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      Comparative clinical prognosis of massive and non‐massive pulmonary embolism: A registry‐based cohort study

      1 , 2 , 1 , 3 , 4 , 5 , 6 , 7 , 8 , 1 , 9 , 10 , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , for the RIETE investigators
      Journal of Thrombosis and Haemostasis
      Wiley

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          2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

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            Is Open Access

            Systemic thrombolytic therapy for acute pulmonary embolism: a systematic review and meta-analysis

            Aim Thrombolytic therapy induces faster clot dissolution than anticoagulation in patients with acute pulmonary embolism (PE) but is associated with an increased risk of haemorrhage. We reviewed the risks and benefits of thrombolytic therapy in the management of patients with acute PE. Methods and results We systematically reviewed randomized controlled studies comparing systemic thrombolytic therapy plus anticoagulation with anticoagulation alone in patients with acute PE. Fifteen trials involving 2057 patients were included in our meta-analysis. Compared with heparin, thrombolytic therapy was associated with a significant reduction of overall mortality (OR; 0.59, 95% CI: 0.36–0.96). This reduction was not statistically significant after exclusion of studies including high-risk PE (OR; 0.64, 95% CI: 0.35–1.17). Thrombolytic therapy was associated with a significant reduction in the combined endpoint of death or treatment escalation (OR: 0.34, 95% CI: 0.22–0.53), PE-related mortality (OR: 0.29; 95% CI: 0.14–0.60) and PE recurrence (OR: 0.50; 95% CI: 0.27–0.94). Major haemorrhage (OR; 2.91, 95% CI: 1.95–4.36) and fatal or intracranial bleeding (OR: 3.18, 95% CI: 1.25–8.11) were significantly more frequent among patients receiving thrombolysis. Conclusions Thrombolytic therapy reduces total mortality, PE recurrence, and PE-related mortality in patients with acute PE. The decrease in overall mortality is, however, not significant in haemodynamically stable patients with acute PE. Thrombolytic therapy is associated with an increase of major and fatal or intracranial haemorrhage.
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              Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry.

              Clinical predictors for fatal pulmonary embolism (PE) in patients with venous thromboembolism have never been studied. Using data from the international prospective Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry about patients with objectively confirmed symptomatic acute venous thromboembolism, we determined independent predictive factors for fatal PE. Between March 2001 and July 2006, 15 520 consecutive patients (mean age+/-SD, 66.3+/-16.9 years; 49.7% men) with acute venous thromboembolism were included. Symptomatic deep-vein thrombosis without symptomatic PE was observed in 58.0% (n=9008) of patients, symptomatic nonmassive PE in 40.4% (n=6264), and symptomatic massive PE in 1.6% (n=248). At 3 months, the cumulative rates of overall mortality and fatal PE were 8.65% and 1.68%, respectively. On multivariable analysis, patients with symptomatic nonmassive PE at presentation exhibited a 5.42-fold higher risk of fatal PE compared with patients with deep-vein thrombosis without symptomatic PE (P 75 years, and cancer. PE remains a potentially fatal disease. The clinical predictors identified in the present study should be included in any clinical risk stratification scheme to optimally adapt the treatment of PE to the risk of the fatal outcome.
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                Author and article information

                Contributors
                Journal
                Journal of Thrombosis and Haemostasis
                J. Thromb. Haemost.
                Wiley
                1538-7933
                1538-7836
                February 2021
                December 19 2020
                February 2021
                : 19
                : 2
                : 408-416
                Affiliations
                [1 ]Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
                [2 ]Respiratory Department Hospital Ramón y Cajal and Medicine Department Universidad de Alcalá (IRYCIS) Madrid Spain
                [3 ]Department of Internal Medicine Hospital General Universitario Gregorio Marañón Madrid Spain
                [4 ]Department of Internal Medicine Hospital Universitario Reina Sofía Cordoba Spain
                [5 ]Department of Internal Medicine Hospital de Mataro Barcelona Spain
                [6 ]Department of Cardiology Ospedale Pauls Stradins Clinical University Hospital Riga Latvia
                [7 ]Department of Haematology Hospital de Tortosa Verge de la Cinta Tarragona Spain
                [8 ]Department of Internal Medicine Hospital Italiano de Buenos Aires Buenos Aires Argentina
                [9 ]Department of Internal Medicine Hospital Germans Trias i Pujol Badalona Spain
                [10 ]Universidad Catolica de Murcia Murcia Spain
                Article
                10.1111/jth.15146
                33119949
                843a528f-7b41-45ff-874f-0899bd50fdfe
                © 2021

                http://onlinelibrary.wiley.com/termsAndConditions#vor

                http://doi.wiley.com/10.1002/tdm_license_1.1

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