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Original Research |

Clinical prognosis of non-massive central and non-central pulmonary embolism: a registry-based cohort study

Bobby Gouin, MD; Marc Blondon, MD; David Jiménez, PhD; Carmen Fernández-Capitán, PhD; Henri Bounameaux, MD; Silvia Soler, MD; Rita Duce, MD; Joan Carles Sahuquillo, PhD; Nuria Ruiz-Giménez, PhD; Manuel Monreal, PhD
Author and Funding Information

Conflicts of interest

Nothing to disclose: B. Gouin, M. Blondon, S. Soler, R. Duce, JC. Sahuquillo, N. Ruiz-Giménez.

Dr Bounameaux reports grants and personal fees form Thrombosis Research Institute (London), personal fees from Bayer Pharma, personal fees from Sanofi-Aventis, outside the submitted work.

D. Jiménez has served as an advisor or consultant for Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Leo Pharma, Pfizer, ROVI and Sanofi; served as a speaker or a member of a speakers’ bureau for Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Leo Pharma, ROVI and Sanofi; received grants for clinical research from Sanofi and ROVI.

C. Fernandez-Capitan has served as an advisor or consultant for Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibby and Pfizer, Daiichi Sankyo, Leo Pharma, ROVI and Sanofi and served as a speaker for Daiichi Sankyo, ROVI and Sanofi

M. Monreal has served as an advisor or consultant for Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim, Leo Pharma, Pfizer and Sanofi; served as a speaker or a member of a speakers’ bureau for Bayer HealthCare Pharmaceuticals, Daiichi Sankyo, Leo Pharma and Sanofi; received grants for clinical research from Sanofi and Bayer.

Funding Information

We express our gratitude to Sanofi Spain for supporting this Registry with an unrestricted educational grant. We also express our gratitude to Bayer Pharma AG for supporting this Registry. Bayer Pharma AG’s support was limited to the part of RIETE outside Spain, which accounts for a 22,92% of the total patients included in the RIETE Registry. B Gouin was supported by a grant from Québec Foundation for progress of internal medicine.

Prior abstract publication / presentation: None

1Division of Angiology & Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland

2Division of General Internal Medicine, Université de Sherbrooke, Sherbrooke, Canada (on leave)

3Respiratory Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain

4Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain

5Department of Internal Medicine, Hospital Olot i Comarcal de la Garrotxa, Gerona, Spain

6Department of Laboratory of Analysis, Ospedale Galliera, Genoa, Italy

7Department of Internal Medicine, Hospital Municipal de Badalona, Barcelona, Spain

8Department of Internal Medicine, Hospital Universitario de La Princesa, Madrid, Spain

9Department of Internal Medicine. Hospital Universitario Germans Trias i Pujol de Badalona. Barcelona. Universidad Católica de Murcia. Spain

Correspondence: Bobby Gouin Division of Angiology and Haemostasis Geneva University Hospitals 4 rue Gabrielle-Perret-Gentil 1211 Genève 4 - Switzerland.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.10.056
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Abstract

Background  Whether the localization of non-massive pulmonary embolism (PE) is associated with the short and long-term prognosis of patients remains unknown. Our aim is to characterize associations of non-massive PE localization with risks of recurrent venous thromboembolism (VTE), major bleeding and mortality during and after anticoagulation.

Methods  Among participants of the RIETE registry with an incident symptomatic non-massive PE diagnosed by computerized tomography (CT), we compared risks of recurrent VTE, major bleeding and mortality during and after anticoagulation period between central PE (main pulmonary artery) and non-central PE (more peripheral arteries), using Cox proportional hazard adjusted models.

Results  Of the 6674 participants, patients with central PE (40.5%) had similar age (mean 66 years), sex (46.9% male) and proportion of idiopathic (45.0%) and cancer-related (22.3%) PE as patients with non-central PE. During anticoagulation (5256.1 patient-years), the risk of recurrent VTE was similar between the two groups (2.5 vs. 2.1 per 100 patient-years; adjusted HR 1.32, 95%CI 0.91-1.90), as were risks of major bleeding and mortality. After anticoagulation was discontinued (2175.4 patient-years), participants with central PE had a borderline greater risk of recurrent VTE than participants with non-central PE (11.0 vs. 8.0 per 100 patient-years; adjusted HR 1.34, CI 95% 1.01-1.78), but not when restricting to participants after unprovoked PE (13.8 vs. 11.9 per 100 patient-years, HR 1.15, 95%CI 0.79-1.68, p= 0.48). Risks of major bleeding and mortality were similar.

Conclusions  Among non-massive PE, central localization of PE is associated with greater risk of recurrent VTE after anticoagulation cessation. However, the low magnitude of this association and the absence of association after unprovoked PE suggest that the clinical relevance of this finding is limited and that the duration of anticoagulation should not be tailored to PE localization after non-massive unprovoked PE.


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