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Risk factors for recurrent venous thromboembolism after unprovoked pulmonary embolism: the PADIS-PE randomised trial.
- Source :
-
The European respiratory journal [Eur Respir J] 2018 Jan 04; Vol. 51 (1). Date of Electronic Publication: 2018 Jan 04 (Print Publication: 2018). - Publication Year :
- 2018
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Abstract
- We aimed to identify risk factors for recurrent venous thromboembolism (VTE) after unprovoked pulmonary embolism.Analyses were based on the double-blind randomised PADIS-PE trial, which included 371 patients with a first unprovoked pulmonary embolism initially treated during 6 months who were randomised to receive an additional 18 months of warfarin or placebo and followed up for 2 years after study treatment discontinuation. All patients had ventilation/perfusion lung scan at inclusion ( i.e. at 6 months of anticoagulation).During a median follow-up of 41 months, recurrent VTE occurred in 67 out of 371 patients (6.8 events per 100 person-years). In main multivariate analysis, the hazard ratio for recurrence was 3.65 (95% CI 1.33-9.99) for age 50-65 years, 4.70 (95% CI 1.78-12.40) for age >65 years, 2.06 (95% CI 1.14-3.72) for patients with pulmonary vascular obstruction index (PVOI) ≥5% at 6 months and 2.38 (95% CI 1.15-4.89) for patients with antiphospholipid antibodies. When considering that PVOI at 6 months would not be available in practice, PVOI ≥40% at pulmonary embolism diagnosis (present in 40% of patients) was also associated with a 2-fold increased risk of recurrence.After a first unprovoked pulmonary embolism, age, PVOI at pulmonary embolism diagnosis or after 6 months of anticoagulation and antiphospholipid antibodies were found to be independent predictors for recurrence.<br />Competing Interests: Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com<br /> (Copyright ©ERS 2018.)
- Subjects :
- Aged
Antibodies, Antiphospholipid blood
Anticoagulants therapeutic use
Double-Blind Method
Female
Follow-Up Studies
Humans
Lung physiopathology
Male
Middle Aged
Multivariate Analysis
Perfusion
Proportional Hazards Models
Pulmonary Embolism complications
Recurrence
Risk Factors
Venous Thromboembolism complications
Warfarin therapeutic use
Pulmonary Embolism diagnosis
Venous Thromboembolism diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1399-3003
- Volume :
- 51
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- The European respiratory journal
- Publication Type :
- Academic Journal
- Accession number :
- 29301920
- Full Text :
- https://doi.org/10.1183/13993003.01202-2017