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Study examines long-term outcomes following blood clots
February 26, 2008Patients who develop a blood clot in their legs (deep vein thrombosis) or lungs (pulmonary embolism) are at risk for experiencing another blood clot within three years, and patients with pulmonary embolism have a higher risk of death, according to a report in the February 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Deep vein thrombosis and pulmonary embolism are considered different manifestations of the same disease process, according to background information in the article. The medical management of both conditions, known collectively as venous thromboembolism, has improved in the past decade, the authors note.
Frederick A. Spencer, M.D., of McMaster University Medical Center, Hamilton, Ontario, Canada, and colleagues analyzed the medical records of 1,691 Worcester, Mass., residents (54 percent women, average age 65) who were diagnosed with venous thromboembolism in 1999, 2001 or 2003. Of those, 549 had pulmonary embolism and 1,142 had isolated deep vein thrombosis.
Over the three-year study, among the 549 patients who presented with pulmonary embolism, 31 (5.7 percent) had a recurrent clot in the lung, 75 (13.7 percent) had a recurrence of either type of venous thromboembolism and 82 (14.9 percent) experienced a major bleeding episode (i.e., so severe they required a transfusion). Among the 1,142 patients who presented with isolated deep vein thrombosis over the same period, 64 (5.6 percent) developed a pulmonary embolism, 217 (19 percent) had recurrent venous thromboembolism and 146 (12.8 percent) had a major bleeding episode.
Individuals with pulmonary embolism were more likely to die after one month (13 percent vs. 5.4 percent), one year (26 percent vs. 20.3 percent) and three years (35.3 percent vs. 29.6 percent) than those with deep vein thrombosis. "Patients whose course was complicated by major bleeding were more likely to experience recurrent venous thromboembolism or to die at three years than those without these complications," the authors write.
"Patients who presented with pulmonary embolism had similar rates of subsequent pulmonary embolism or recurrent venous thrombosis compared with patients with isolated deep vein thrombosis," the authors conclude. "However, rates of recurrent venous thromboembolism and major bleeding after deep vein thrombosis and pulmonary embolism remain unacceptably high in the community setting. Efforts are needed to identify patients most at risk for venous thrombosis-associated complications and to develop better anticoagulation strategies conducive to long-term use in the community setting."
JAMA and Archives Journals
Over the three-year study, among the 549 patients who presented with pulmonary embolism, 31 (5.7 percent) had a recurrent clot in the lung, 75 (13.7 percent) had a recurrence of either type of venous thromboembolism and 82 (14.9 percent) experienced a major bleeding episode (i.e., so severe they required a transfusion). Among the 1,142 patients who presented with isolated deep vein thrombosis over the same period, 64 (5.6 percent) developed a pulmonary embolism, 217 (19 percent) had recurrent venous thromboembolism and 146 (12.8 percent) had a major bleeding episode.
Individuals with pulmonary embolism were more likely to die after one month (13 percent vs. 5.4 percent), one year (26 percent vs. 20.3 percent) and three years (35.3 percent vs. 29.6 percent) than those with deep vein thrombosis. "Patients whose course was complicated by major bleeding were more likely to experience recurrent venous thromboembolism or to die at three years than those without these complications," the authors write.
"Patients who presented with pulmonary embolism had similar rates of subsequent pulmonary embolism or recurrent venous thrombosis compared with patients with isolated deep vein thrombosis," the authors conclude. "However, rates of recurrent venous thromboembolism and major bleeding after deep vein thrombosis and pulmonary embolism remain unacceptably high in the community setting. Efforts are needed to identify patients most at risk for venous thrombosis-associated complications and to develop better anticoagulation strategies conducive to long-term use in the community setting."
JAMA and Archives Journals
Pulmonary Embolism Current Events and Pulmonary Embolism News RSSWhen seconds count: Interventional radiology treatment for pulmonary embolism saves lives
Catheter-directed therapy or catheter-directed thrombolysis-an interventional radiology treatment that uses targeted image-guided drug delivery with specially designed catheters to dissolve dangerous blood clots in the lungs-saves lives and should be considered a first-line treatment option for massive pulmonary embolism, note researchers in the November Journal of Vascular and Interventional Radiology.
Drugs to treat anemia in cancer patients linked to thromboembolism
Medications frequently given to cancer patients to reduce their risk of anemia are associated with an increased risk of deep vein thrombosis or pulmonary embolism, according to new research led by Dawn Hershman, M.D, M.S., co-director of the breast cancer program at the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian Hospital/Columbia University Medical Center.
Study shows hormone replacement therapy decreases mortality in younger postmenopausal woman
Hormone replacement therapy (HRT) to treat menopausal estrogen deficiency has been in widespread use for over 60 years. Several observational studies over the years showed that HRT use by younger postmenopausal women was associated with a significant reduction in total mortality; available evidence supported the routine use of HRT to increase longevity in postmenopausal women.
Stanford study recommends change in treating pulmonary embolisms
William Kuo, MD, was the on-call interventional radiologist one Friday night three years ago when he received a call from the intensive care unit at Stanford Hospital & Clinics.
Lung scintigraphy more reliable than CTA in excluding pulmonary embolism in pregnant patients
A medical imaging procedure known as lung scintigraphy may be more reliable than pulmonary CT angiography (CTA) for identifying or excluding pulmonary embolism (PE) in pregnant patients.
Clots traveling from lower veins may not be the cause of pulmonary embolism in trauma patients
A report from a team of Massachusetts General Hospital (MGH) physicians calls into question the longstanding belief that pulmonary embolism (PE) - the life-threatening blockage of a major blood vessel in the lungs - is caused in trauma patients by a blood clot traveling from vessels deep within the legs or lower torso.
Blood clots in lungs might not always originate in deep veins of legs and pelvis in trauma patients
Few trauma patients who develop potentially deadly blood clots in the lungs (pulmonary embolism) also have clots in the deep veins of their pelvis and legs (deep venous thrombosis), challenging commonly held beliefs about the association between the two conditions.
U-M researchers find those with severe H1N1 at risk for pulmonary emboli
University of Michigan researchers have found that patients with severe cases of the H1N1 virus are at risk for developing severe complications, including pulmonary emboli, according to a study published today in the American Journal of Roentgenology.
CT scans show patients with severe cases of H1N1 are at risk for developing acute pulmonary emboli
Researchers utilizing computed tomography (CT) scans have found that patients with severe cases of the H1N1 virus are at risk for developing severe complications, including pulmonary emboli (PE).
Pulmonary CT angiography identifies disease and injury beyond the pulmonary arteries in children
Computed tomography angiography (CTA) can identify abnormalities and injury beyond the pulmonary arteries, including broken bones and heart disease, according to a study published in the September issue of the American Journal of Roentgenology (AJR)
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