The outcome after treatment of venous thromboembolism is different in surgical and acutely ill medical patients. Findings from the RIETE registry

Monréal, Manuel; Kakkar, Ajay K.; Caprini, Joseph A.; Barba, Raquel; Uresandi, Fernando; Valle, Reina; Suárez, Carmen; Otero, Remedios

doi:10.1111/j.1538-7836.2004.01012.x

Cited by 164 publications

(121 citation statements)

References 17 publications

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“…The present study used a retrospective cohort design to assess data from patients enrolled in the Registro Informatizado de la Enfermedad TromboEmbo´lica (RIETE registry) [8,9].…”

Section: Methodsmentioning

confidence: 99%

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Thrombolytic therapy and outcome of patients with an acute symptomatic pulmonary embolism

Riera-Mestre

Jiménez

Muriel

et al. 2012

Journal of Thrombosis and Haemostasis

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Summary. Background: While the primary therapy for most patients with a pulmonary embolism (PE) consists of anticoagulation, the efficacy of thrombolysis relative to standard therapy remains unclear. Methods: In this retrospective cohort study of 15 944 patients with an objectively confirmed symptomatic acute PE, identified from the multicenter, international, prospective, Registro Informatizado de la Enfermedad TromboEmbo´lica (RIETE registry), we aimed to assess the association between thrombolytic therapy and all-cause mortality during the first 3 months after the diagnosis of a PE. After creating two subgroups, stratified by systolic blood pressure (SBP) (< 100 mm Hg vs. other), we used propensity scorematching for a comparison of patients who received thrombolysis to those who did not in each subgroup. Results: Patients who received thrombolysis were younger, had fewer comorbid diseases and more signs of clinical severity compared with those who did not receive it. In the subgroup with systolic hypotension, analysis of propensity score-matched pairs (n = 94 pairs) showed a non-statistically significant but clinically relevant lower risk of death for thrombolysis compared with no thrombolysis (odds ratio [OR] 0.72; 95% confidence interval [CI], 0.36-1.46; P = 0.37). In the normotensive subgroup, analysis of propensity score-matched pairs (n = 217 pairs) showed a statistically significant and clinically meaningful increased risk of death for thrombolysis compared with no thrombolysis (OR 2.32; 95% CI, 1.15-4.68; P = 0.018). When we imputed data for missing values for echocardiography and troponin tests in the group of normotensive patients, we no longer detected the increased risk of death associated with thrombolytic therapy. Conclusions: In normotensive patients with acute symptomatic PE, thrombolytic therapy is associated with a higher risk of death than no thrombolytic therapy. In hemodynamically unstable patients, thrombolytic therapy is possibly associated with a lower risk of death than no thrombolytic therapy. However, study design limitations do not imply a causal relationship between thrombolytics and outcome.

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“…The present study used a retrospective cohort design to assess data from patients enrolled in the Registro Informatizado de la Enfermedad TromboEmbo´lica (RIETE registry) [8,9].…”

Section: Methodsmentioning

confidence: 99%

“…The study analyzed data from patients with a symptomatic acute venous thromboembolism (VTE) enrolled in an international, multicenter, prospective registry [8,9].…”

Section: Introductionmentioning

confidence: 99%

Thrombolytic therapy and outcome of patients with an acute symptomatic pulmonary embolism

Riera-Mestre

Jiménez

Muriel

et al. 2012

Journal of Thrombosis and Haemostasis

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“…To this end, we analyzed data from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry, focusing on patients with symptomatic isolated distal and proximal DVT [17,18]. Each DVT was managed according to each physicianÕs usual clinical practise.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the clinical history of symptomatic isolated distal deep‐vein thrombosis vs. proximal deep vein thrombosis in 11 086 patients

Galanaud

Quenet²,

Rivron-Guillot

et al. 2009

Journal of Thrombosis and Haemostasis

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Summary. Background: The clinical significance of symptomatic isolated distal deep vein thrombosis (DVT) is uncertain. Consequently, this leads to important disparities in its management. Objective: To examine the clinical history of isolated distal DVT and to compare it with that of proximal DVT. Methods: Using data from the international, prospective, RIETE registry on patients with confirmed symptomatic venous thromboembolism (VTE), we compared the risk factors and 3‐month outcome in patients with isolated distal DVT vs. proximal DVT. Results: Eleven thousand and eighty‐six patients with symptomatic DVT, but without pulmonary embolism, were included between 2001 and 2008; 1921 (17.3%) exhibited isolated distal DVT. Anticoagulant treatment was received by 89.1% (1680/1885) of isolated distal DVT and 91.8% (7911/8613) of proximal DVT patients for the entire follow‐up period. Isolated distal DVTs were more associated with transient risk factors (i.e. recent travel, hospitalization, recent surgery), whereas proximal DVTs were more associated with chronic states (i.e. ≥75 years or with active cancer). At 3 months, major bleeding rate was lower in patients with isolated distal DVT (1.0% vs. 2.2%, P < 0.01), whereas VTE recurrence rate was equivalent (2.0% vs. 2.7%, P = 0.07). The mortality rate was lower in patients with isolated distal DVT (2.7% vs. 7.5%; P < 0.001); this was mainly due to a lower rate of non‐VTE‐related deaths (2.2% vs. 6.3%; P < 0.001). Active cancer was the main predictive factor of death in patients with isolated distal DVT. Conclusions: Proximal and isolated distal DVT patients differ in terms of risk factors and clinical outcomes, suggesting different populations. In the short term, the life expectancy of patients with isolated distal DVT depended chiefly on their cancer status.

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“…Although less well characterized, hospitalization for medical illness may also be associated with a low to moderate risk of venous thromboembolism, with 50-70% of symptomatic venous thromboembolism and 70-80% of fatal pulmonary embolism occurring in nonsurgical patients [1]. Furthermore, the prognosis of the disease is worse in medical than in surgical patients [3]. Consequently, on the grounds of the results of several trials [4][5][6], pharmacological thromboprophylaxis in hospitalized bedridden patients for an acute medical illness with additional thrombosis risk factors is recommended by experts and international consensus guidelines [1,7].…”

Section: Introductionmentioning

confidence: 99%

A prospective observational study of a cohort of outpatients with an acute medical event and reduced mobility: incidence of symptomatic thromboembolism and description of thromboprophylaxis practices

Bosson¹,

Pouchain²,

Bergmann³

2006

Journal of Internal Medicine

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The outcome after treatment of venous thromboembolism is different in surgical and acutely ill medical patients. Findings from the RIETE registry

Cited by 164 publications

References 17 publications

Thrombolytic therapy and outcome of patients with an acute symptomatic pulmonary embolism

Thrombolytic therapy and outcome of patients with an acute symptomatic pulmonary embolism

Comparison of the clinical history of symptomatic isolated distal deep‐vein thrombosis vs. proximal deep vein thrombosis in 11 086 patients

A prospective observational study of a cohort of outpatients with an acute medical event and reduced mobility: incidence of symptomatic thromboembolism and description of thromboprophylaxis practices

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