scholarly journals Right heart thrombi in pulmonary embolism

2016 ◽  
Vol 48 (5) ◽  
pp. 1377-1385 ◽  
Author(s):  
Deisy Barrios ◽  
Vladimir Rosa-Salazar ◽  
David Jiménez ◽  
Raquel Morillo ◽  
Alfonso Muriel ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Major Bleeding ◽  
Prognostic Significance ◽  
Right Heart ◽  
Younger Age ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Oxyhaemoglobin Saturation ◽  
Related Mortality

There is a lack of comprehensive data on the prevalence, predictors and prognostic significance of right heart thrombi (RHT) in pulmonary embolism.In this study of patients with pulmonary embolism from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry, we assessed the prevalence and predictors of RHT, and the association between the presence of RHT and the outcomes of all-cause mortality, pulmonary embolism-related mortality, recurrences, and major bleeding through 30 days after initiation of pulmonary embolism treatment.Of 12 441 patients with pulmonary embolism and baseline echocardiographic data, 2.6% had RHT. The following increased the risk of RHT: younger age, previous bleeding, congestive heart failure, cancer, syncope, systolic blood pressure <100 mmHg, and arterial oxyhaemoglobin saturation <90%. Patients with RHT were significantly more likely to die from any cause (adjusted OR 2.50 (95% CI 1.62–3.84); p<0.001) and from pulmonary embolism (adjusted OR 4.29 (95% CI 2.45–7.48); p<0.001) during follow-up. RHT was associated with an increased risk of recurrence during follow-up (1.8% versus 0.7%; p=0.04). Major bleeding was similar in patients with and without RHT.In patients presenting with pulmonary embolism, RHT is relatively infrequent. Patients with RHT had a worse outcome when compared with those without RHT.

scholarly journals Management appropriateness and outcomes of patients with acute pulmonary embolism

2018 ◽  
Vol 51 (5) ◽  
pp. 1800445 ◽  
Author(s):  
David Jiménez ◽  
Behnood Bikdeli ◽  
Deisy Barrios ◽  
Raquel Morillo ◽  
Rosa Nieto ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Major Bleeding ◽  
Acute Pulmonary Embolism ◽  
External Validation ◽  
Vena Cava ◽  
Vena Cava Filters ◽  
All Cause Mortality ◽  
The Impact ◽  
Related Mortality

The impact of adherence to published guidelines on the outcomes of patients with acute pulmonary embolism (PE) has not been well defined by previous studies.In this prospective cohort study of patients admitted to a respiratory department (n=2096), we evaluated whether patients with PE had better outcomes if they were acutely managed according to international guidelines. Outcomes consisted of all-cause mortality, PE-related mortality, recurrent venous thromboembolism (VTE) and major bleeding events during the first month of follow-up after diagnosis.Overall, 408 patients (19% (95% CI 18–21%)) did not receive guideline-adherent PE management. Patients receiving non-adherent management were significantly more likely to experience all-cause mortality (adjusted odds ratio (OR) 2.39 (95% CI 1.57–3.61) or PE-related mortality (adjusted OR 5.02 (95% CI 2.42–10.42); p<0.001) during follow-up. Non-adherent management was also a significant independent predictor of recurrent VTE (OR 2.19 (95% CI 1.11–4.32); p=0.03) and major bleeding (OR 2.65 (95% CI 1.66–4.24); p<0.001). An external validation cohort of 34 380 patients with PE from the RIETE registry confirmed these findings.PE management that does not adhere to guidelines for indications related to anticoagulation, thrombolytics and inferior vena cava filters is associated with worse patient outcomes.

Clinical characteristics and 3-month outcomes in cancer patients with incidental versus clinically-suspected and confirmed pulmonary embolism

2020 ◽  
pp. 2002723
Author(s):  
Marisa Peris ◽  
Juan J. López-Nuñez ◽  
Ana Maestre ◽  
David Jimenez ◽  
Alfonso Muriel ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Mortality Rate ◽  
Cancer Patients ◽  
Major Bleeding ◽  
Management Strategies ◽  
Multivariable Analysis ◽  
Heparin Therapy ◽  
Incidental Pulmonary Embolism ◽  
All Cause Mortality ◽  
Related Mortality

BackgroundCurrent guidelines suggest treating cancer patients with incidental pulmonary embolism (PE) similar to those with clinically-suspected and confirmed PE. However, the natural history of these presentations has not been thoroughly compared.MethodsWe used the data from the RIETE registry to compare the 3-month outcomes in patients with active cancer and incidental PE versus those with clinically-suspected and confirmed PE. The primary outcome was 90-day all-cause mortality. Secondary outcomes were PE-related mortality, symptomatic PE recurrences and major bleeding.ResultsFrom July 2012 to January 2019, 946 cancer patients with incidental asymptomatic PE and 2274 with clinically-suspected and confirmed PE were enrolled. Most patients (95% versus 90%) received low-molecular-weight heparin therapy. During the first 90 days, 598 patients died, including 42 from PE. Patients with incidental PE had a lower all-cause mortality rate than those with suspected and confirmed PE (11% versus 22%; odds ratio [OR]: 0.43; 95%CI: 0.34–0.54). Results were consistent for PE-related mortality (0.3% versus 1.7%; OR: 0.18; 95% CI: 0.06–0.59). Multivariable analysis confirmed that patients with incidental PE were at lower risk to die (adjusted OR: 0.43; 95%CI: 0.34–0.56). Overall, 29 patients (0.9%) developed symptomatic PE recurrences, and 122 (3.8%) had major bleeding. There were no significant differences in PE recurrences (OR: 0.62; 95%CI: 0.25–1.54) or major bleeding (OR: 0.78; 95%CI: 0.51–1.18).ConclusionsCancer patients with incidental PE had a lower mortality rate than those with clinically-suspected and confirmed PE. Further studies are required to validate these findings, and to explore optimal management strategies in these patients.

Long-term clinical outcomes after major bleeding in patients with atrial fibrillation: the Fushimi AF registry

2020 ◽  
Author(s):  
Hisashi Ogawa ◽  
Yoshimori An ◽  
Kenjiro Ishigami ◽  
Syuhei Ikeda ◽  
Kosuke Doi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischaemic Stroke ◽  
Clinical Outcomes ◽  
Major Bleeding ◽  
Bleeding Event ◽  
Community Based ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Aims Oral anticoagulants reduce the risk of ischaemic stroke but may increase the risk of major bleeding in atrial fibrillation (AF) patients. Little is known about the clinical outcomes of patients after a major bleeding event. This study assessed the outcomes of AF patients after major bleeding. Methods and results The Fushimi AF Registry is a community-based prospective survey of the AF patients in Fushimi-ku, Kyoto, Japan. Analyses were performed on 4304 AF patients registered by 81 institutions participating in the Fushimi AF Registry. We investigated the demographics and outcomes of AF patients who experienced major bleeding during follow-up period. During the median follow-up of 1307 days, major bleeding occurred in 297 patients (6.9%). Patients with major bleeding were older than those without (75.6 vs. 73.4 years; P &lt; 0.01). They were more likely to have pre-existing heart failure (33.7% vs. 26.7%; P &lt; 0.01), history of major bleeding (7.7% vs. 4.0%; P &lt; 0.01), and higher mean HAS-BLED score (2.05 vs.1.73; P &lt; 0.01). On landmark analysis, ischaemic stroke or systemic embolism occurred in 17 patients (3.6/100 person-years) after major bleeding and 227 patients (1.7/100 person-years) without major bleeding, with an adjusted hazard ratio (HR) of 1.93 [95% confidence interval (CI), 1.06–3.23; P = 0.03]. All-cause mortality occurred in 97 patients with major bleeding (20.0/100 person-years) and 709 (5.1/100 person-years) patients without major bleeding [HR 2.73 (95% CI, 2.16–3.41; P &lt; 0.01)]. Conclusion In this community-based cohort, major bleeding is associated with increased risk of subsequent all-cause mortality and thromboembolism in the long-term amongst AF patients. Trial registration https://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000005834. (last accessed 22 October 2020)

scholarly journals Outcome of patients with right heart thrombi: the Right Heart Thrombi European Registry

2016 ◽  
Vol 47 (3) ◽  
pp. 869-875 ◽  
Author(s):  
Marcin Koć ◽  
Maciej Kostrubiec ◽  
Waldemar Elikowski ◽  
Nicolas Meneveau ◽  
Mareike Lankeit ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Prognostic Significance ◽  
Multivariable Analysis ◽  
Right Ventricular Dysfunction ◽  
Severity Index ◽  
Control Group ◽  
Right Heart ◽  
End Point ◽  
The Right ◽  
Related Mortality

Our aim was the assessment of the prognostic significance of right heart thrombi (RiHT) and their characteristics in pulmonary embolism in relation to established prognostic factors.138 patients (69 females) aged (mean±sd) 62±19 years with RiHT were included into a multicenter registry. A control group of 276 patients without RiHT was created by propensity scoring from a cohort of 963 contemporary patients. The primary end-point was 30-day pulmonary embolism-related mortality; the secondary end-point included 30-day all-cause mortality. In RiHT patients, pulmonary embolism mortality was higher in 31 patients with systolic blood pressure <90 mmHg than in 107 normotensives (42% versus 12%, p=0.0002) and was higher in the 83 normotensives with right ventricular dysfunction (RVD) than in the 24 normotensives without RVD (16% versus 0%, p=0.038). In multivariable analysis the simplified Pulmonary Embolism Severity Index predicted mortality (hazard ratio 2.43, 95% CI 1.58–3.73; p<0.0001), while RiHT characteristics did not. Patients with RiHT had higher pulmonary embolism mortality than controls (19% versus 8%, p=0.003), especially normotensive patients with RVD (16% versus 7%, p=0.02).30-day mortality in patients with RiHT is related to haemodynamic consequences of pulmonary embolism and not to RiHT characteristics. However, patients with RiHT and pulmonary embolism resulting in RVD seem to have worse prognosis than propensity score-matched controls.

Personality disorders and cause-specific mortality: a nationwide study of 2 million adolescents

2020 ◽  
pp. 1-9
Author(s):  
Shmuel Tiosano ◽  
Lucian Laur ◽  
Amir Tirosh ◽  
Ariel Furer ◽  
Arnon Afek ◽  
...  
Keyword(s):  
Personality Disorders ◽  
Late Adolescence ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Israeli Army ◽  
Study Participants ◽  
Lifestyle Education ◽  
Related Mortality

Abstract Background Personality disorders are prevalent in 6–10% of the population, but their risk for cause-specific mortality is unclear. The aim of the study was to assess the association between personality disorders diagnosed in late adolescence and all-cause as well as cause-specific (cardiovascular-related, external-related) mortality. Methods We performed a longitudinal study on a historical prospective cohort based on nationwide screening prior to recruitment to the Israeli army. The study participants were 16–19-year-old persons who attended the army screening (medical and cognitive, including screening for psychiatric disorders) between 1967 and 2006. Participants were followed from 1967 till 2011. Results The study included 2 051 606 subjects, of whom 1 229 252 (59.9%) were men and 822 354 (40.1%) were women, mean age 17.36 years. There were 55 508 (4.5%) men and 8237 (1.0%) women diagnosed with personality disorders. The adjusted hazard ratio (HRs) for coronary, stroke, cardiovascular, external-related causes and all-cause mortality among men with personality disorders were 1.34 (1.03–1.74), 1.82 (1.20–2.76), 1.45 (1.23–1.71), 1.41 (1.30–1.53) and 1.44 (1.36–1.51), respectively. The absolute rate difference for all-cause mortality was 56.07 and 13.19 per 105 person-years among men and women, respectively. Among women with personality disorders, the adjusted HRs for external-related causes and all-cause mortality were 2.74 (1.87–4.00) and 2.01 (1.56–2.58). Associations were already evident within 10 years of follow-up. Conclusions Personality disorder in late adolescence is associated with increased risk of cardiovascular, external- and all-cause mortality. Increased cardiovascular mortality is evident before the age of 40 years and may point to the importance of lifestyle education already in youth.

Venous Thromboembolism in Patients with Liver Cirrhosis: Findings from the RIETE (Registro Informatizado de la Enfermedad TromboEmbolica) Registry

2019 ◽  
Vol 45 (08) ◽  
pp. 793-801 ◽  
Author(s):  
Behnood Bikdeli ◽  
David Jiménez ◽  
Guadalupe Garcia-Tsao ◽  
Raquel Barba ◽  
Carme Font ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Hazard Ratio ◽  
Risk Of Bleeding ◽  
Fatal Bleeding ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Recurrent Vte ◽  
One Year ◽  
Related Mortality

AbstractPatients with cirrhosis are not only at an increased risk of bleeding but also at risk of venous thromboembolism (VTE). We sought to determine the clinical characteristics, management, and outcomes after VTE in patients with cirrhosis. We used the data from RIETE (Registro Informatizado de la Enfermedad TromboEmbolica), an international registry of patients with VTE, to compare the outcomes in patients with and without cirrhosis. Main outcomes included all-cause mortality, pulmonary embolism (PE)-related mortality, recurrent VTE, and bleeding. Among 43,611 patients with acute VTE, 187 (0.4%) had cirrhosis. Of these, 184 (98.4%) received anticoagulation for a median of 109 days (interquartile range [IQR]: 43–201 days), most commonly with enoxaparin (median dose: 1.77 [IQR: 1.38–2.00] mg/kg/day). Compared with patients without cirrhosis, those with cirrhosis had a higher rate of all-cause mortality (10.7 vs. 3.4%; odds ratio [OR]: 3.41; 95% confidence interval [CI]: 2.03–5.46) and fatal bleeding (2.1 vs. 0.2%; OR: 13.94; 95% CI: 3.65–37.90) but similar rates of fatal PE (0.5 vs. 0.5%; OR: 1.17; 95% CI: 0.03–6.70). Patients with cirrhosis had a higher rate of all-cause mortality per 100 patient-years of follow-up (58.9 vs. 16.0; hazard ratio [HR]: 3.70; 95% CI: 2.69–4.91). One-year hazard ratio of clinically relevant bleeding (HR: 2.86; 95% CI: 1.91–4.27), fatal bleeding (HR: 8.51; 95% CI: 3.5–20.7), or recurrent VTE (HR: 2.08; 95% CI: 1.00–4.36) was higher in patients with cirrhosis. Cirrhosis is a challenging comorbidity in patients with VTE. Most patients were treated with anticoagulation and had an elevated risk of recurrence, similar risk of fatal PE, and a very high risk of bleeding including fatal bleeds.

scholarly journals Pulmonary embolism and acute psychosis, a case report of an outpatient with a mild course of COVID-19

2021 ◽  
Author(s):  
Nina Makivic ◽  
Claudia Stöllberger ◽  
Dominic Schauer ◽  
Laura Bernhofer ◽  
Erich Pawelka ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Case Report ◽  
Anticoagulant Therapy ◽  
Massive Pulmonary Embolism ◽  
Acute Psychosis ◽  
Healthy Patient ◽  
Right Heart ◽  
Case Presentation ◽  
Increased Risk

Abstract Introduction The increased risk for thromboembolism in hospitalized COVID-19 patients has been communicated extensively. The fact that home quarantined patients can develop pulmonary embolism, however, has so far not been reported. Furthermore, attention should be brought to psychotic developments in COVID-19 patients.Case Presentation We report a 46-year-old previously healthy patient with a mild course of COVID-19, who developed a massive pulmonary embolism with right heart strain while being home quarantined. He was hospitalized and anticoagulant therapy was started. Nine days after admission, the patient appeared increasingly psychotic and suffered from hallucinations as well as paranoid thoughts. After treatment with risperidone and valproate the patient’s condition improved. At a follow-up one month after discharge, he was completely recovered regarding the respiratory, cardiac and psychic situation.Conclusion SARS-CoV-2 infection cannot only increase the prevalence of thromboembolism in hospitalized patients, but also in outpatients. COVID-19 also increases the risk of developing psychiatric reactions.

Safety and efficacy of aspirin for primary prevention of cancer: A meta-analysis of randomized controlled trials.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1533-1533
Author(s):  
Tarek Haykal ◽  
Mahmoud Barbarawi ◽  
Yazan Zayed ◽  
Babikir Kheiri ◽  
Anitha Yelangi ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Major Bleeding ◽  
Cancer Incidence ◽  
Controlled Trials ◽  
Gi Bleeding ◽  
Randomized Controlled ◽  
All Cause Mortality ◽  
Prevention Of Cancer ◽  
Related Mortality

1533 Background: In the United States, cancer is the second leading cause of mortality, and millions more battle cancer worldwide. As such, primary prevention of cancer is a major interest globally. Aspirin has been studied as a primary prevention method for multiple diseases, mainly cardiovascular disease and various forms of cancer. The role of aspirin as a primary prevention of cancer is still controversial and may be more beneficial in certain cancers over others. With rapidly surfacing large randomized controlled trials (RCTs) studying this subject, we aimed to evaluate the efficacy and safety of aspirin as a primary prophylaxis for cancer. Methods: A comprehensive electronic database search was conducted for all RCTs that compared aspirin versus placebo for the prevention of any type of disease, and where cancer incidence or mortality was reported. The primary outcome was cancer-related mortality. Secondary outcomes were cancer incidence, all-cause mortality, major bleeding, any bleeding and gastrointestinal (GI) bleeding. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model at the longest follow-up period. Results: We included 16 RCTs with 104,018total patients, mean age of 60.51 years, mean follow-up of 5.48 years, and a male percentage of 38.72%. We found that aspirin was not associated with a significant reduction of cancer-related mortality compared with placebo (RR 0.99; 95% CI: 0.87-1.12; P = 0.85: I2= 41%). Compared with placebo, aspirin was not associated with significant reduction of all-cause mortality (RR 0.97; 95% CI: 0.92-1.02; P = 0.19; I2= 13%) or cancer incidence (RR: 0.98; 95% CI: 0.92-1.04; P = 0.43; I2= 16%). However, aspirin treatment was associated with significantly increased risks of any bleeding (RR 1.63; 95% CI: 1.31-2.03; P < 0.01), major bleeding (RR 1.41; 95% CI: 1.26-1.57; P < 0.01), and GI bleeding (RR 1.85; 95% CI: 1.38-2.48; P < 0.01) compared with placebo. Conclusions: Our study did not find any significant reductions in cancer-related mortality or cancer incidence when compared with placebo. Our study also highlights the dangers of aspirin for primary prevention of cancer as aspirin was found to cause higher rates of bleeding (any bleeding, major bleeding, and GI bleeding) compared to placebo at the longest follow-up period with no significant benefit in cancer primary prevention.

scholarly journals Pulmonary Embolism and Coexisting Deep Vein Thrombosis: A Detrimental Association?

2019 ◽  
Vol 8 (6) ◽  
pp. 899 ◽  
Author(s):  
Elena-Mihaela Cordeanu ◽  
Hélène Lambach ◽  
Marie Heitz ◽  
Julie Di Cesare ◽  
Corina Mirea ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Prognostic Significance ◽  
Vein Thrombosis ◽  
All Cause Mortality ◽  
Deep Vein ◽  
The Impact

Background: The prognostic significance of coexisting deep vein thrombosis (DVT) in acute pulmonary embolism (PE) is controversial. This study aimed to provide routine patient care data on the impact of this association on PE severity and 3-month outcomes in a population presenting with symptomatic venous thromboembolism (VTE) from the REMOTEV registry. Methods and Results: REMOTEV is a prospective, non-interventional study of patients with acute symptomatic VTE, treated with direct oral anticoagulants (DOACs) or standard anticoagulation (vitamin K antagonists (VKA) or parenteral heparin/fondaparinux alone) for at least 3 months. From 1 November 2013 to 28 February 2018, among 1241 consecutive patients included, 1192 had a follow-up of at least 3 months and, among them, 1037 had PE with (727) or without DVT (310). The median age was 69 (55–80, 25th–75th percentiles). Patients with PE-associated DVT had more severe forms of PE (p < 0.0001) and, when DVT was present, proximal location was significantly correlated to PE severity (p < 0.01). However, no difference in all-cause mortality rate (hazard ratio (HR) 1.36 (CI 95% 0.69–2.92)), nor in the composite criterion of all-cause mortality and recurrence rate (HR 1.56 (CI 95% 0.83–3.10)) was noted at 3 months of follow-up. Conclusion: In REMOTEV, coexisting DVT was associated with a higher severity of PE, with no impact on short-term prognosis.

Prognostic Impact of Obstructive Sleep Apnea in Patients Presenting with Acute Symptomatic Pulmonary Embolism

2020 ◽  
Author(s):  
Raphael Le Mao ◽  
David Jiménez ◽  
Behnood Bikdeli ◽  
Mateo Porres-Aguilar ◽  
Alberto García-Ortega ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Prognostic Significance ◽  
Multivariable Analysis ◽  
Prognostic Impact ◽  
Symptomatic Pulmonary Embolism ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Related Mortality

Abstract Background In patients with pulmonary embolism (PE), there is a lack of comprehensive data on the prevalence and prognostic significance of pre-existing obstructive sleep apnea (OSA). Methods In this study of patients with PE from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry, we assessed the prevalence of OSA, and the association between pre-existing OSA and the outcomes of all-cause mortality, PE-related mortality, recurrences, and major bleeding over 30 days after initiation of PE treatment. Additionally, we also examined rates of outcomes within 90 days and 1 year following the diagnosis of PE. Results Of 4,153 patients diagnosed with PE, 241 (5.8%; 95% confidence interval [CI]: 5.1–6.6%) had pre-existing OSA. Overall, 166 (4.0%; 95% CI: 3.4–4.6%) died during the first 30 days of follow-up. In multivariable analysis, the OSA syndrome was not a significant predictor of death from any cause (odds ratio [OR]: 1.5; 95% CI: 0.8–2.9; p = 0.19). However, patients with pre-existing OSA had an increased PE-specific mortality (adjusted OR: 3.0; 95% CI: 1.3–6.8; p = 0.01) compared with those without OSA. OSA was not significantly associated with 30-day recurrent venous thromboembolism (adjusted OR: 0.6; 95% CI: 0.1–4.7; p = 0.65) or major bleeds (adjusted OR: 1.0; 95% CI: 0.4–2.2; p = 1.0). Findings were similar at 90-day and 1-year follow-ups. Conclusion In patients presenting with PE, pre-existing OSA is relatively infrequent. Patients with OSA were at increased risk of PE-related mortality when compared with those without OSA.

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