| Therapy and outcomes in massive pulmonary embolism from the Emergency Medicine Pulmonary Embolism in the Real World Registry. | |
| | |
MedLine Citation:
|
PMID: 22633723 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
|
STUDY AIM: Clinical guidelines recommend fibrinolysis or embolectomy for acute massive pulmonary embolism (PE) (MPE). However, actual therapy and outcomes of emergency department (ED) patients with MPE have not previously been reported. We characterize the current management of ED patients with MPE in a US registry. METHODS: A prospective, observational, multicenter registry of ED patients with confirmed PE was conducted from 2006 to 2008. Massive PE was defined as PE with an initial systolic blood pressure less than 90 mm Hg. We compared inpatient and 30-day mortality, bleeding complications, and recurrent venous thromboembolism. RESULTS: Of 1875 patients enrolled, 58 (3.1%) had MPE. There was no difference in frequency of parenteral anticoagulation (98.3% [95% confidence interval {CI}, 90.5-101.6] vs 98.5% [95% CI, 97.9-99.1], P = .902) between patients with and without MPE. Fibrinolytic therapy and embolectomy were infrequently used but were used more in patients with MPE than in patients without MPE (12.1% [95% CI, 3.7-20.5] vs 2.4% [95% CI, 1.7-3.1], P < .001, and 3.4% [95% CI, 0.0-8.1] vs 0.7% [95% CI, 0.3-1.1], P = .022, respectively). Comparison of outcomes revealed higher all-cause inpatient mortality (13.8% [95% CI, 4.9-22.7] vs 3.0% [95% CI, 2.2-3.8], P < .001), higher risk of inpatient bleeding complications (10.3% [95% CI, 2.5-18.1] vs 3.5% [95% CI, 2.7-4.3], P = .007), and a higher 30-day mortality (14.0% [95% CI, 4.4-23.6] vs 1.8% [95% CI, 1.2-2.4], P < .001) for patients with MPE. CONCLUSIONS: In a contemporary registry of ED patients, MPE mortality was 4-fold higher than patients without MPE, yet only 12% of the MPE cohort received fibrinolytic therapy. Variability exists between the treatment of MPE and current recommendations. |
| | |
Authors:
|
Brian W Lin; Donald H Schreiber; Gigi Liu; Beau Briese; Brian Hiestand; David Slattery; Jeffrey A Kline; Samuel Z Goldhaber; Charles V Pollack |
Related Documents
:
|
19407113 - Treatment of severe sepsis with artemether-lumefantrine is associated with decreased mo... 22305843 - Perceived sexual difficulties and associated factors in patients with heart failure. 9222403 - Association of leprosy with hla-dr2 in a southern brazilian population. |
Publication Detail:
|
Type: JOURNAL ARTICLE Date: 2012-5-23 |
Journal Detail:
|
Title: The American journal of emergency medicine Volume: - ISSN: 1532-8171 ISO Abbreviation: - Publication Date: 2012 May |
Date Detail:
|
Created Date: 2012-5-28 Completed Date: - Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 8309942 Medline TA: Am J Emerg Med Country: - |
Other Details:
|
Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
|
Copyright © 2012. Published by Elsevier Inc. |
Affiliation:
|
Department of Emergency Medicine, Kaiser Permanente, San Francisco, CA, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Intravenous contrast alone vs intravenous and oral contrast computed tomography for the diagnosis of...
Next Document: Characteristics of and outcome for patients with chest pain in relation to transport by the emergenc...