Death due to recurrent thromboembolism among younger healthier individuals hospitalized for idiopathic pulmonary embolism

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Abstract

The incidence of death due to recurrent pulmonary embolism (PE) after a first-time idiopathic PE is not well defined. We conducted a retrospective study of patients age 18 to 56 years who had idiopathic PE between 1994-2001. The incidence and cause of death within five years was determined using linked discharge records and a master death registry. A total of 3,456 patients had a first-time idiopathic PE. The rate of recurrent VTE 0-6 months after the index event was 13.1%/year, and 2.9%/year 6-60 months after the event. During the mean follow-up of 3.2 years 118 (3.4%, 95% confidence interval [CI]=2.8-4.1%) patients died. Fifty-two (44%) deaths occurred <29 days after the index PE (case-fatality rate =1.5%,95%CI=1.1-2.0%). Among the 66 cases (1.9%) that died after 28 days, 18 (0.52%) were due to recurrent PE or its sequelae: eight had recurrent PE alone, five had recurrent PE and a serious co-morbid illness, and five had thromboembolic pulmonary hypertension with or without acute PE. The person-time rate of death (deaths per 100 patient-years) attributed to any recurrent thromboembolism 6-60 months after the event was 0.16% (95%CI=0.1-0.26%). Ten of the 18 (56%) late thromboembolic deaths reflected a first-time recurrent PE. The 28-day case-fatality rate for recurrent VTE was 2.8% (95%CI= 1.5-4.9%). In this cohort of younger patients with idiopathic PE, the rate of death due to recurrent VTE, particularly to first-time recurrent PE, was low. Among the patients who died of thromboembolism >28 days after the index PE, 28% had developed pulmonary hypertension.

Original languageEnglish (US)
Pages (from-to)683-690
Number of pages8
JournalThrombosis and Haemostasis
Volume99
Issue number4
DOIs
StatePublished - Apr 2008

Fingerprint

Thromboembolism
Pulmonary Embolism
Incidence
Pulmonary Hypertension
Registries
Cause of Death
Retrospective Studies
Confidence Intervals

Keywords

  • Administrative data
  • Epidemiology
  • PE
  • Thromboembolism
  • Venous thrombosis

ASJC Scopus subject areas

  • Hematology

Cite this

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title = "Death due to recurrent thromboembolism among younger healthier individuals hospitalized for idiopathic pulmonary embolism",
abstract = "The incidence of death due to recurrent pulmonary embolism (PE) after a first-time idiopathic PE is not well defined. We conducted a retrospective study of patients age 18 to 56 years who had idiopathic PE between 1994-2001. The incidence and cause of death within five years was determined using linked discharge records and a master death registry. A total of 3,456 patients had a first-time idiopathic PE. The rate of recurrent VTE 0-6 months after the index event was 13.1{\%}/year, and 2.9{\%}/year 6-60 months after the event. During the mean follow-up of 3.2 years 118 (3.4{\%}, 95{\%} confidence interval [CI]=2.8-4.1{\%}) patients died. Fifty-two (44{\%}) deaths occurred <29 days after the index PE (case-fatality rate =1.5{\%},95{\%}CI=1.1-2.0{\%}). Among the 66 cases (1.9{\%}) that died after 28 days, 18 (0.52{\%}) were due to recurrent PE or its sequelae: eight had recurrent PE alone, five had recurrent PE and a serious co-morbid illness, and five had thromboembolic pulmonary hypertension with or without acute PE. The person-time rate of death (deaths per 100 patient-years) attributed to any recurrent thromboembolism 6-60 months after the event was 0.16{\%} (95{\%}CI=0.1-0.26{\%}). Ten of the 18 (56{\%}) late thromboembolic deaths reflected a first-time recurrent PE. The 28-day case-fatality rate for recurrent VTE was 2.8{\%} (95{\%}CI= 1.5-4.9{\%}). In this cohort of younger patients with idiopathic PE, the rate of death due to recurrent VTE, particularly to first-time recurrent PE, was low. Among the patients who died of thromboembolism >28 days after the index PE, 28{\%} had developed pulmonary hypertension.",
keywords = "Administrative data, Epidemiology, PE, Thromboembolism, Venous thrombosis",
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AU - White, Richard H

AU - Zhou, Hong

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N2 - The incidence of death due to recurrent pulmonary embolism (PE) after a first-time idiopathic PE is not well defined. We conducted a retrospective study of patients age 18 to 56 years who had idiopathic PE between 1994-2001. The incidence and cause of death within five years was determined using linked discharge records and a master death registry. A total of 3,456 patients had a first-time idiopathic PE. The rate of recurrent VTE 0-6 months after the index event was 13.1%/year, and 2.9%/year 6-60 months after the event. During the mean follow-up of 3.2 years 118 (3.4%, 95% confidence interval [CI]=2.8-4.1%) patients died. Fifty-two (44%) deaths occurred <29 days after the index PE (case-fatality rate =1.5%,95%CI=1.1-2.0%). Among the 66 cases (1.9%) that died after 28 days, 18 (0.52%) were due to recurrent PE or its sequelae: eight had recurrent PE alone, five had recurrent PE and a serious co-morbid illness, and five had thromboembolic pulmonary hypertension with or without acute PE. The person-time rate of death (deaths per 100 patient-years) attributed to any recurrent thromboembolism 6-60 months after the event was 0.16% (95%CI=0.1-0.26%). Ten of the 18 (56%) late thromboembolic deaths reflected a first-time recurrent PE. The 28-day case-fatality rate for recurrent VTE was 2.8% (95%CI= 1.5-4.9%). In this cohort of younger patients with idiopathic PE, the rate of death due to recurrent VTE, particularly to first-time recurrent PE, was low. Among the patients who died of thromboembolism >28 days after the index PE, 28% had developed pulmonary hypertension.

AB - The incidence of death due to recurrent pulmonary embolism (PE) after a first-time idiopathic PE is not well defined. We conducted a retrospective study of patients age 18 to 56 years who had idiopathic PE between 1994-2001. The incidence and cause of death within five years was determined using linked discharge records and a master death registry. A total of 3,456 patients had a first-time idiopathic PE. The rate of recurrent VTE 0-6 months after the index event was 13.1%/year, and 2.9%/year 6-60 months after the event. During the mean follow-up of 3.2 years 118 (3.4%, 95% confidence interval [CI]=2.8-4.1%) patients died. Fifty-two (44%) deaths occurred <29 days after the index PE (case-fatality rate =1.5%,95%CI=1.1-2.0%). Among the 66 cases (1.9%) that died after 28 days, 18 (0.52%) were due to recurrent PE or its sequelae: eight had recurrent PE alone, five had recurrent PE and a serious co-morbid illness, and five had thromboembolic pulmonary hypertension with or without acute PE. The person-time rate of death (deaths per 100 patient-years) attributed to any recurrent thromboembolism 6-60 months after the event was 0.16% (95%CI=0.1-0.26%). Ten of the 18 (56%) late thromboembolic deaths reflected a first-time recurrent PE. The 28-day case-fatality rate for recurrent VTE was 2.8% (95%CI= 1.5-4.9%). In this cohort of younger patients with idiopathic PE, the rate of death due to recurrent VTE, particularly to first-time recurrent PE, was low. Among the patients who died of thromboembolism >28 days after the index PE, 28% had developed pulmonary hypertension.

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