The Prognostic Value of Syncope on Mortality in Patients With Pulmonary Embolism: A Systematic Review and Meta-analysis

Winter, Maria A. de; Bergen, Eline D P van; Welsing, Paco; Kraaijeveld, Adriaan O.; Kaasjager, Karin; Nijkeuter, Mathilde

doi:10.1016/j.annemergmed.2020.03.026

Cited by 12 publications

(13 citation statements)

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“…The association between syncope and outcomes in patients with acute pulmonary embolism (PE) is controversial. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] In a recent study using data from the RIETE registry, we found that the presence of syncope at baseline predicted the risk for major bleeding during the first 30 days in PE patients receiving thrombolytic drugs. 16 Another group recently identified syncope as a predictor for the occurrence of early major bleeding (during the hospital stay).…”

Section: Introductionmentioning

confidence: 83%

“…One in every 7 patients in our cohort (15%) presented with syncope, and these patients were more likely to present with haemodynamic instability than those without syncope, as previously reported. 13,14 Interestingly, 51% of the major bleeds and 53% of the fatal bleeds in patients with syncope appeared during the first 7 days (when most PE patients are still in hospital), as compared to 35% and 29%, respectively, in those without syncope.…”

Section: Discussionmentioning

confidence: 99%

“…The association between syncope and outcomes in patients with acute pulmonary embolism (PE) is controversial 1‐15 . In a recent study using data from the RIETE registry, we found that the presence of syncope at baseline predicted the risk for major bleeding during the first 30 days in PE patients receiving thrombolytic drugs 16 .…”

Section: Introductionmentioning

confidence: 99%

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Major bleeding in patients with pulmonary embolism presenting with syncope

Maestre-Peiró

Escribano

Lobo

et al. 2022

Eur J Clin Investigation

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Introduction Syncope has been shown to be a risk factor of bleeding in patients receiving thrombolytic therapy for acute pulmonary embolism (PE). Whether syncope predicts bleeding in a broader population of patients with PE remains unknown. Methods We used the RIETE registry data to assess whether initial presentation with syncope could predict bleeding in PE patients receiving anticoagulant therapy, and to explore the association between presence of syncope and timing and site of major bleeding events. Results Among 45,765 patients with acute PE from March 2001 to January 2021, 6760 (14.8%) had syncope. Patients with syncope were older and more likely to have hypotension, tachycardia, hypoxaemia or elevated troponin levels than those without syncope. They also were more likely to receive thrombolytics. During the first 90 days, 1097 patients (2.4%) suffered major bleeding (gastrointestinal 335, hematoma 271 and intracranial 163) and 3611 died (158 had fatal bleeding). Patients with syncope had a higher rate of major bleeding (odds ratio [OR]: 1.63; 95% CI: 1.41–1.89) and a nonsignificantly higher rate of fatal bleeding (OR: 1.47; 95% CI: 0.99–2.17) than those without syncope. Multivariable analysis confirmed that patients with syncope were at increased risk for major bleeding (adjusted hazard ratio [aHR]: 1.34; 95% CI: 1.15–1.55). On sensitivity analysis, the increased risk for major bleeding was confirmed in patients initially receiving anticoagulant therapy without thrombolytics at 7 days (aHR: 1.47; 95% CI: 1.13–1.91) and 90 days (aHR: 1.33; 95%CI: 1.13–1.56). Discussion Syncope is a predictor of major bleeding events in patients with PE, even among those receiving anticoagulation monotherapy.

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Section: Introductionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Major bleeding in patients with pulmonary embolism presenting with syncope

Maestre-Peiró

Escribano

Lobo

et al. 2022

Eur J Clin Investigation

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“…Syncope is the most common symptom of a pulmonary embolism, maybe the only or earliest sign, and is most often accompanied by hypotension, right heart failure, and hypoxemia. The association between syncope and short-term mortality in patients with pulmonary embolism is due to a difference in hemodynamic instability, emphasizing the importance of risk strati cation by hemodynamic status in patients with and without syncope [2] . Our patient was assessed to be a low-risk patient based on favorable vital signs, stable blood ow dynamics, and normal levels of cardiac markers [3] .…”

Section: Discussionmentioning

confidence: 99%

Acute upper gastrointestinal hemorrhage with acute pulmonary embolism: A difficult decision?

Che

Chu

Zhang

et al. 2022

Preprint

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Upper gastrointestinal hemorrhage and pulmonary embolism are potentially life-threatening conditions with high morbidity and mortality, However, acute upper gastrointestinal hemorrhage with acute pulmonary embolism (APE) is rare, and whether anti-coagulation is a difficult choice for doctors. We report the case of a 70-year-old man with a 3-day history of abdominal pain accompanied by a black stool, He was admitted to our department, then, he was diagnosed with gastric ulcers, and he suffered from a near-syncopal episode accompanied by heavy sweating. Computed tomography pulmonary angiography (CTPA) revealed a partial embolism in the two side pulmonary arteries. Anticoagulant treatment was performed after a complete hematologic assessment for 20 days. The patient improved and was discharged home on warfarin anticoagulation for 3 months without any complications. For patients with a high bleeding risk of pulmonary embolism, clinicians should evaluate adequately before deciding to take anticoagulant therapy.

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“…According to the patients included in our study, the most common symptoms of TPE were cough (74.6%), fever (51.7%), chest pain (50.8%), and dyspnoea (49.6%). Chest pain, haemoptysis, and dyspnoea consist of the PE triad without specificity [ 10 ]. When PE co-occurs with TPE, the symptoms are more complicated.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of D-dimer in predicting pulmonary embolism in tuberculous pleural effusion patients

Qin²,

et al. 2021

BMC Pulm Med

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Background Tuberculous pleural effusion (TPE) patients usually have elevated D-dimer levels. The diagnostic performance of D-dimer in predicting pulmonary embolism (PE) in the TPE population is unclear. This study aimed to assess the diagnostic performance of D-dimer for PE in the TPE population and explore its potential mechanism. Methods We retrospectively analysed patients who were admitted to Xinhua Hospital and Weifang Respiratory Disease Hospital with confirmed TPE between March 2014 and January 2020. D-dimer levels were compared between patients with and without PE. To test the diagnostic performance of D-dimer in predicting PE, receiver operating characteristic curve analysis was performed. Positive predictive value (PPV) and negative predictive value (NPV) were also reported. To explore the potential mechanism of PE in TPE, inflammatory biomarkers were compared between PE and non-PE patients. Results This study included 248 patients (170 males and 78 females) aged 43 ± 20.6 years. Elevated D-dimer levels (≥ 0.5 mg/L) were detected in 186/248 (75%) patients. Of the 150 patients who underwent computed tomography pulmonary angiography, 29 were diagnosed with PE. Among the TPE population, the PE patients had significantly higher D-dimer levels than the non-PE patients (median, 1.06 mg/L vs. 0.84 mg/L, P < 0.05). The optimal cut-off value for D-dimer in predicting PE in TPE was 1.18 mg/L, with a sensitivity of 89.7% and a specificity of 77.8% (area under curve, 0.893; 95% confidence interval 0.839–0.947; P < 0.01). The PPV was 49.1%, while the NPV was 96.9% at a D-dimer cut-off of 1.18 mg/L for PE. PE patients had lower median WBC and interleukin (IL)-8 values (5.14 × 109/L vs. 6.1 × 109/L, P < 0.05; 30.2 pg/ml vs. 89.7 pg/ml, P < 0.05) but a higher median IL-2 receptor value (1964.8 pg/ml vs. 961.2 pg/ml, P < 0.01) than those in the non-PE patients. Conclusions D-dimer is an objective biomarker for predicting PE in patients with TPE. A D-dimer cut-off of 1.18 mg/L in the TPE population may reduce unnecessary radiological tests due to its excellent sensitivity, specificity, and NPV for PE. The imbalance of prothrombotic and antithrombotic cytokines may partly be attributed to the formation of pulmonary emboli in patients with TPE.

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The Prognostic Value of Syncope on Mortality in Patients With Pulmonary Embolism: A Systematic Review and Meta-analysis

Cited by 12 publications

References 50 publications

Major bleeding in patients with pulmonary embolism presenting with syncope

Major bleeding in patients with pulmonary embolism presenting with syncope

Acute upper gastrointestinal hemorrhage with acute pulmonary embolism: A difficult decision?

Diagnostic performance of D-dimer in predicting pulmonary embolism in tuberculous pleural effusion patients

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