Is pulmonary embolism recurrence linked with the severity of the first event? A French retrospective cohort study
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ..
OBJECTIVES: Severity of a first pulmonary embolism (PE) is sometimes proposed as a criterion for prolonging anticoagulant treatment. However, little evidence supports this idea. We attempted to determine the connection between severity of first PE and the risk of recurrence.
PARTICIPANTS: Patients admitted with PE between 2012 and 2018 and for whom anticoagulant treatment had been discontinued were followed. PEs were classified according to the severity into the following two groups: those with associated cardiac involvement (increased cardiac biomarker(s) and/or echocardiographic right ventricular dysfunction) and those with no cardiac involvement which were classified as non-severe. Recurrence-free survivals were estimated using the Kaplan-Meier method and compared using the log-rank test.
RESULTS: 417 patients with PEs (186 with cardiac involvement) were followed for at least 1 year after discontinuation of treatment with a mean follow-up of: 3.5±1.9 years. 72 patients (17.3%) experienced venous thromboembolism recurrence: 24 (5.8%), 44 (12 %) and 72 (28.3 %) respectively, at 1, 2 and 5 years. In 63 patients (88%), recurrence was a PE. Mean time to onset of recurrence was 24.9±19.9 months. At 5 years, the recurrence rate is higher when the first PE was associated with cardiac involvement p=0.043. In contrast, in patients with provoked PE, the recurrence rate is higher when the first PE event was associated with cardiac involvement: p=0.032. Multivariate analysis demonstrates that PE severity is an independent factor of recurrence (HR 1.634 (1.015-2.632), p=0.043).
CONCLUSION: We report for the first time a possible link between a higher recurrence rate and the severity of the first PE. This result which must be confirmed in a dedicated prospective trial could become an important criterion for the duration of anticoagulant therapy after a PE.
TRIAL REGISTRATION NUMBER: NCT04980924.
Medienart: |
E-Artikel |
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Erscheinungsjahr: |
2021 |
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Erschienen: |
2021 |
Enthalten in: |
Zur Gesamtaufnahme - volume:11 |
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Enthalten in: |
BMJ open - 11(2021), 9 vom: 29. Sept., Seite e050910 |
Sprache: |
Englisch |
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Beteiligte Personen: |
Ferrari, Emile [VerfasserIn] |
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Links: |
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Themen: |
Adult cardiology |
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Anmerkungen: |
Date Completed 02.11.2021 Date Revised 02.11.2021 published: Electronic ClinicalTrials.gov: NCT04980924 Citation Status MEDLINE |
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doi: |
10.1136/bmjopen-2021-050910 |
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funding: |
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Förderinstitution / Projekttitel: |
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PPN (Katalog-ID): |
NLM331297558 |
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245 | 1 | 0 | |a Is pulmonary embolism recurrence linked with the severity of the first event? A French retrospective cohort study |
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520 | |a © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | ||
520 | |a OBJECTIVES: Severity of a first pulmonary embolism (PE) is sometimes proposed as a criterion for prolonging anticoagulant treatment. However, little evidence supports this idea. We attempted to determine the connection between severity of first PE and the risk of recurrence | ||
520 | |a PARTICIPANTS: Patients admitted with PE between 2012 and 2018 and for whom anticoagulant treatment had been discontinued were followed. PEs were classified according to the severity into the following two groups: those with associated cardiac involvement (increased cardiac biomarker(s) and/or echocardiographic right ventricular dysfunction) and those with no cardiac involvement which were classified as non-severe. Recurrence-free survivals were estimated using the Kaplan-Meier method and compared using the log-rank test | ||
520 | |a RESULTS: 417 patients with PEs (186 with cardiac involvement) were followed for at least 1 year after discontinuation of treatment with a mean follow-up of: 3.5±1.9 years. 72 patients (17.3%) experienced venous thromboembolism recurrence: 24 (5.8%), 44 (12 %) and 72 (28.3 %) respectively, at 1, 2 and 5 years. In 63 patients (88%), recurrence was a PE. Mean time to onset of recurrence was 24.9±19.9 months. At 5 years, the recurrence rate is higher when the first PE was associated with cardiac involvement p=0.043. In contrast, in patients with provoked PE, the recurrence rate is higher when the first PE event was associated with cardiac involvement: p=0.032. Multivariate analysis demonstrates that PE severity is an independent factor of recurrence (HR 1.634 (1.015-2.632), p=0.043) | ||
520 | |a CONCLUSION: We report for the first time a possible link between a higher recurrence rate and the severity of the first PE. This result which must be confirmed in a dedicated prospective trial could become an important criterion for the duration of anticoagulant therapy after a PE | ||
520 | |a TRIAL REGISTRATION NUMBER: NCT04980924 | ||
650 | 4 | |a Journal Article | |
650 | 4 | |a adult cardiology | |
650 | 4 | |a echocardiography | |
650 | 4 | |a thromboembolism | |
650 | 7 | |a Anticoagulants |2 NLM | |
700 | 1 | |a Fourrier, Etienne |e verfasserin |4 aut | |
700 | 1 | |a Asarisi, Florian |e verfasserin |4 aut | |
700 | 1 | |a Heme, Nathan |e verfasserin |4 aut | |
700 | 1 | |a Redjimi, Nassim |e verfasserin |4 aut | |
700 | 1 | |a Berkane, Nathalie |e verfasserin |4 aut | |
700 | 1 | |a Labbaoui, Mohamed |e verfasserin |4 aut | |
700 | 1 | |a Breittmayer, Jean Philippe |e verfasserin |4 aut | |
700 | 1 | |a Bun, Sok Sithikun |e verfasserin |4 aut | |
700 | 1 | |a Moceri, Pamela |e verfasserin |4 aut | |
700 | 1 | |a Squara, Fabien |e verfasserin |4 aut | |
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