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Recurrent pulmonary embolism. A prospective study.

M Monreal1, J Ruiz, R Salvador

  • 1Hospital de Badalona Germans Trias i Pujol, Universidad Autonoma, Barcelona, Spain.

Chest
|May 1, 1989
PubMed
Summary
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Pulmonary embolism recurrences were identified in patients despite heparin therapy. Free-floating thrombus on venography significantly increased the risk of recurrent pulmonary embolism, highlighting its importance in risk assessment.

Area of Science:

  • Cardiology
  • Radiology
  • Hematology

Background:

  • Venous thromboembolism (VTE) encompasses pulmonary embolism (PE) and deep vein thrombosis (DVT).
  • Recurrent VTE poses a significant clinical challenge, even with adequate anticoagulation therapy.

Purpose of the Study:

  • To prospectively investigate the recurrence rate of pulmonary embolism in patients with VTE receiving heparin therapy.
  • To identify clinical and laboratory predictors of recurrent pulmonary embolism, particularly the role of venography.

Main Methods:

  • Prospective study of 121 consecutive VTE patients (38 PE, 83 lower extremity DVT).
  • Baseline ventilation-perfusion lung scans and routine repeat scans at 8 days of heparin.
  • Clinical and laboratory data, including venography findings, were correlated with lung scan results.

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Main Results:

  • Recurrences were observed in 7/38 patients with initial PE and 5/83 patients with initial DVT (p=0.034).
  • The presence of a free-floating thrombus on venography was significantly associated with higher recurrence rates (p=0.014).
  • Risk of new defects ranged from 3.05% (DVT, no free-floating thrombus) to 38.67% (PE with free-floating thrombus).

Conclusions:

  • Venography is crucial in patients with pulmonary embolism to identify those at high risk for recurrence.
  • Identifying free-floating thrombi aids in stratifying VTE patients and guiding management strategies to prevent recurrent events.