Cécile Tromeur , Olivier Sanchez , Emilie Presles , Gilles Pernod , Laurent Bertoletti , Patrick Jego , Elisabeth Duhamel , Karine Provost , Florence Parent , Philippe Robin , Lucile Deloire , Florent Leven , Fanny Mingant , Luc Bressollette , Pierre-Yves Le Roux , Pierre-Yves Salaun , Michel Nonent , Brigitte Pan-Petesch , Benjamin Planquette , Philippe Girard , Karine Lacut , Solen Melac , Patrick Mismetti , Silvy Laporte , Guy Meyer , Dominique Mottier , Christophe Leroyer , Francis Couturaud
January 25 2018
January 04 2018
We aimed to identify risk factors for recurrent venous thromboembolism (VTE) after unprovoked pulmonary embolism.
Analyses were based on the double-blind randomised PADIS-PE trial, which included 371 patients with a first unprovoked pulmonary embolism initially treated during 6 months who were randomised to receive an additional 18 months of warfarin or placebo and followed up for 2 years after study treatment discontinuation. All patients had ventilation/perfusion lung scan at inclusion ( i.e. at 6 months of anticoagulation).
During a median follow-up of 41 months, recurrent VTE occurred in 67 out of 371 patients (6.8 events per 100 person-years). In main multivariate analysis, the hazard ratio for recurrence was 3.65 (95% CI 1.33–9.99) for age 50–65 years, 4.70 (95% CI 1.78–12.40) for age >65 years, 2.06 (95% CI 1.14–3.72) for patients with pulmonary vascular obstruction index (PVOI) ≥5% at 6 months and 2.38 (95% CI 1.15–4.89) for patients with antiphospholipid antibodies. When considering that PVOI at 6 months would not be available in practice, PVOI ≥40% at pulmonary embolism diagnosis (present in 40% of patients) was also associated with a 2-fold increased risk of recurrence.
After a first unprovoked pulmonary embolism, age, PVOI at pulmonary embolism diagnosis or after 6 months of anticoagulation and antiphospholipid antibodies were found to be independent predictors for recurrence.