Residual pulmonary embolism as a predictor for recurrence after a first unprovoked episode: Results from the REVERSE cohort study

Tony Wan, Marc Rodger, Wanzhen Zeng, Philippe Robin, Marc Righini, Michael J. Kovacs, Melanie Tan, Marc Carrier, Susan R. Kahn, Philip S. Wells, David R. Anderson, Isabelle Chagnon, Susan Solymoss, Mark Crowther, Richard H White, Linda Vickars, Sadri Bazarjani, Grégoire Le Gal

Research output: Contribution to journalArticle

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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 languageEnglish (US)
Pages (from-to)104-109
Number of pages6
JournalThrombosis Research
Volume162
DOIs
StatePublished - Feb 1 2018

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Pulmonary Embolism
Venous Thromboembolism
Cohort Studies
Blood Vessels
Ventilation
Recurrence
Anticoagulants
Perfusion
Therapeutics
Lung
Venous Thrombosis
Decision Making
Prospective Studies

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 journalArticle

Wan, T, Rodger, M, Zeng, W, Robin, P, Righini, M, Kovacs, MJ, Tan, M, Carrier, M, Kahn, SR, Wells, PS, Anderson, DR, Chagnon, I, Solymoss, S, Crowther, M, White, RH, Vickars, L, Bazarjani, S & Le Gal, G 2018, 'Residual pulmonary embolism as a predictor for recurrence after a first unprovoked episode: Results from the REVERSE cohort study', Thrombosis Research, vol. 162, pp. 104-109. https://doi.org/10.1016/j.thromres.2017.11.020
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. / Residual pulmonary embolism as a predictor for recurrence after a first unprovoked episode : Results from the REVERSE cohort study. In: Thrombosis Research. 2018 ; Vol. 162. pp. 104-109.
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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.",
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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

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