Major bleeding in patients with pulmonary embolism presenting with syncope

Area of Science:

• Cardiology
• Hematology
• Internal Medicine

Background:

• Syncope is a known bleeding risk factor in acute pulmonary embolism (PE) patients on thrombolytic therapy.
• The predictive value of syncope for bleeding in a broader PE population, particularly those on anticoagulation, remains unclear.

Purpose of the Study:

• To determine if syncope at presentation predicts bleeding in PE patients receiving anticoagulant therapy.
• To investigate the association between syncope and the timing/location of major bleeding events in PE patients.

Main Methods:

• Utilized data from the RIETE registry, including 45,765 patients with acute PE (March 2001-January 2021).
• Assessed the incidence of syncope and major bleeding events (including gastrointestinal, hematoma, intracranial) within 90 days.
• Employed multivariable and sensitivity analyses to evaluate the risk of major bleeding associated with syncope, considering anticoagulant monotherapy.

Main Results:

• 14.8% of PE patients presented with syncope; these patients were older and had more comorbidities.
• Patients with syncope had a significantly higher rate of major bleeding (OR: 1.63; aHR: 1.34).
• Increased major bleeding risk associated with syncope was confirmed in patients on anticoagulant monotherapy at 7 and 90 days.

Conclusions:

• Syncope is an independent predictor of major bleeding in patients with acute pulmonary embolism.
• This association holds true even for patients receiving anticoagulation monotherapy, underscoring the clinical significance of syncope in risk stratification.