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10.1097/MD.0000000000004364

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suck abstract from ncbi


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pmid27559946
      Medicine+(Baltimore) 2016 ; 95 (34 ): e4364
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  • Five-year follow-up of pulmonary embolism under anticoaugulation: The PISA-PEET (Pulmonary Embolism Extension Therapy) study #MMPMID27559946
  • Marconi L ; Carrozzi L ; Aquilini F ; Celi A ; Pistelli F ; Palla A
  • Medicine (Baltimore) 2016[Aug]; 95 (34 ): e4364 PMID27559946 show ga
  • Benefits and harms of long-term anticoagulant therapy (AT) after acute pulmonary embolism (PE) are poorly known. The aim of this study was to investigate the outcome of patients with PE treated with AT for 5 years according to American College of Chest Physicians (ACCP) guidelines.Patients with both unprovoked and secondary PE were consecutively enrolled in a "real life" study. After a 12-month AT, they continued or stopped the treatment according to ACCP guidelines, and were followed-up for 5 years. Outcomes were all-cause mortality, recurrence, and fatal recurrence under AT.Of the original consecutive 585 patients, 471 were included (83 dead, 31 lost during the 1st year). Of these, 361 (76.6%) continued AT. During 5 years, death occurred in 109 (30.2%) patients, with a mortality rate of 8.00?events/100 person-years of follow-up; recurrence in 34 (9.4%), with an incidence rate of 2.58?events/person-years; fatal recurrence in 13 (3.6%), with an incidence rate of 0.95?events/person-years. The case fatality rate for recurrence was 38.2%. In the subgroup of patients with unprovoked PE, the chance of dying was significantly lower (RR 0.35; 95% confidence interval 0.24-0.53) and the tendency to fatal recurrence (not significantly) greater (0.11?events/100 person-years vs 0.07?events/100 person-years) than in the remaining patients. Major bleeding occurred in 5 (1.3%) patients. The case fatality rate for bleeding was 14.3%.During 5-year AT, 30% of patients dies, 10% experiences recurrences, and 5% has fatal recurrences. According to guidelines, most patients need to continue AT; the case fatality rate for bleeding is lower than that for recurrence.
  • |Aged [MESH]
  • |Aged, 80 and over [MESH]
  • |Anticoagulants/adverse effects/*therapeutic use [MESH]
  • |Cause of Death [MESH]
  • |Female [MESH]
  • |Follow-Up Studies [MESH]
  • |Hemorrhage/*chemically induced/*mortality [MESH]
  • |Heparin, Low-Molecular-Weight/therapeutic use [MESH]
  • |Humans [MESH]
  • |Incidence [MESH]
  • |Male [MESH]
  • |Middle Aged [MESH]
  • |Practice Guidelines as Topic [MESH]
  • |Prospective Studies [MESH]
  • |Pulmonary Embolism/*drug therapy/*mortality [MESH]
  • |Recurrence [MESH]
  • |Risk Factors [MESH]
  • |Secondary Prevention [MESH]
  • |Time Factors [MESH]


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