V.I. Tseluyko, S.M. Sukhova, L.M. Yakovleva, K.Yu. Kinoshenko Factors associated with unfavorable long-term prognosis in patients with acute pulmonary embolism

The aim – to investigate the possible relation between anamnestic, instrumental, laboratory indicators and venous thromboembolism (VTE) recurrence and bleeding in patients with pulmonary embolism (PE) within 4 months after discharge from the hospital.

Material and methods. The study involved 104 patients with acute PE. Intra-hospital mortality was 13.5 % (14 patients that died were excluded from further analysis). All patients were examined by TTE, 2D STE and venous duplex ultrasound (VDU); indicators were assessed at the first day and after anticoagulant therapy. Anticoagulant therapy was prescribed by envelope method: rivaroxaban or warfarin. VTE recurrence was defined as the appearance of new signs of venous thrombosis according to the data of the VDU and/or computed tomography pulmonary angiography. The assessment of the severity of the bleeding was performed by the TIMI scale.

Results. In the group of patients with recurrent VTE, there were significantly more cases of the observe varicose veins (Р=0.02) with thrombosis localized in the proximal veins (Р=0.03), atrial fibrillation (Р=0.01) and earlier VTE (Р=0.05). Patients in this group were more likely to report hemodynamic disorders: low systolic pressure (Р=0.03), high systolic pulmonary artery pressure (Р=0.03), and segmental fraction of the apical RV segment release less than 65 %, as a sign of right ventricular dysfunction (Р=0.01). The bleedings occurred in 11.1 % of patients during anticoagulant therapy. Among them, there were significantly more patients with arterial hypertension (Р=0.03). In addition, the risk of bleeding is associated with use of drugs, such as streptokinase (Р=0.03) and warfarin (Р=0.03).

Conclusions. VTE reoccurred in 6.7 % (bleeding – 11.1 %) of patients with pulmonary embolism during anticoagulant therapy during 4.2±1.9 months after discharge from hospital. In patients with PE, VTE reoccurrence (regression analysis) is due to the presence of factors (39.6 % (Р<0.05)), such as femoral vein thrombosis (according to VDU), atrial fibrillation, varicose veins, earlier PE episodes; the value of segmental fraction of the apical RV segment release is less than 65 % based on 2D STE. According to regression analysis, the risk of bleeding occurrence is related to the presence of arterial hypertension (8.2 %, Р=0.007), the use of warfarin (8.5 %, Р=0.007) and streptokinase (7.9 %, Р=0.01).

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