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D-dimer levels and 90-day outcome in patients with acute pulmonary embolism with or without cancer.

Thromb Res. 2014 Jan 6;

Authors: Maestre A, Trujillo-Santos J, Visoná A, Lobo JL, Grau E, Malý R, Duce R, Monreal M, The RIETE Investigators

Abstract
BACKGROUND: The prognostic value of D-dimer testing in patients with acute pulmonary embolism (PE) has not been thoroughly studied.
METHODS: We used the RIETE Registry data to assess the 90-day prognostic value of increased IL Test D-dimer® levels at baseline in patients with PE, according to the presence or absence of cancer.
RESULTS: As of May 2013, 3,283 patients with acute PE underwent D-dimer testing using IL Test D-dimer®. Among 2,588 patients without cancer, those with D-dimer levels in the highest quartile had a higher rate of fatal PE (2.6% vs. 0.9%; p=0.002), fatal bleeding (1.1% vs. 0.3%; p=0.017) and all-cause death (9.1% vs. 4.4%; p<0.001) at 90days compared with those with levels in the lowest quartiles. Among 695 patients with cancer, those with levels in the highest quartile had a similar rate of fatal PE or fatal bleeding but higher mortality (35% vs. 24%; p<0.01). On multivariate analysis, non-cancer patients with D-dimer levels in the highest quartile had an increased risk for fatal PE (odds ratio [OR]: 3.3; 95% CI: 1.6-6.6), fatal bleeding (OR: 4.3; 95% CI: 1.4-13.7) and all-cause death (OR: 2.1; 95% CI: 1.4-3.1) compared with patients with levels in the lowest quartiles.
CONCLUSIONS: Non-cancer patients with acute PE and IL Test D-dimer® levels in the highest quartile had an independently higher risk for fatal PE, fatal bleeding and all-cause death at 90days than those with levels in the lowest quartiles. In patients with cancer, D-dimer levels failed to predict fatal PE or fatal bleeding.

PMID: 24438941 [PubMed - as supplied by publisher]

Related Articles

Home versus in-hospital treatment of outpatients with acute deep venous thrombosis of the lower limbs.

J Vasc Surg. 2014 Jan 15;

Authors: Lozano F, Trujillo-Santos J, Barrón M, Gallego P, Babalis D, Santos M, Falgá C, Monreal M, the RIETE Investigators

Abstract
BACKGROUND: Some physicians are still concerned about the safety of treatment at home of patients with acute deep venous thrombosis (DVT).
METHODS: We used data from the RIETE (Registro Informatizado de la Enfermedad TromboEmbólica) registry to compare the outcomes in consecutive outpatients with acute lower limb DVT according to initial treatment at home or in the hospital. A propensity score-matching analysis was carried out with a logistic regression model.
RESULTS: As of December 2012, 13,493 patients had been enrolled. Of these, 4456 (31%) were treated at home. Patients treated at home were more likely to be male and younger and to weigh more; they were less likely than those treated in the hospital to have chronic heart failure, lung disease, renal insufficiency, anemia, recent bleeding, immobilization, or cancer. During the first week of anticoagulation, 27 patients (0.20%) suffered pulmonary embolism (PE), 12 (0.09%) recurrent DVT, and 51 (0.38%) major bleeding; 80 (0.59%) died. When only patients treated at home were considered, 12 (0.27%) had PE, 4 (0.09%) had recurrent DVT, 6 (0.13%) bled, and 4 (0.09%) died (no fatal PE, 3 fatal bleeds). After propensity analysis, patients treated at home had a similar rate of venous thromboembolism recurrences and a lower rate of major bleeding (odds ratio, 0.4; 95% confidence interval, 0.1-1.0) or death (odds ratio, 0.2; 95% confidence interval, 0.1-0.7) within the first week compared with those treated in the hospital.
CONCLUSIONS: In outpatients with DVT, home treatment was associated with a better outcome than treatment in the hospital. These data may help safely treat more DVT patients at home.

PMID: 24439322 [PubMed - as supplied by publisher]

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Clinical course and predictive factors for complication of inferior vena cava filters.

Thromb Res. 2014 Jan 9;

Authors: Lee JK, So YH, Choi YH, Park SS, Heo EY, Kim DK, Chung HS

Abstract
RATIONALE: The use of inferior vena cava (IVC) filters is associated with various complications. We aimed to elucidate the clinical course and predictive factors for complications of IVC filters, especially IVC penetration METHODS: A retrospective observational study was performed in 45 adult patients with retrievable IVC filters and follow-up computed tomography (CT) between January 2003 and December 2012. Primary outcomes were the prevalence and predictive factors of IVC penetration. Secondary outcome was other complications of IVC filters.
RESULTS: IVC penetration following filter placement occurred in 87.6% of patients, and 57.8% of those involved significant penetration. Embedding of filter tips, suggestive of lateral tilting, was observed in 51.1%. Both Vertebral body erosions and aortic penetrations were seen in 4.4%, but they were asymptomatic. Longer indwelling duration of the IVC filter was significantly associated with a higher grade of IVC penetration, and the risk of significant IVC penetration increased in patients with the filter indwelling time of more than 20 days and an IVC diameter of less than 24.2mm.
CONCLUSIONS: In patients with a retrievable IVC filter, IVC penetration on CT was common, and significant IVC penetration was associated with a longer indwelling time of the IVC filter and a lesser IVC diameter.

PMID: 24448057 [PubMed - as supplied by publisher]

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Incidence and predictors of venous thromboembolism recurrence after a first isolated distal deep-vein thrombosis.

J Thromb Haemost. 2014 Jan 22;

Authors: Galanaud JP, Sevestre MA, Genty C, Kahn SR, Pernod G, Rolland C, Diard A, Dupas S, Jurus C, Diamand JM, Quere I, Bosson JL, The OPTIMEV-SFMV investigators

Abstract
BACKGROUND: Isolated distal deep-vein thrombosis (iDDVT) (i.e. without proximal DVT or pulmonary embolism (PE)) represents half of all lower limb DVT. Its clinical significance and management are controversial. Data on long-term follow-up are scarce, especially concerning risk and predictors of venous thromboembolism (VTE) recurrence.
METHODS: Using data from the OPTIMEV study, a prospective, observational, multicentre study, we compared, three years after an index VTE event and after discontinuation of anticoagulants, i) the incidence and type of recurrence in patients without cancer with a first iDDVT vs. a first isolated proximal deep-vein thrombosis (iPDVT); ii) predictors of recurrence after iDDVT.
RESULTS: As compared with patients with iPDVT (n=259), patients with an iDDVT (n=490) had a lower annualized incidence of overall VTE recurrence (5.2% [3.6-7.6] vs. 2.7% (95% CI) [1.9-3.8]) respectively, p=0.02) but a similar incidence of PE recurrence (1.0% [0.5-2.3] vs. 0.9% [0.5-1.6] respectively, p=0.83). An Age>50 years, unprovoked character of index iDDVT, and involvement of more than one vein in one or both legs each independently tripled the risk of recurrence, this latter being then ≥3% per patient-year. Neither muscular vein nor deep-calf vein location of iDDVT nor clot diameter with compression influenced the risk of recurrence.
CONCLUSION: After stopping anticoagulants, patients with iDDVT have a significantly lower risk of overall VTE recurrence than patients with iPDVT, but a similar risk of serious recurrent VTE. Age>50, unprovoked iDDVT, and number of thrombosed veins (>1) influenced the risk of recurrence and may help to define patients at significant risk of recurrence. This article is protected by copyright. All rights reserved.

PMID: 24450376 [PubMed - as supplied by publisher]