Document Detail


Incidence of recurrent venous thromboembolism and of chronic thromboembolic pulmonary hypertension in patients after a first episode of pulmonary embolism.
MedLine Citation:
PMID:  20157841     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
After a first episode of pulmonary embolism (PE), two major problems need to be considered: risk of recurrence when anticoagulation is stopped, and risk of chronic thromboembolic pulmonary hypertension (CTPH). We followed prospectively consecutive patients who survived a first episode of PE, with or without deep vein thrombosis, to assess the incidence of venous thromboembolism (VTE) recurrences and of symptomatic and asymptomatic CTPH. After 3-6 months of oral anticoagulant therapy (OAT) patients underwent transthoracic echocardiography for measuring transtricuspid (rV-rA) gradient. When rV-rA gradient was >35 mmHg further evaluations were performed to rule in or out CTPH. During follow-up patients who developed persistent dyspnea were re-evaluated. In patients who underwent OAT withdrawal D-dimer (DD), prothrombin fragment 1 + 2 (F1 + 2), and thrombophilia were evaluated one month after warfarin discontinuation. Overall, 239 patients, 118 males, median age 59(16-89) years, were followed up for a median time of 36(9-192) months. Nine patients had rV-rA gradient >30 mmHg and ≤35 mmHg, and one of 37 mmHg. Among patients with normal rV-rA gradient, one developed persistent dyspnea 55 months after the first event and CPTH was confirmed. Among 206 patients who stopped OAT, 23(11.2%) had VTE recurrence, 11 PE(48%). Elevated DD and F1 + 2 levels after stopping OAT were significantly associated with recurrence. None of patients with recurrent VTE had elevated rV-rA gradient. In our series the incidence of CTPH after a first episode of PE was 0.4%. VTE recurrence and elevated DD and F1 + 2 levels seemed not to be related to the development of CTPH.
Authors:
Daniela Poli; Elisa Grifoni; Emilia Antonucci; Chiara Arcangeli; Domenico Prisco; Rosanna Abbate; Massimo Miniati
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of thrombosis and thrombolysis     Volume:  30     ISSN:  1573-742X     ISO Abbreviation:  J. Thromb. Thrombolysis     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-24     Completed Date:  2011-02-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9502018     Medline TA:  J Thromb Thrombolysis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  294-9     Citation Subset:  IM    
Affiliation:
Department of Heart and Vessels, Centro di Riferimento Regionale per la Trombosi, Azienda Ospedaliero-Universitaria Careggi, Vle Morgagni 85, 50134 Firenze, Florence, Italy. polida@aou-careggi.toscana.it
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Anticoagulants
Antifibrinolytic Agents / blood
Female
Fibrin Fibrinogen Degradation Products / analysis
Humans
Hypertension, Pulmonary / epidemiology*
Incidence
Male
Middle Aged
Peptide Fragments / blood
Prospective Studies
Prothrombin
Pulmonary Embolism / complications*
Recurrence
Venous Thromboembolism / epidemiology*
Young Adult
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Antifibrinolytic Agents; 0/Fibrin Fibrinogen Degradation Products; 0/Peptide Fragments; 0/fibrin fragment D; 0/prothrombin fragment 1.2; 9001-26-7/Prothrombin

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