Risk of recurrent venous thromboembolism after acute pulmonary embolism: Role of residual pulmonary obstruction and persistent right ventricular dysfunction. A meta‐analysis

Becattini, Cecilia; Giustozzi, Michela; Cerdà, Pau; Cimini, Ludovica Anna; Riera‐Mestre, Antoni; Agnelli, Giancarlo

doi:10.1111/jth.14477

Cited by 30 publications

(18 citation statements)

References 49 publications

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“…In a recent meta-analysis, a twofold increased risk of recurrent VTE was observed in patients with RPVO. 21 In post hoc analysis of the PADIS-PE trial, we also found that PVOI measured at PE diagnosis was correlated with RPVO. 13,22 Since initial PVOI is easily measurable at PE diagnosis, our finding suggests that clinicians could use initial PVOI measurement instead of RPVO, and so spare patients one additional V/Q scan.…”

Section: Pulmonary Vascular Obstruction and Pulmonary Embolism Orionementioning

confidence: 56%

The Impact of Pulmonary Vascular Obstruction on the Risk of Recurrence of Pulmonary Embolism: A French Prospective Cohort

et al. 2021

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Background We aimed to assess whether high pulmonary vascular obstruction index (PVOI) measured at the time of pulmonary embolism (PE) diagnosis is associated with an increased risk of recurrent venous thromboembolism (VTE). Study Design and Methods French prospective cohort of patients with a symptomatic episode of PE diagnosed with spiral computerized tomography pulmonary angiography (CTPA) or ventilation-perfusion (V/Q) lung scan and a follow-up of at least 6 months after anticoagulation discontinuation. PVOI was assessed based on the available diagnostic exam (V/Q lung scan or CTPA). All patients had standardized follow-up and independent clinicians adjudicated all deaths and recurrent VTE events. Main outcome was recurrent VTE after stopping anticoagulation. Results A total of 418 patients with PE were included. During a median follow-up period of 3.6 (1.2–6.0) years, 109 recurrences occurred. In multivariate analysis, PVOI ≥ 40% was an independent risk factor for recurrence (hazard ratio 1.77, 95% confidence interval 1.20–2.62, p < 0.01), whether PE was provoked by a major transient risk factor or not. A threshold at 41% was identified as the best value associated with the risk of recurrence 6 months after stopping anticoagulation (area under curve = 0.64). Conclusion PVOI ≥ 40% at PE diagnosis was an independent risk factor for recurrence VTE. Further prospective validation studies are needed.

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Section: Pulmonary Vascular Obstruction and Pulmonary Embolism Orionementioning

confidence: 56%

The Impact of Pulmonary Vascular Obstruction on the Risk of Recurrence of Pulmonary Embolism: A French Prospective Cohort

et al. 2021

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“…Risk stratification for patients with unprovoked venous thromboembolism may also help to determine the risk of recurrent thrombosis. Prognostic markers of recurrent venous thromboembolism include male sex, advanced age,137138 inherited thrombophilia,70 obesity,70 persistently positive D-dimer,77139 and residual pulmonary obstruction on ventilation-perfusion lung scan 140. Individually, these risk factors are insufficient to recommend long term anticoagulation; however, risk prediction models incorporating various combinations have been proposed 137138.…”

Section: Duration Of Treatment For Pulmonary Embolismmentioning

confidence: 99%

Pulmonary embolism: update on management and controversies

Duffett

Castellucci

Forgie

2020

BMJ

139

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Pulmonary embolism is a common and potentially fatal cardiovascular disorder that must be promptly diagnosed and treated. The diagnosis, risk assessment, and management of pulmonary embolism have evolved with a better understanding of efficient use of diagnostic and therapeutic options. The use of either clinical probability adjusted or age adjusted D-dimer interpretation has led to a reduction in diagnostic imaging to exclude pulmonary embolism. Direct oral anticoagulation therapies are safe, effective, and convenient treatments for most patients with acute venous thromboembolism, with a lower risk of bleeding than vitamin K antagonists. These oral therapeutic options have opened up opportunities for safe outpatient management of pulmonary embolism in selected patients. Recent clinical trials exploring the use of systemic thrombolysis in intermediate to high risk pulmonary embolism suggest that this therapy should be reserved for patients with evidence of hemodynamic compromise. The role of low dose systemic or catheter directed thrombolysis in other patient subgroups is uncertain. After a diagnosis of pulmonary embolism, all patients should be assessed for risk of recurrent venous thromboembolism to guide duration of anticoagulation. Patients with a venous thromboembolism associated with a strong, transient, provoking risk factor can safely discontinue anticoagulation after three months of treatment. Patients with an ongoing strong risk factor, such as cancer, or unprovoked events are at increased risk of recurrent events and should be considered for extended treatment. The use of a risk prediction score can help to identify patients with unprovoked venous thromboembolism who can benefit from extended duration therapy. Despite major advances in the management of pulmonary embolism, up to half of patients report chronic functional limitations. Such patients should be screened for chronic thromboembolic pulmonary hypertension, but only a small proportion will have this as the explanation of their symptoms. In the remaining patients, future studies are needed to understand the pathophysiology and explore interventions to improve quality of life.

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“…The rate of RPO following an acute PE appears to depend on the size of the initial clot burden and is reported to be as high as 60% [26,27]. Many studies have now evaluated the utility of RPO in predicting recurrent PE in patients with an acute PE treated with at least three months of oral anticoagulation.…”

Section: Residual Pulmonary Obstructionmentioning

confidence: 99%

“…Pesavento et al showed that, in patients with RPO, 25/324 (7.7%) developed recurrent VTE versus 15/323 (4.6%) in patients without RPO, and RPO was found to be an independent predictor of both VTE recurrence and CTEPH (hazard ratio (HR) 2.26, 95% confidence interval (CI) 1.23-4.16, p = 0.009) [29]. Furthermore, a recent meta-analysis evaluating RPO and recurrent VTE determined that RPO was associated with an increased risk of recurrent VTE detected by VQ scan (odds ratio (OR) 2.22, 95% CI 1.61-3.05) [26]. These findings demonstrate that RPO detection following acute PE may increase the risk of recurrent VTE, but as the overall rate of recurrence in this cohort remains relatively low, its utility in predicting the likelihood of recurrent events is minimal, and it should not be used primarily for this purpose.…”

Section: Residual Pulmonary Obstructionmentioning

confidence: 99%

Predicting the Risk of Recurrent Venous Thromboembolism: Current Challenges and Future Opportunities

Stevens

Peter

Tran

et al. 2020

JCM

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Acute venous thromboembolism (VTE) is a commonly diagnosed condition and requires treatment with anticoagulation to reduce the risk of embolisation as well as recurrent venous thrombotic events. In many cases, cessation of anticoagulation is associated with an unacceptably high risk of recurrent VTE, precipitating the use of indefinite anticoagulation. In contrast, however, continuing anticoagulation is associated with increased major bleeding events. As a consequence, it is essential to accurately predict the subgroup of patients who have the highest probability of experiencing recurrent VTE, so that treatment can be appropriately tailored to each individual. To this end, the development of clinical prediction models has aided in calculating the risk of recurrent thrombotic events; however, there are several limitations with regards to routine use for all patients with acute VTE. More recently, focus has shifted towards the utility of novel biomarkers in the understanding of disease pathogenesis as well as their application in predicting recurrent VTE. Below, we review the current strategies used to predict the development of recurrent VTE, with emphasis on the application of several promising novel biomarkers in this field.

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Risk of recurrent venous thromboembolism after acute pulmonary embolism: Role of residual pulmonary obstruction and persistent right ventricular dysfunction. A meta‐analysis

Cited by 30 publications

References 49 publications

The Impact of Pulmonary Vascular Obstruction on the Risk of Recurrence of Pulmonary Embolism: A French Prospective Cohort

The Impact of Pulmonary Vascular Obstruction on the Risk of Recurrence of Pulmonary Embolism: A French Prospective Cohort

Pulmonary embolism: update on management and controversies

Predicting the Risk of Recurrent Venous Thromboembolism: Current Challenges and Future Opportunities

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