TY - JOUR
T1 - Symptomatic subsegmental versus more central pulmonary embolism
T2 - Clinical outcomes during anticoagulation
AU - Fernández-Capitán, Carmen
AU - Rodriguez Cobo, Ana
AU - Jiménez, David
AU - Madridano, Olga
AU - Ciammaichella, Maurizio
AU - Usandizaga, Esther
AU - Otero, Remedios
AU - Di Micco, Pierpaolo
AU - Moustafa, Farès
AU - Monreal, Manuel
AU - The RIETE Investigators
A2 - Adarraga, M. D.
A2 - Aibar, M. A.
A2 - Alfonsa, M.
A2 - Arcelus, J. I.
A2 - Azcarate-Agüero, P.
A2 - Ballaz, A.
A2 - Baños, P.
A2 - Barba, R.
A2 - Barrón, M.
A2 - Barrón-Andrés, B.
A2 - Bascuñana, J.
A2 - Blanco-Molina, A.
A2 - Camón, A. M.
A2 - Chasco, L.
A2 - Cruz, A. J.
A2 - del Pozo, R.
A2 - de Miguel, J.
A2 - del Toro, J.
A2 - Díaz-Pedroche, M. C.
A2 - Díaz-Peromingo, J. A.
A2 - Escribano, J. C.
A2 - Falgá, C.
A2 - Fernández-Aracil, C.
A2 - Fidalgo, M. A.
A2 - Font, C.
A2 - Font, L.
A2 - García, M. A.
A2 - García-Bragado, F.
A2 - García-Morillo, M.
A2 - García-Raso, A.
A2 - García-Sánchez, A. I.
A2 - Gavín, O.
A2 - Gaya, I.
A2 - Gómez, C.
A2 - Gómez, V.
A2 - González, J.
A2 - Grau, E.
A2 - Guijarro, R.
A2 - Skride, Andris
A2 - Vitola, B.
A2 - Gibietis, Valdis
N1 - Link to the RIETE Registry participating centers
https://www.riete.org/info/centros_participantes/index.php
Publisher Copyright:
© 2020 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH).
PY - 2021/1
Y1 - 2021/1
N2 - Background: The optimal therapy of patients with acute subsegmental pulmonary embolism (PE) is controversial. Methods: We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the rate of symptomatic PE recurrences during anticoagulation in patients with subsegmental, segmental, or more central PEs. Results: Among 15 963 patients with a first episode of symptomatic PE, 834 (5.2%) had subsegmental PE, 3797 (24%) segmental, and 11 332 (71%) more central PE. Most patients in all subgroups received initial therapy with low-molecular-weight heparin, and then most switched to vitamin K antagonists. Median duration of therapy was 179, 185, and 204 days, respectively. During anticoagulation, 183 patients developed PE recurrences, 131 developed deep vein thrombosis (DVT), 543 bled, and 1718 died (fatal PE, 135). The rate of PE recurrences was twofold higher in patients with subsegmental PE than in those with segmental (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.16-3.85) or more central PE (HR, 1.89; 95% CI, 1.12-3.13). On multivariable analysis, patients with subsegmental PE had a higher risk for PE recurrences than those with central PE (adjusted HR, 1.75; 95% CI, 1.02-3.03). After stratifying patients with subsegmental PE according to ultrasound imaging in the lower limbs, the rate of PE recurrences was similar in patients with DVT, in patients without DVT, and in those with no ultrasound imaging. Conclusions: Our study reveals that the risk for PE recurrences in patients with segmental PE is not lower than in those with more central PE, thus suggesting that the risk of PE recurrences is not influenced by the anatomic location of PE.
AB - Background: The optimal therapy of patients with acute subsegmental pulmonary embolism (PE) is controversial. Methods: We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the rate of symptomatic PE recurrences during anticoagulation in patients with subsegmental, segmental, or more central PEs. Results: Among 15 963 patients with a first episode of symptomatic PE, 834 (5.2%) had subsegmental PE, 3797 (24%) segmental, and 11 332 (71%) more central PE. Most patients in all subgroups received initial therapy with low-molecular-weight heparin, and then most switched to vitamin K antagonists. Median duration of therapy was 179, 185, and 204 days, respectively. During anticoagulation, 183 patients developed PE recurrences, 131 developed deep vein thrombosis (DVT), 543 bled, and 1718 died (fatal PE, 135). The rate of PE recurrences was twofold higher in patients with subsegmental PE than in those with segmental (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.16-3.85) or more central PE (HR, 1.89; 95% CI, 1.12-3.13). On multivariable analysis, patients with subsegmental PE had a higher risk for PE recurrences than those with central PE (adjusted HR, 1.75; 95% CI, 1.02-3.03). After stratifying patients with subsegmental PE according to ultrasound imaging in the lower limbs, the rate of PE recurrences was similar in patients with DVT, in patients without DVT, and in those with no ultrasound imaging. Conclusions: Our study reveals that the risk for PE recurrences in patients with segmental PE is not lower than in those with more central PE, thus suggesting that the risk of PE recurrences is not influenced by the anatomic location of PE.
KW - anticoagulant
KW - deep vein thrombosis
KW - outcomes
KW - pulmonary embolism
KW - subsegmental
UR - http://www.scopus.com/inward/record.url?scp=85096661801&partnerID=8YFLogxK
U2 - 10.1002/rth2.12446
DO - 10.1002/rth2.12446
M3 - Article
AN - SCOPUS:85096661801
SN - 2475-0379
VL - 5
SP - 168
EP - 178
JO - Research and Practice in Thrombosis and Haemostasis
JF - Research and Practice in Thrombosis and Haemostasis
IS - 1
ER -