Influence of recent immobilization and recent surgery on mortality in patients with pulmonary embolism

Abstract

To cite this article: Nauffal D, Ballester M, Reyes RLó pez, Jimé nez D, Otero R, Quintavalla R, Monreal M, the RIETE investigators. Influence of recent immobilization and recent surgery on mortality in patients with pulmonary embolism. J Thromb Haemost 2012; 10: 1752-60.Summary. Background: The influence of recent immobilization or surgery on mortality in patients with pulmonary embolism (PE) is not well known. Methods: We used the Registro Informatizado de Enfermedad TromboEmbo´lica (RIETE) data to compare the 3-month mortality rate in patients with PE, with patients categorized according to the presence of recent immobilization, recent surgery, or neither. Results: Of 18 028 patients with PE, 4169 (23%) had recent immobilization, 2212 (12%) had recent surgery, and 11 647 (65%) had neither. The all-cause mortality was 10.0% (95% confidence interval [CI] 9.5-10.4), and the PE-related mortality was 2.6% (95% CI 2.4-2.9). One in every two patients who died from PE had recent immobilization (43%) or recent surgery (6.7%). Only 25% of patients with immobilization had received prophylaxis, as compared with 65% of the surgical patients. Fatal PE was more common in patients with recent immobilization (4.9%; 95% CI 4.3-5.6) than in those with surgery (1.4%; 95% CI 1.0-2.0) or those with neither (2.1%; 95% CI 1.8-2.3). On multivariate analysis, patients with immobilization were at increased risk for fatal PE (odds ratio 2.2; 95% CI 1.8-2.7), with no differences being seen between patients immobilized in hospital or in the community. Conclusions: Forty-three per cent of patients dying from PE had recent immobilization for ‡ 4 days. Many of these deaths could have been prevented.

Predictors of Long-Term Mortality in Older People With Hip Fracture

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Sex Differences in Patients Receiving Anticoagulant Therapy for Venous Thromboembolism

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Identification of Low-Risk Patients with Acute Symptomatic Pulmonary Embolism for Outpatient Therapy

“…[1][2][3][4][5] In normotensive patients with PE, stratification may be assessed using the Pulmonary Embolism Severity Index (PESI) or its simplified version (sPESI). 8 In the only study evaluating the prognostic value of PESI and sPESI to identify PE patients at low risk of adverse events within the first five days of therapy, nine of 109 patients classified as low risk according to PESI had an adverse clinical event within the first five days after the diagnosis. However, clinical care should be based on a broader set of medical outcomes than just mortality, and only half of PE patients dying within the first 30 days had a PE-related death.…”