| Incidence of recurrent venous thromboembolism and of chronic thromboembolic pulmonary hypertension in patients after a first episode of pulmonary embolism. | |
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MedLine Citation:
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PMID: 20157841 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Daniela Poli; Elisa Grifoni; Emilia Antonucci; Chiara Arcangeli; Domenico Prisco; Rosanna Abbate; Massimo Miniati |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of thrombosis and thrombolysis Volume: 30 ISSN: 1573-742X ISO Abbreviation: J. Thromb. Thrombolysis Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-09-24 Completed Date: 2011-02-02 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9502018 Medline TA: J Thromb Thrombolysis Country: Netherlands |
Other Details:
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Languages: eng Pagination: 294-9 Citation Subset: IM |
Affiliation:
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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:
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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:
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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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