Treatment and Outcomes of Acute Pulmonary Embolism and Deep Venous Thrombosis: The CVRN VTE Study.
Acute Disease
Adult
Aged
Anticoagulants
/ therapeutic use
Cohort Studies
Databases, Factual
Female
Humans
Male
Middle Aged
Multivariate Analysis
Prognosis
Proportional Hazards Models
Pulmonary Embolism
/ diagnostic imaging
Retrospective Studies
Risk Assessment
Severity of Illness Index
Survival Analysis
Treatment Outcome
Venous Thrombosis
/ diagnostic imaging
Anticoagulation
Deep venous thrombosis
Mortality
Pulmonary embolism
Venous thromboembolism
Journal
The American journal of medicine
ISSN: 1555-7162
Titre abrégé: Am J Med
Pays: United States
ID NLM: 0267200
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
20
03
2019
revised:
23
05
2019
accepted:
24
05
2019
pubmed:
28
6
2019
medline:
21
3
2020
entrez:
28
6
2019
Statut:
ppublish
Résumé
Few studies describe both inpatient and outpatient treatment and outcomes of patients with acute venous thromboembolism in the United States. A multi-institutional cohort of patients diagnosed with confirmed pulmonary embolism or deep venous thrombosis during the years 2004 through 2010 was established from 4 large, US-based integrated health care delivery systems. Computerized databases were accessed and medical records reviewed to collect information on patient demographics, clinical risk factors, initial antithrombotic treatment, and vital status. Multivariable Cox regression models were used to estimate the risk of death at 90 days. The cohort comprised 5497 adults with acute venous thromboembolism. Pulmonary embolism was predominantly managed in the hospital setting (95.0%), while 54.5% of patients with lower extremity thrombosis were treated as outpatients. Anticoagulant treatment differed according to thromboembolism type: 2688 patients (92.8%) with pulmonary embolism and 1625 patients (86.9%) with lower extremity thrombosis were discharged on anticoagulants, compared with 286 patients (80.1%) with upper extremity thrombosis and 69 (54.8%) patients with other thrombosis. While 4.5% of patients died during the index episode, 15.4% died within 90 days. Pulmonary embolism was associated with a higher 90-day death risk than lower extremity thrombosis (adjusted hazard ratio 1.23; 95% confidence interval, 1.04-1.47), as was not being discharged on anticoagulants (adjusted hazard ratio 5.56; 95% confidence interval, 4.76-6.67). In this multicenter, community-based study of patients with acute venous thromboembolism, anticoagulant treatment and outcomes varied by thromboembolism type. Although case fatality during the acute episode was relatively low, 15.4% of people with thromboembolism died within 90 days of the index diagnosis.
Sections du résumé
BACKGROUND
Few studies describe both inpatient and outpatient treatment and outcomes of patients with acute venous thromboembolism in the United States.
METHODS
A multi-institutional cohort of patients diagnosed with confirmed pulmonary embolism or deep venous thrombosis during the years 2004 through 2010 was established from 4 large, US-based integrated health care delivery systems. Computerized databases were accessed and medical records reviewed to collect information on patient demographics, clinical risk factors, initial antithrombotic treatment, and vital status. Multivariable Cox regression models were used to estimate the risk of death at 90 days.
RESULTS
The cohort comprised 5497 adults with acute venous thromboembolism. Pulmonary embolism was predominantly managed in the hospital setting (95.0%), while 54.5% of patients with lower extremity thrombosis were treated as outpatients. Anticoagulant treatment differed according to thromboembolism type: 2688 patients (92.8%) with pulmonary embolism and 1625 patients (86.9%) with lower extremity thrombosis were discharged on anticoagulants, compared with 286 patients (80.1%) with upper extremity thrombosis and 69 (54.8%) patients with other thrombosis. While 4.5% of patients died during the index episode, 15.4% died within 90 days. Pulmonary embolism was associated with a higher 90-day death risk than lower extremity thrombosis (adjusted hazard ratio 1.23; 95% confidence interval, 1.04-1.47), as was not being discharged on anticoagulants (adjusted hazard ratio 5.56; 95% confidence interval, 4.76-6.67).
CONCLUSIONS
In this multicenter, community-based study of patients with acute venous thromboembolism, anticoagulant treatment and outcomes varied by thromboembolism type. Although case fatality during the acute episode was relatively low, 15.4% of people with thromboembolism died within 90 days of the index diagnosis.
Identifiants
pubmed: 31247183
pii: S0002-9343(19)30522-4
doi: 10.1016/j.amjmed.2019.05.040
pmc: PMC6917856
mid: NIHMS1533061
pii:
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1450-1457.e1Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL103820
Pays : United States
Organisme : NHLBI NIH HHS
ID : U19 HL091179
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.
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