Abstract
Background: The optimal duration of oral anticoagulant therapy after a first, unprovoked venous thromboembolism is controversial due to tightly balanced risks and benefits of indefinite anticoagulation. Risk stratification tools may assist in decision making. Objectives: We sought to determine the relationship between residual pulmonary embolism assessed by baseline ventilation-perfusion scan after completion of 5–7 months of oral anticoagulant therapy and the risk of recurrent venous thromboembolism in patients with the first episode of unprovoked pulmonary embolism. Methods: We conducted a multicentre prospective cohort study of participants with a first, unprovoked venous thromboembolism enrolled after the completion of 5–7 months of oral anticoagulation therapy. The participants completed a mean 18-month follow-up. Participants with pulmonary embolism had baseline ventilation-perfusion scan before discontinuation of oral anticoagulant therapy and the percentage of vascular obstruction on baseline ventilation-perfusion scan was determined. During follow-up after discontinuation of oral anticoagulant therapy, all episodes of suspected recurrent venous thromboembolism were independently adjudicated with reference to baseline imaging. Measurements and main results: During follow-up, 24 of 239 (10.0%) participants with an index event of isolated pulmonary embolism or pulmonary embolism associated with deep vein thrombosis and central assessment of percentage of vascular obstruction on baseline ventilation-perfusion scan had confirmed recurrent venous thromboembolism. As compared to participants with no residual pulmonary embolism on baseline ventilation-perfusion scan, the hazard ratio for recurrent venous thromboembolism was 2.0 (95% CI 0.5–7.3) for participants with percentage of vascular obstruction of 0.1%–4.9%, 2.1 (95% CI 0.5–7.8) for participants with percentage vascular obstruction of 5.0%–9.9% and 5.3 (95% CI 1.8–15.4) for participants with percentage vascular obstruction greater than or equal to 10%. Conclusions: Residual pulmonary embolism assessed by pulmonary vascular obstruction on baseline ventilation-perfusion performed after 5–7 months of oral anticoagulant therapy for the first episode of unprovoked pulmonary embolism was associated with a statistically significant higher risk of subsequent recurrent venous thromboembolism. Percentage of pulmonary vascular obstruction assessment by ventilation-perfusion scans maybe a useful tool to help guide the duration of oral anticoagulant therapy after a first unprovoked pulmonary embolism. Trial registration: Registered at www.clinicaltrials.gov identifier: NCT00261014.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 104-109 |
| Number of pages | 6 |
| Journal | Thrombosis Research |
| Volume | 162 |
| DOIs | |
| State | Published - Feb 1 2018 |
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Keywords
- Cohort studies
- Pulmonary embolism
- Radionuclide imaging
- Recurrence
- Risk factors
ASJC Scopus subject areas
- Hematology
Cite this
Residual pulmonary embolism as a predictor for recurrence after a first unprovoked episode : Results from the REVERSE cohort study. / Wan, Tony; Rodger, Marc; Zeng, Wanzhen; Robin, Philippe; Righini, Marc; Kovacs, Michael J.; Tan, Melanie; Carrier, Marc; Kahn, Susan R.; Wells, Philip S.; Anderson, David R.; Chagnon, Isabelle; Solymoss, Susan; Crowther, Mark; White, Richard H; Vickars, Linda; Bazarjani, Sadri; Le Gal, Grégoire.
In: Thrombosis Research, Vol. 162, 01.02.2018, p. 104-109.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Residual pulmonary embolism as a predictor for recurrence after a first unprovoked episode
T2 - Results from the REVERSE cohort study
AU - Wan, Tony
AU - Rodger, Marc
AU - Zeng, Wanzhen
AU - Robin, Philippe
AU - Righini, Marc
AU - Kovacs, Michael J.
AU - Tan, Melanie
AU - Carrier, Marc
AU - Kahn, Susan R.
AU - Wells, Philip S.
AU - Anderson, David R.
AU - Chagnon, Isabelle
AU - Solymoss, Susan
AU - Crowther, Mark
AU - White, Richard H
AU - Vickars, Linda
AU - Bazarjani, Sadri
AU - Le Gal, Grégoire
PY - 2018/2/1
Y1 - 2018/2/1
N2 - Background: The optimal duration of oral anticoagulant therapy after a first, unprovoked venous thromboembolism is controversial due to tightly balanced risks and benefits of indefinite anticoagulation. Risk stratification tools may assist in decision making. Objectives: We sought to determine the relationship between residual pulmonary embolism assessed by baseline ventilation-perfusion scan after completion of 5–7 months of oral anticoagulant therapy and the risk of recurrent venous thromboembolism in patients with the first episode of unprovoked pulmonary embolism. Methods: We conducted a multicentre prospective cohort study of participants with a first, unprovoked venous thromboembolism enrolled after the completion of 5–7 months of oral anticoagulation therapy. The participants completed a mean 18-month follow-up. Participants with pulmonary embolism had baseline ventilation-perfusion scan before discontinuation of oral anticoagulant therapy and the percentage of vascular obstruction on baseline ventilation-perfusion scan was determined. During follow-up after discontinuation of oral anticoagulant therapy, all episodes of suspected recurrent venous thromboembolism were independently adjudicated with reference to baseline imaging. Measurements and main results: During follow-up, 24 of 239 (10.0%) participants with an index event of isolated pulmonary embolism or pulmonary embolism associated with deep vein thrombosis and central assessment of percentage of vascular obstruction on baseline ventilation-perfusion scan had confirmed recurrent venous thromboembolism. As compared to participants with no residual pulmonary embolism on baseline ventilation-perfusion scan, the hazard ratio for recurrent venous thromboembolism was 2.0 (95% CI 0.5–7.3) for participants with percentage of vascular obstruction of 0.1%–4.9%, 2.1 (95% CI 0.5–7.8) for participants with percentage vascular obstruction of 5.0%–9.9% and 5.3 (95% CI 1.8–15.4) for participants with percentage vascular obstruction greater than or equal to 10%. Conclusions: Residual pulmonary embolism assessed by pulmonary vascular obstruction on baseline ventilation-perfusion performed after 5–7 months of oral anticoagulant therapy for the first episode of unprovoked pulmonary embolism was associated with a statistically significant higher risk of subsequent recurrent venous thromboembolism. Percentage of pulmonary vascular obstruction assessment by ventilation-perfusion scans maybe a useful tool to help guide the duration of oral anticoagulant therapy after a first unprovoked pulmonary embolism. Trial registration: Registered at www.clinicaltrials.gov identifier: NCT00261014.
AB - Background: The optimal duration of oral anticoagulant therapy after a first, unprovoked venous thromboembolism is controversial due to tightly balanced risks and benefits of indefinite anticoagulation. Risk stratification tools may assist in decision making. Objectives: We sought to determine the relationship between residual pulmonary embolism assessed by baseline ventilation-perfusion scan after completion of 5–7 months of oral anticoagulant therapy and the risk of recurrent venous thromboembolism in patients with the first episode of unprovoked pulmonary embolism. Methods: We conducted a multicentre prospective cohort study of participants with a first, unprovoked venous thromboembolism enrolled after the completion of 5–7 months of oral anticoagulation therapy. The participants completed a mean 18-month follow-up. Participants with pulmonary embolism had baseline ventilation-perfusion scan before discontinuation of oral anticoagulant therapy and the percentage of vascular obstruction on baseline ventilation-perfusion scan was determined. During follow-up after discontinuation of oral anticoagulant therapy, all episodes of suspected recurrent venous thromboembolism were independently adjudicated with reference to baseline imaging. Measurements and main results: During follow-up, 24 of 239 (10.0%) participants with an index event of isolated pulmonary embolism or pulmonary embolism associated with deep vein thrombosis and central assessment of percentage of vascular obstruction on baseline ventilation-perfusion scan had confirmed recurrent venous thromboembolism. As compared to participants with no residual pulmonary embolism on baseline ventilation-perfusion scan, the hazard ratio for recurrent venous thromboembolism was 2.0 (95% CI 0.5–7.3) for participants with percentage of vascular obstruction of 0.1%–4.9%, 2.1 (95% CI 0.5–7.8) for participants with percentage vascular obstruction of 5.0%–9.9% and 5.3 (95% CI 1.8–15.4) for participants with percentage vascular obstruction greater than or equal to 10%. Conclusions: Residual pulmonary embolism assessed by pulmonary vascular obstruction on baseline ventilation-perfusion performed after 5–7 months of oral anticoagulant therapy for the first episode of unprovoked pulmonary embolism was associated with a statistically significant higher risk of subsequent recurrent venous thromboembolism. Percentage of pulmonary vascular obstruction assessment by ventilation-perfusion scans maybe a useful tool to help guide the duration of oral anticoagulant therapy after a first unprovoked pulmonary embolism. Trial registration: Registered at www.clinicaltrials.gov identifier: NCT00261014.
KW - Cohort studies
KW - Pulmonary embolism
KW - Radionuclide imaging
KW - Recurrence
KW - Risk factors
UR - http://www.scopus.com/inward/record.url?scp=85041497382&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85041497382&partnerID=8YFLogxK
U2 - 10.1016/j.thromres.2017.11.020
DO - 10.1016/j.thromres.2017.11.020
M3 - Article
C2 - 29224973
AN - SCOPUS:85041497382
VL - 162
SP - 104
EP - 109
JO - Thrombosis Research
JF - Thrombosis Research
SN - 0049-3848
ER -