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01. History of Cardiology
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
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32. Cardiovascular Nursing
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Direct oral anticoagulants in acute pulmonary embolism: safe and effective
Session:
Posters 2 - Écran 08 - Circulação Pulmonar
Speaker:
James Milner
Congress:
CPC 2018
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.4 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Treatment
Session Type:
Posters
FP Number:
---
Authors:
James Milner; Cátia Santos Ferreira; Tatiana Gonçalves; Joana Moura Ferreira; Natália António; Rui Baptista; Lèlita Santos; Mariano Pêgo
Abstract
<p><strong>Background:</strong> Venous thromboembolism (VTE) is a serious condition with high in-hospital mortality and long-term morbidity. The introduction of Direct Oral Anticoagulants (DOACs) changed the in-hospital patient management and might affect short-term VTE prognosis. We sought to evaluate the impact of DOAC therapy in a large cohort of patients admitted for pulmonary embolism (PE).</p> <p><strong>Methods: </strong>In a single center, 752 patients admitted for PE were retrospectively studied. Patients were divided into two groups, depending on the acute-phase PE therapy: group A, treated with DOACs (N=98) and group B, treated with vitamin K antagonists and/or heparin (N=654). Baseline demographic and clinical characteristics were compared. The primary co-endpoints were in-hospital and 30-day mortality.</p> <p><strong>Results: </strong>Average age was similar in both groups, with a higher proportion of males in group A (65% vs 49% respectively, p=0.002). There was no significant between-group difference in PE etiology, with a similar proportion of idiopathic PE (65% vs 51% respectively, p=0.092). Anatomical extension differed among the groups, with a higher proportion of central PE in group B (61% vs 47%, p=0.007), despite no significant difference in clinical severity according to the Simplified Pulmonary Embolism Severity Index (low-risk PE in 31% vs 24%, p=0.174). Both in-hospital and 30-day mortality were significantly higher in group B (13.3% vs 1.0%, p<0.0005 and 15.0% vs 3.1%, p=0.001, respectively), with significantly different survival between both groups (Log Rank p=0.002). In multivariate analysis, after adjustment for gender, anatomical extension and clinical severity, non-DOAC therapy remained as an independent predictor of 30-day mortality (OR 5.309, 95% CI 1.636-17.228, p=0.005).</p> <p><strong>Conclusions: </strong>DOAC therapy in acute-phase PE seems to be associated with better short-term outcomes, regardless of the anatomical extension of PE and the clinical severity. However, confounding by indication cannot be excluded.</p>
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