Adverse Events and Mortality in Anticoagulated Patients with Different Categories of Pulmonary Embolism
Objective: To determine whether the pulmonary embolism (PE) categories of massive, submassive, PE with no right ventricle dysfunction (NRVD), and subsegmental only (SSO) adequately predict clinical outcome. Methods: Patients treated for acute PE (March 1, 2013, through July 31, 2019) were followed f...
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doaj-dab7e8793ec249b39eb77831092641ec2020-11-25T03:14:59ZengElsevierMayo Clinic Proceedings: Innovations, Quality & Outcomes2542-45482020-06-0143249258Adverse Events and Mortality in Anticoagulated Patients with Different Categories of Pulmonary EmbolismJulia C. Cambron, BS0Elias S. Saba, BS1Robert D. McBane, MD2Ana I. Casanegra, MD3Hector R. Villarraga, MD4Damon E. Houghton, MD5Danielle T. Vlazny, PA-C, MS6David Froehling, MD7David Hodge, MS8Lisa G. Peterson, MAN, RN9Dalene M. Bott-Kitslaar, APRN, CNP10Waldemar E. Wysokinski, MD, PhD11Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MNMayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MNDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MNDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MNDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MNDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MNDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MNDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MNDepartment of Health Sciences Research, Mayo Clinic, Jacksonville, FLDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MNDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MNDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Correspondence: Address to Waldemar E. Wysokinski, MD, Gonda Vascular Center, Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905.Objective: To determine whether the pulmonary embolism (PE) categories of massive, submassive, PE with no right ventricle dysfunction (NRVD), and subsegmental only (SSO) adequately predict clinical outcome. Methods: Patients treated for acute PE (March 1, 2013, through July 31, 2019) were followed forward prospectively to compare venous thromboembolism (VTE) recurrence, all-cause mortality, major bleeding, and clinically relevant nonmajor bleeding (CRNMB) across 4 PE categories. Results: Of 2703 patients with VTE, 1188 (44%) had PE, of which 1021 (85.9%) completed at least 3 months of therapy or had clinical outcomes precluding further treatment (27 with massive, 217 submassive, 557 NRVD, and 220 SSO PE). One patient with massive, 8 with submassive, 23 with NRVD, and 5 with SSO PE had recurrent VTE (3.90, 5.33, 5.36, and 3.66 per 100 person-years, respectively; P=.84). There were 3 deaths in massive, 27 in submassive, 140 in NRVD, and 34 in SSO PE groups (11.59, 17.37, 31.74, and 24.74 per 100 person-years, respectively; P=.02); when adjusted for cancer, the relationship was no longer significant (P=.27). One patient with massive, 5 with submassive, 22 with NRVD, and 5 with SSO PE had major bleeding (3.90, 3.31, 5.24, and 3.75 per 100 person-years, respectively; P=.66). Similar cumulative rates for CRNMB were observed (P=.87). Three-month rates of VTE recurrence, death, major bleeding, and CRNMB did not differ by PE category. Conclusion: In the setting of anticoagulation therapy with maximal standardization and evidence-based practice, there is no evidence of a difference between PE categories and outcomes. Trial Registration: clinicaltrials.gov Identifier: NCT03504007http://www.sciencedirect.com/science/article/pii/S2542454820300436 |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Julia C. Cambron, BS Elias S. Saba, BS Robert D. McBane, MD Ana I. Casanegra, MD Hector R. Villarraga, MD Damon E. Houghton, MD Danielle T. Vlazny, PA-C, MS David Froehling, MD David Hodge, MS Lisa G. Peterson, MAN, RN Dalene M. Bott-Kitslaar, APRN, CNP Waldemar E. Wysokinski, MD, PhD |
spellingShingle |
Julia C. Cambron, BS Elias S. Saba, BS Robert D. McBane, MD Ana I. Casanegra, MD Hector R. Villarraga, MD Damon E. Houghton, MD Danielle T. Vlazny, PA-C, MS David Froehling, MD David Hodge, MS Lisa G. Peterson, MAN, RN Dalene M. Bott-Kitslaar, APRN, CNP Waldemar E. Wysokinski, MD, PhD Adverse Events and Mortality in Anticoagulated Patients with Different Categories of Pulmonary Embolism Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
author_facet |
Julia C. Cambron, BS Elias S. Saba, BS Robert D. McBane, MD Ana I. Casanegra, MD Hector R. Villarraga, MD Damon E. Houghton, MD Danielle T. Vlazny, PA-C, MS David Froehling, MD David Hodge, MS Lisa G. Peterson, MAN, RN Dalene M. Bott-Kitslaar, APRN, CNP Waldemar E. Wysokinski, MD, PhD |
author_sort |
Julia C. Cambron, BS |
title |
Adverse Events and Mortality in Anticoagulated Patients with Different Categories of Pulmonary Embolism |
title_short |
Adverse Events and Mortality in Anticoagulated Patients with Different Categories of Pulmonary Embolism |
title_full |
Adverse Events and Mortality in Anticoagulated Patients with Different Categories of Pulmonary Embolism |
title_fullStr |
Adverse Events and Mortality in Anticoagulated Patients with Different Categories of Pulmonary Embolism |
title_full_unstemmed |
Adverse Events and Mortality in Anticoagulated Patients with Different Categories of Pulmonary Embolism |
title_sort |
adverse events and mortality in anticoagulated patients with different categories of pulmonary embolism |
publisher |
Elsevier |
series |
Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
issn |
2542-4548 |
publishDate |
2020-06-01 |
description |
Objective: To determine whether the pulmonary embolism (PE) categories of massive, submassive, PE with no right ventricle dysfunction (NRVD), and subsegmental only (SSO) adequately predict clinical outcome. Methods: Patients treated for acute PE (March 1, 2013, through July 31, 2019) were followed forward prospectively to compare venous thromboembolism (VTE) recurrence, all-cause mortality, major bleeding, and clinically relevant nonmajor bleeding (CRNMB) across 4 PE categories. Results: Of 2703 patients with VTE, 1188 (44%) had PE, of which 1021 (85.9%) completed at least 3 months of therapy or had clinical outcomes precluding further treatment (27 with massive, 217 submassive, 557 NRVD, and 220 SSO PE). One patient with massive, 8 with submassive, 23 with NRVD, and 5 with SSO PE had recurrent VTE (3.90, 5.33, 5.36, and 3.66 per 100 person-years, respectively; P=.84). There were 3 deaths in massive, 27 in submassive, 140 in NRVD, and 34 in SSO PE groups (11.59, 17.37, 31.74, and 24.74 per 100 person-years, respectively; P=.02); when adjusted for cancer, the relationship was no longer significant (P=.27). One patient with massive, 5 with submassive, 22 with NRVD, and 5 with SSO PE had major bleeding (3.90, 3.31, 5.24, and 3.75 per 100 person-years, respectively; P=.66). Similar cumulative rates for CRNMB were observed (P=.87). Three-month rates of VTE recurrence, death, major bleeding, and CRNMB did not differ by PE category. Conclusion: In the setting of anticoagulation therapy with maximal standardization and evidence-based practice, there is no evidence of a difference between PE categories and outcomes. Trial Registration: clinicaltrials.gov Identifier: NCT03504007 |
url |
http://www.sciencedirect.com/science/article/pii/S2542454820300436 |
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