Journal
THROMBOSIS AND HAEMOSTASIS
Volume 121, Issue 7, Pages 955-963Publisher
GEORG THIEME VERLAG KG
DOI: 10.1055/s-0040-1722190
Keywords
pulmonary embolism; deep vein thrombosis; venous thromboembolism; pulmonary vascular obstruction
Categories
Funding
- Programme Hospitalier de Recherche Clinique (French Department of Health)
- Foundation Archipel Sante
- University Hospital of Brest
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This study aimed to assess the association between high PVOI at PE diagnosis and the risk of recurrent VTE. The results showed that PVOI >= 40% was an independent risk factor for VTE recurrence in PE patients, even six months after stopping anticoagulation therapy. Further prospective validation studies are needed to confirm these findings.
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 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 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, p<0.01), whether PE was provoked by a major transient risk factor or not. A threshold at 41% was identified as the best value associated with the risk of recurrence 6 months after stopping anticoagulation (area under curve=0.64). Conclusion PVOI >= 40% at PE diagnosis was an independent risk factor for recurrence VTE. Further prospective validation studies are needed.
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