication:
Jul 2021
Jul 2021
Historique:
pubmed:
21
1
2021
medline:
22
12
2021
entrez:
20
1
2021
Statut:
ppublish
Résumé
We aimed to assess whether high pulmonary vascular obstruction index (PVOI) measured at the time of pulmonary embolism (PE) diagnosis is associated with an increased risk of recurrent venous thromboembolism (VTE). French prospective cohort of patients with a symptomatic episode of PE diagnosed with spiral computerized tomography pulmonary angiography (CTPA) or ventilation-perfusion (V/Q) lung scan and a follow-up of at least 6 months after anticoagulation discontinuation. PVOI was assessed based on the available diagnostic exam (V/Q lung scan or CTPA). All patients had standardized follow-up and independent clinicians adjudicated all deaths and recurrent VTE events. Main outcome was recurrent VTE after stopping anticoagulation. A total of 418 patients with PE were included. During a median follow-up period of 3.6 (1.2-6.0) years, 109 recurrences occurred. In multivariate analysis, PVOI ≥ 40% was an independent risk factor for recurrence (hazard ratio 1.77, 95% confidence interval 1.20-2.62, PVOI ≥ 40% at PE diagnosis was an independent risk factor for recurrence VTE. Further prospective validation studies are needed.
Sections du résumé
BACKGROUND
BACKGROUND
We aimed to assess whether high pulmonary vascular obstruction index (PVOI) measured at the time of pulmonary embolism (PE) diagnosis is associated with an increased risk of recurrent venous thromboembolism (VTE).
STUDY DESIGN AND METHODS
METHODS
French prospective cohort of patients with a symptomatic episode of PE diagnosed with spiral computerized tomography pulmonary angiography (CTPA) or ventilation-perfusion (V/Q) lung scan and a follow-up of at least 6 months after anticoagulation discontinuation. PVOI was assessed based on the available diagnostic exam (V/Q lung scan or CTPA). All patients had standardized follow-up and independent clinicians adjudicated all deaths and recurrent VTE events. Main outcome was recurrent VTE after stopping anticoagulation.
RESULTS
RESULTS
A total of 418 patients with PE were included. During a median follow-up period of 3.6 (1.2-6.0) years, 109 recurrences occurred. In multivariate analysis, PVOI ≥ 40% was an independent risk factor for recurrence (hazard ratio 1.77, 95% confidence interval 1.20-2.62,
CONCLUSION
CONCLUSIONS
PVOI ≥ 40% at PE diagnosis was an independent risk factor for recurrence VTE. Further prospective validation studies are needed.
Identifiants
pubmed: 33469906
doi: 10.1055/s-0040-1722190
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
955-963Informations de copyright
Thieme. All rights reserved.
Déclaration de conflit d'intérêts
F.C. reports having received research grant support from Pfizer and fees for board memberships or symposia from Bayer and Astra Zeneca and having received travel support from Bayer, Daiichi Sankyo, Leo Pharma, Intermune, and Actelion. C.O. declares he has no conflict of interest related to this research. C.T. declares she has no conflict of interest related to this research. P.R. declares he has no conflict of interest related to this research. R.L.M. declares he has no conflict of interest related to this research. P.-Y.L.R. declares he has no conflict of interest related to this research. P.-Y.S. declares he has no conflict of interest related to this research. C.H. declares he has no conflict of interest related to this research. L.B. declares he has no conflict of interest related to this research. P.-Y.L.F. declares he has no conflict of interest related to this research. M.N. declares he has no conflict of interest related to this research. M.G. declares she has no conflict of interest related to this research. E.P. declares she has no conflict of interest related to this research. C.A.L. declares she has no conflict of interest related to this research. K.L. reports having received personal fees from Bayer-Health Care, Bristol-Myers Squibb, and Boehringer Ingelheim. C.L. reports having received research grant support from Pfizer and fees for board memberships or symposia from Bayer and Astra Zeneca and having received travel support from Bayer, Daiichi Sankyo, Leo Pharma, Intermune, and Actelion. No other potential conflict of interest relevant to this article was reported.