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Unprovoked pulmonary embolism: high rate of events but low adherence to long term anticoagulation.
Session:
Posters 2 - Écran 08 - Circulação Pulmonar
Speaker:
Cátia Santos Ferreira
Congress:
CPC 2018
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.2 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Cátia Santos Ferreira; James Milner; Tatiana Gonçalves; Célia Domingues; Joana Moura Ferreira; Rui Baptista; Nelson Pedro; Lèlita Santos; Mariano Pêgo
Abstract
<p><strong>Background:</strong> After the first 3 months of anticoagulation after a pulmonary embolism (PE), a decision has to be taken regarding its duration. However, there are very few data in real-world populations. We sought to characterize the patterns of anticoagulation for the long-term prophylaxis of venous thromboembolism (VTE).</p> <p><strong>Population and Methods: </strong>We conducted a retrospective, observational study including 752 patients (384 males, mean age 73 years) with PE from two cohorts: cohort A, between January, 2010 and December, 2011 (n=506) and cohort B, between January, 2014 and December, 2015 (n=246). Median (interquartile range) follow-up was 2.5 (0.4-6) years [3.8 (0.3-6.6) years for cohort A and 2.0 (0.8-2.8) years for cohort B]. The primary endpoint was a composite of recurrent fatal or nonfatal VTE (PE and deep vein thrombosis).</p> <p><strong>Results:</strong> Almost half of the cohort had a trigger for the PE, either cancer (22.2%) or other provocative factor (24.9%); 52.9% had an idiopathic PE. Globally, the in-hospital mortality was 11.7%. After discharge, the primary endpoint occurred in 47 patients (7.1%) after a median time of 11 months, with no significant association with age (p=0.84) and sPESI (p=0.41). Conversely, we found an interaction between the PE trigger and the risk of recurrence. Unprovoked PE (idiopathic or cancer) had an HR of 3.64 (1.30–10.17; p=0.01) of having a recurrent event versus patients with a provoked PE. Patients with an idiopathic PE had a significantly higher risk of recurrence if not anticoagulated [HR 4.55 (1.56-13.16); p=0.005] compared with those anticoagulated. The absolute risk of recurrent VTE for patients with idiopathic PE for anticoagulated and not anticoagulated patients was 1.2% vs 4.4% at 1 year and 2.9% vs 9.8% at 5 years, respectively. Among patients with idiopathic PE, after 2 years only 52% were anticoagulated. Of these, 2% were treated with enoxaparin, 52% with warfarin and 46% with direct oral anticoagulants (DOACs). No interaction was found between warfarin and DOACs and the risk of recurrence (6.0% vs 7.3%, p=0.74). Idiopathic PE patients were more commonly anticoagulated than those with provoked PE (OR 2.76; 1.65-4.63); p<0.001).</p> <p><strong>Conclusion:</strong> We found a significant interaction between PE etiology and recurrent VTE. Additionally, the risk for recurrence is increased 4.5-fold for idiopathic PE patients under no anticoagulation. Critically, only half of idiopathic PE patients were actually anticoagulated after 2 years of the index event.</p>
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