High D-dimer levels after stopping anticoagulants in pulmonary embolism with sleep apnoea

Suquia, Angela García; Alonso-Fernández, Alberto; Peña, Mónica de la; Romero, David; Piérola, Javier; Carrera, Miguel; Barceló, Antònia; Soriano, Joan B.; Arqué, Meritxell; Fernández‐Capitán, Carmen; Lorenzo, Alicia; García‐Río, Francisco

doi:10.1183/13993003.02041-2014

Cited by 24 publications

(9 citation statements)

References 42 publications

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“…We have previously reported that OSA is an independent risk factor for a first episode of PE and for its recurrence (Alonso-Fernández et al, 2013. It has also been established that an elevated D-dimer level after stopping anticoagulation is another risk factor for recurrent PE (Faber, De Groot, & Visseren, 2009), and we reported that D-dimer levels of patients who discontinued anticoagulation after a PE episode were directly related to OSA severity (García Suquia et al, 2015). The patho- mortality.…”

Section: Discussionmentioning

confidence: 75%

“…On the one hand, both conditions share risk factors like advanced age, obesity and sedentarism (Durán, Esnaola, Rubio, & Iztueta, ; Konstantinides et al., ). On the other hand, PE is the result of Virchow's classical risk triad: vascular endothelial impairment, stasis of blood flow and increased coagulability (García Suquia et al., ). OSA could hypothetically affect all three mechanistic pathways.…”

Section: Discussionmentioning

confidence: 99%

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Obstructive sleep apnea is associated with worse clinical‐radiological risk scores of pulmonary embolism

Toledo-Pons

Alonso-Fernández

Peña

et al. 2019

Journal of Sleep Research

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Summary Obstructive sleep apnea is a risk factor for pulmonary embolism, although its association with pulmonary embolism severity is unknown. Our objective was to study if obstructive sleep apnea is associated with worse pulmonary embolism severity scores and greater extent of arterial obstruction. In consecutive pulmonary embolism patients, we performed respiratory polygraphy and recorded sleep characteristics, classical risk factors for pulmonary embolism and physical activity 6–12 months after the pulmonary embolism episode. Simplified Geneva Prognostic Score and Pulmonary Embolism Severity Index were calculated at the time of the pulmonary embolism diagnosis. The Pulmonary Artery Obstruction Index and the right ventricle to left ventricle diameter ratio were measured by computed tomography pulmonary angiography. We included 120 patients, of whom 45.8% had moderate‐severe obstructive sleep apnea (apnea–hypopnea index > 15 hr−1). There was a larger proportion of moderate‐severe obstructive sleep apnea patients in the third and fourth Pulmonary Artery Obstruction Index quartiles and in the III‐V Pulmonary Embolism Severity Index levels compared with apnea–hypopnea index < 15 hr−1 group. However, no differences were found between the proportion of patients with or without moderate‐severe obstructive sleep apnea in their stratification by simplified Geneva Prognostic Score. The mean adjusted values of the simplified Geneva Prognostic Score, Pulmonary Embolism Severity Index and Pulmonary Artery Obstruction Index scores were higher in the apnea–hypopnea index > 15 hr−1 group (p < .05). Multiple linear regression analysis identified apnea–hypopnea index as the only independent factor related to Pulmonary Artery Obstruction Index and Pulmonary Embolism Severity Index, whereas desaturation index was associated with simplified Geneva Prognostic Score. Patients with pulmonary embolism and moderate‐severe obstructive sleep apnea had greater pulmonary artery obstruction as well as more pulmonary embolism severity, assessed by both the simplified Geneva Prognostic Score and the Pulmonary Embolism Severity Index, compared with patients with apnea–hypopnea index ≤ 15 hr−1. Moreover, these prognostic indices were independently related to sleep parameters.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Obstructive sleep apnea is associated with worse clinical‐radiological risk scores of pulmonary embolism

Toledo-Pons

Alonso-Fernández

Peña

et al. 2019

Journal of Sleep Research

Self Cite

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“…Contemporary clinical studies have further implied that OSA may be an independent risk factor for PE as well as recurrent venous thromboembolism 7,8 . Another set of studies suggest that OSA is associated P e e r R e v i e w V e r s i o n with increase in levels of tumor necrosis factor-alpha, fibrinogen, D-dimer as well as platelet activity and that CPAP use may alleviate some of these effects [17][18][19][20] . However, a cross-over randomized trial evaluating the impact of CPAP in OSA and pulmonary hypertension did suggest that CPAP use decreased systolic pulmonary artery pressures in all patients 21 .…”

Section: Pulmonary Embolism and Obstructive Sleep Apneamentioning

confidence: 99%

Outcomes of patients hospitalized for acute pulmonary embolism by obstructive sleep apnea status

Joshi

Hajjali²,

Gokhale

et al. 2021

Pulm. circ.

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Pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. Obstructive sleep apnea (OSA) is increasingly recognized in the ageing population, especially with the rising obesity epidemic. The impact of OSA on inpatient mortality in PE is not well understood. We used the Nationwide Inpatient Sample databases from 2005 to 2016 to identify 755,532 acute PE patients (ageï³18 years). Among these 61,050 (8.1%) were OSA+. Temporal trends in length of stay (LOS), inpatient mortality and its association with OSA in PE patients were analyzed. The proportion of PE patients who were OSA+ increased from 2005 to 2016. OSA+ PE patients were younger and predominantly men. Despite a higher prevalence of traditional risk factors for inpatient mortality in OSA+ patients, OSA was associated with a lower risk of mortality in PE patients (OR, 95% CI; p: unadjusted 0.56, 0.53-0.58; p<0.0001 and adjusted 0.55, 0.52-0.58; p<0.0001). Overall mortality and LOS in PE patients decreased over time. Relative to OSA- patients, there was a slight increase in mortality among OSA+ PE patients over time, although the LOS remained unchanged between the 2 groups. In conclusion, OSA+ PE patients had a lower inpatient mortality compared to OSA- patients despite a higher prevalence of traditional mortality risk factors. Secondary pulmonary hypertension related to OSA with pre-conditioning of the right ventricle to elevated afterload may potentially explain the protective effect of OSA on mortality in PE. However, mechanistic studies need to further elucidate the links behind this association.

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“…We included 15 studies containing 2190 participants 7,14,20-32 for our systematic review and meta-analysis (Table 2). The information of the first author’s name, year of publication, design of the study, sample size, mean age, study population, numbers of each AHI level, and NOS score of each study are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Prothrombotic Factors in Obstructive Sleep Apnea: A Systematic Review With Meta-Analysis

Qiu

Zhang

et al. 2020

Ear Nose Throat J

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Background: Previous studies revealed that the prothrombotic factors in patients with obstructive sleep apnea (OSA) remain controversial. Aim/Objective: The aim of the systematic review is to elucidate the relationship between prothrombotic factors and OSA. Materials and Methods: This systematic review was performed under the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The literature we investigated was extracted from 4 main medical databases (PubMed, Web of Science, Cochrane Library, and Chinese databases) as of February 2020. We used significant weighted mean differences (SMDs) with 95% CIs from random-effects model. Results: A total of 15 studies comprising 2190 patients were available for the meta-analysis. The pooled results showed that the levels of fibrinogen (SMD = 0.95, 95% CI = 0.26 to 1.65, P = .000), vascular endothelial growth factor (SMD = 0.37, 95% CI = −0.90 to 1.63, P = .000), and plasminogen activator inhibitor 1 (SMD = 0.61, 95% CI = 0.29 to 0.92, P = .040) increased in patients with OSA. There were no statistical differences between groups in terms of d-dimer ( P = .108) and platelet counts ( P = .233). Subgroup analyses demonstrated that specimen types and age could account for the heterogeneity. Conclusions and Significance: This meta-analysis indicated the relationship between prothrombotic factors in OSA hypopnea. Obstructive sleep apnea–related effects may underline the importance of considering the dysfunction of the hemostatic system. The prothrombotic factors in OSA can influence making a choice of appropriate therapy.

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High D-dimer levels after stopping anticoagulants in pulmonary embolism with sleep apnoea

Cited by 24 publications

References 42 publications

Obstructive sleep apnea is associated with worse clinical‐radiological risk scores of pulmonary embolism

Obstructive sleep apnea is associated with worse clinical‐radiological risk scores of pulmonary embolism

Outcomes of patients hospitalized for acute pulmonary embolism by obstructive sleep apnea status

Prothrombotic Factors in Obstructive Sleep Apnea: A Systematic Review With Meta-Analysis

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