PE Mortality Research Articles

30: The efficacy of prophylactic IVC filter in bariatric surgery

This is a retrospective study of all patients in the Hurley Bariatric Center database who underwent surgery between April 2000 and June 2006. This study compared the incidence of DVT, PE and all-cause peri-operative mortality in patients who received prophylactic IVC filters and those who did not. Patients received prophylactic filters for risk factors identified in their pre-operative evaluation.

Clinical Outcome of Patients with Venous Thromboembolism and Recent Major Bleeding: Findings from a Prospective Registry (RIETE).

Introduction Patients who have experienced a recent major bleeding episode are usually excluded from clinical trials of venous thromboembolism (VTE) treatment. Therefore, recommendations based on evidence from clinical trials of VTE treatment may not be optimal for these patients. The Registro Informatizado de la Enfermedad TromboEmbólica (RIETE), initiated in March 2001, is a multicenter, observational registry gathering data on VTE treatment practices and clinical outcomes in patients with objectively confirmed, symptomatic, acute VTE. The aim of this analysis was to study outcomes in patients with VTE who had experienced major bleeding <30 days prior to VTE diagnosis.Methods Patients with objectively confirmed symptomatic acute VTE are consecutively enrolled into the RIETE registry. Patients are excluded if they are participating in a therapeutic clinical trial or not available for 3-months follow-up. Patient characteristics, details of antithrombotic therapy, and clinical outcomes at 3-months are recorded.Results Of 6361 patients enrolled up to January 2004, 170 (2.7%) had experienced recent major bleeding prior to VTE diagnosis: 69 (40.6%) gastrointestinal tract; 60 (35.3%) intracranial; 41 (24.1%) other. More patients with recent major bleeding had cancer compared with those without recent major bleeding (26.4% vs 20.4%, respectively; p=0.05). More patients who experienced recent major bleeding had undergone surgery <2 months prior to enrollment or had immobility ≥4 days. The incidences of recurrent PE and minor, major, and fatal bleeding complications were also higher in patients who had experienced recent major bleeding (table 1). Patients with recent major bleeding and cancer had an increased incidence of major bleeding compared to those without cancer (20.0% vs. 2.4%, respectively; OR 10.0; 95% CI 2.3–50.0; p<0.001); 11.0% of patients who had recent major bleeding prior to VTE diagnosis and cancer experienced fatal PE compared with none in patients who had recent major bleeding but without cancer (OR 4.1; 95% CI 4.98–17; p<0.05).Conclusion Patients with VTE and recent major bleeding prior to VTE diagnosis (2.7% of total enrolled patients) had poorer clinical outcomes, in terms of bleeding complications, fatal PE and overall mortality compared with those who had not experienced recent major bleeding. In patients who had recent major bleeding prior to VTE diagnosis, those with cancer had a poorer clinical outcome than those without cancer.Table 1. Clinical outcome of enrolled patients3-month outcomeRecent major bleedingNo recent major bleedingOR (95% CI)p valuen (%)n=170n=6191Fatal bleeding7 (4.1)41 (0.6)6.4 (2.6-15)<0.001Major bleeding12 (7.1)146 (2.3)3.1 (1.6-5.9)0.001Minor bleeding12 (7.1)172 (2.8)2.6 (1.4-5.0)<0.005Fatal (initial) PE1 (0.6)14 (0.2)2.6 (0.2-19)NSFatal (recurrent) PE4 (2.4)33 (0.5)4.5 (1.3-14)<0.05Recurrent VTE8 (4.7)184 (2.9)1.6 (0.7-3.4)NSOverall mortality25 (15.0)479 (7.7)2.1 (1.3-3.2)<0.005

Geographic distribution of pulmonary embolism mortality rates in the United States, 1980 to 1984

The identification of individuals who are at high risk for developing PE has focused on clinically identified groups. Epidemiologic characterization of high-risk populations has been less successful. To provide a demographic basis for further epidemiologic inquiry into groups at high risk for PE, we investigated the geographic distribution of PE mortality rates in the United States from 1980 to 1984. We found that for most sections of the United States, PE mortality rate patterns mirrored those that were observed previously for the nation. Men had greater PE mortality rates than women in most regions, and nonwhites had greater PE mortality rates than did whites. The exception to this pattern was the Pacific region, where the PE mortality rate was lower than rates in other parts of the country, particularly among nonwhites. This pattern probably reflects the different racial compositions in the regional populations of the United States, with corresponding PE risk factor differences. However, the specific risk factors that are responsible for these patterns have not been identified. Further inquiry into these geographic patterns may provide a means for the prevention of high PE morbidity and mortality rates.

Mortality From Pulmonary Embolism in the United States: 1962 to 1984

To examine the effect of advances in the prevention of and therapy for PE, we reviewed mortality for PE in the United States from 1962 to 1984. Age-adjusted PE mortality increased by 67 to 100 percent between 1962 and 1974 for white and non-white men and women. From 1975 to 1984, these rates declined by 20 to 28 percent. Non-white PE mortality was greater than white PE mortality; men had a greater risk of PE death than women. Age-specific patterns (more than 40 years of age) of PE mortality followed those of the age-adjusted death rates, with increases noted in all groups between 1962 and 1974 and declines during the 1975-1984 period. These patterns might reflect improved ascertainment of cases and better prevention of disease. The magnitude of the rates suggests that the list of indications for prophylactic anticoagulation should be re-examined for possible expansion.