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Rehman A, Bahk J, Baloch HNU, Salman S, Sharma V, Singh A, Steiger DJ. Association of Different Anticoagulation Strategies With Outcomes in Patients Hospitalized With Acute Pulmonary Embolism. Cureus 2024; 16:e61545. [PMID: 38962644 PMCID: PMC11219246 DOI: 10.7759/cureus.61545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2024] [Indexed: 07/05/2024] Open
Abstract
Background Therapeutic anticoagulation is the cornerstone of treatment for pulmonary embolism (PE), but the impact of different anticoagulation strategies on patient outcomes remains unclear. In this study, we assessed the association of different anticoagulation strategies with the outcomes of patients with acute PE. Methods A retrospective chart review of 207 patients with acute PE who were admitted to one of three urban teaching hospitals in the Mount Sinai Health System (in New York City) from January 2020 to September 2022 was performed. Demographic, clinical, and radiographic data were recorded for all patients. Multivariate regression analyses were performed to assess the association of different outcomes with the approach of therapeutic anticoagulation used. Results The median age of the included patients was 65 years, and 50.2% were women. The most common approach (n = 153, 73.9%) to therapeutic anticoagulation was initial treatment with unfractionated or low molecular weight heparin followed by a direct-acting oral anticoagulant (DOAC), while heparin alone (either unfractionated or low molecular weight heparin) was used in 37 (17.9%) patients, and another 17 (8.2%) patients were treated with heparin followed by bridging to warfarin. Hospital length of stay was longer for patients in the "heparin to warfarin" group (risk-adjusted incidence rate ratio of 2.52). The rates of in-hospital bleeding, all-cause 30-day mortality, and all-cause 30-day re-admissions did not have any significant association with the therapeutic anticoagulation approach used. Conclusion Patients with acute PE who were initially treated with heparin and subsequently bridged to warfarin had a longer hospital stay. Rates of in-hospital bleeding, 30-day mortality, and 30-day re-admission were not associated with the strategy of therapeutic anticoagulation employed.
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Affiliation(s)
- Abdul Rehman
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Jeeyune Bahk
- Internal Medicine, Mount Sinai Hospital, New York City, USA
| | | | - Sidra Salman
- Internal Medicine, Mount Sinai Hospital, New York City, USA
| | - Venus Sharma
- Internal Medicine, Mount Sinai Hospital, New York City, USA
| | - Avinash Singh
- Pulmonary and Critical Care Medicine, Mount Sinai Hospital, New York City, USA
| | - David J Steiger
- Pulmonary and Critical Care Medicine, Mount Sinai Hospital, New York City, USA
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Moreira Amado1 V, Nicodemos Cruz Santana2,3 A. Challenges in the management of patients with pulmonary embolism in Brazil. J Bras Pneumol 2022; 48:e20220187. [PMID: 35830057 PMCID: PMC9262428 DOI: 10.36416/1806-3756/e20220187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Veronica Moreira Amado1
- 1. Universidade de Brasília, Faculdade de Medicina, Campus Darcy Ribeiro, Brasília (DF) Brasil
| | - Alfredo Nicodemos Cruz Santana2,3
- 2. Curso de Medicina e Enfermagem, Escola Superior de Ciências da Saúde, Hospital Regional da Asa Norte – HRAN – Brasília (DF) Brasil. 3. Núcleo Avançado de Tórax, Hospital Sírio-Libanês, Brasília (DF) Brasil
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3
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Gomes JA, Barros JEB, Nascimento ALOD, Rocha CADO, Almeida JPOD, Santana GBDA, Correia DS, Santos MB, Carmo RFD, Souza CDFD. Hospitalizations for pulmonary embolism in Brazil (2008-2019): an ecological and time series study. JORNAL BRASILEIRO DE PNEUMOLOGIA : PUBLICACAO OFICIAL DA SOCIEDADE BRASILEIRA DE PNEUMOLOGIA E TISILOGIA 2022; 48:e20210434. [PMID: 35476042 PMCID: PMC9038095 DOI: 10.36416/1806-3756/e20210434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/29/2022] [Indexed: 11/17/2022]
Abstract
Objective To assess the temporal trends of hospitalizations for pulmonary embolism (PE) in Brazil, its regions, and states between 2008 and 2019. Methods An ecological and time series study was conducted. Data were obtained from the Hospital Information System (SIH) of the Brazilian Ministry of Health. The inflection point regression model was applied for temporal trend analyses. Trends were classified as increasing, decreasing, or stationary according to the slope of the regression line. The Annual Percent Charge (APC) and the Average Annual Percent Change (AAPC) were calculated considering a confidence interval of 95% and p-value <0.05. Furthermore, spatial distribution maps of epidemiological indicators related to PE in Brazil were elaborated. Results There was an increasing trend in the hospitalization rate for PE in Brazil, ranging from 2.57 in 2008 to 4.44/100,000 in 2019 (AAPC=5.6%; p<0.001). Total and average hospitalizations costs also showed increasing trend in the country (AAPC=9.2% and 3.0%, respectively). Still, there was a decrease in the in-hospital mortality rate (from 21.21% to 17.11%; AAPC=-1.9%; p<0.001). Similar trends were observed in most regions. The average hospitalization time in Brazil showed a stationary trend. The hospitalization rate has also increased in 18 states (66.67%). Seven states showed a decrease in the mortality rate (25.93%), except for Roraima, which showed an increasing trend. Conclusion Hospitalizations for PE represent a serious public health problem in Brazil and the temporal patterns observed herein demonstrate an increasing trend in all regions and states of the country.
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Affiliation(s)
- Jéssica Alves Gomes
- Núcleo de Estudos de Medicina Social e Preventiva, Departamento de Medicina, Universidade Federal de Alagoas, Arapiraca (AL), Brasil
| | - José Elias Bezerra Barros
- Núcleo de Estudos de Medicina Social e Preventiva, Departamento de Medicina, Universidade Federal de Alagoas, Arapiraca (AL), Brasil
| | - André Luis Oliveira do Nascimento
- Núcleo de Estudos de Medicina Social e Preventiva, Departamento de Medicina, Universidade Federal de Alagoas, Arapiraca (AL), Brasil
| | - Carlos Alberto de Oliveira Rocha
- Núcleo de Estudos de Medicina Social e Preventiva, Departamento de Medicina, Universidade Federal de Alagoas, Arapiraca (AL), Brasil
| | - João Paulo Oliveira de Almeida
- Núcleo de Estudos de Medicina Social e Preventiva, Departamento de Medicina, Universidade Federal de Alagoas, Arapiraca (AL), Brasil
| | - Gibson Barros de Almeida Santana
- Núcleo de Estudos de Medicina Social e Preventiva, Departamento de Medicina, Universidade Federal de Alagoas, Arapiraca (AL), Brasil
| | | | | | - Rodrigo Feliciano do Carmo
- Faculdade de Ciências Farmacêuticas, Universidade Federal do Vale do São Francisco, Petrolina (PE), Brasil.,Programas de Pós-Graduação em Biociências e Ciências da Saúde e Biológicas, Universidade Federal do Vale do São Francisco, Petrolina (PE), Brasil
| | - Carlos Dornels Freire de Souza
- Núcleo de Estudos de Medicina Social e Preventiva, Departamento de Medicina, Universidade Federal de Alagoas, Arapiraca (AL), Brasil.,Programa de Pós-Graduação em Saúde da Família, Universidade Federal de Alagoas, Arapiraca (AL), Brasil
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Shalaby K, Kahn A, Silver ES, Kim MJ, Balakumaran K, Kim AS. Outcomes of acute pulmonary embolism in hospitalized patients with cancer. BMC Pulm Med 2022; 22:11. [PMID: 34986814 PMCID: PMC8734325 DOI: 10.1186/s12890-021-01808-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/16/2021] [Indexed: 01/22/2023] Open
Abstract
Background Cancer-associated pulmonary embolism (PE) places a significant burden on patients and health care systems.
Methods A retrospective cross-sectional analysis of the National Inpatient Sample (NIS) database was performed in patients with acute PE from 2002 to 2014. Among patients hospitalized with PE, we investigated the differences in clinical outcomes and healthcare utilization in patients with and without cancer. A multivariate logistic regression model was applied to calculate adjusted odds ratios (OR) to estimate the impact of cancer on clinical outcomes. Wilcoxon rank sum tests were used to determine the differences in healthcare utilization between the two cohorts. Results Among 3,313,044 patients who were discharged with a diagnosis of acute PE, 84.2% did not have cancer, while 15.8% had cancer as a comorbidity (56% metastatic cancer, 35% solid tumor without metastasis, and 9% lymphoma). Patients with cancer had a higher mean age but lower rates of common comorbidities except for coagulation deficiency than patients without a cancer diagnosis. In patients with cancer, the rate of IVC filter placement was higher (21.7% vs. 13.11%, OR 1.76 (95% CI 1.73–1.79); p < 0.0001) and thrombolytic use lower (1.34% vs. 2.15%, OR 0.68 (95% CI 0.64–0.72); p < 0.0001). Patients with cancer hospitalized for PE had a higher all-cause in-hospital mortality (11.8% vs. 6.6%, OR 1.79 (95% CI 1.75–1.83); p < 0.0001), longer length of stay (6 vs. 5 days; p < 0.0001), higher total charge per hospitalization ($30,885 vs. $27,273; p < 0.0001), and higher rates of home health services upon discharge (35.8% vs. 23.2%; p < 0.0001) compared with those without cancer. Conclusion Concurrent cancer diagnosis in patients hospitalized for acute PE was associated with a 90% increase in all-cause mortality, longer length of stay, higher total charge per hospitalization, and higher rates of home health services upon discharge. The majority (56%) of patients with cancer had metastatic disease. Furthermore, there were identifiable differences in the intervention for acute PE between the two groups.
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Affiliation(s)
- Khalid Shalaby
- Department of Internal Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030-1235, USA
| | - Adriana Kahn
- Department of Internal Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030-1235, USA
| | - Elizabeth S Silver
- Department of Internal Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030-1235, USA
| | - Min Jung Kim
- Department of Internal Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030-1235, USA
| | - Kathir Balakumaran
- Advanced Heart Failure and Transplant Cardiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Agnes S Kim
- Department of Internal Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030-1235, USA. .,Department of Medicine, Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030, USA.
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Doundoulakis I, Antza C, Karvounis H, Giannakoulas G. Non-Vitamin K Antagonist Oral Anticoagulants in Pulmonary Embolism: An Overview of Systematic Reviews. Curr Pharm Des 2020; 26:2686-2691. [DOI: 10.2174/1381612826666200506114450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022]
Abstract
Background:
Anticoagulation in patients with pulmonary embolism.
Objective:
To identify how non-vitamin K antagonist oral anticoagulants are associated with multiple outcomes in
patients with pulmonary embolism.
Methods:
We performed a systematic search of systematic reviews via multiple electronic databases from inception to August 19th, 2019, without language restriction. Two authors independently extracted data and assessed
the methodological quality of the included systematic reviews using the ROBIS tool.
Results:
We found twelve systematic reviews. Eleven SRs collected their data from randomized clinical trials and
one from observational studies. All the included studies were published between 2014 and 2019 in English. The
methodological quality of the 12 systematic reviews was low to high. None of the systematic reviews, which are
included in our overview of systematic reviews, has evaluated the overall quality of evidence outcome using the
Grading of Recommendations Assessments, Development and Evaluation (GRADE) approach.
Conclusion:
This is the first effort to summarize evidence about non-vitamin K antagonist oral anticoagulants in
an overview of systematic reviews focusing exclusively on patients with pulmonary embolism. The evidence
suggests that the non-vitamin K antagonist oral anticoagulants seem to be more effective and safer than a dualdrug approach with LMWH- VKA.
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Affiliation(s)
- Ioannis Doundoulakis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Antza
- Third Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Haralambos Karvounis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Karaman K, Celik C, Oskay A, Armağan HH, Tomruk O. SUCCESSFUL TREATMENT OF PULMONARY EMBOLISM AND ASSOCIATED UPPER EXTREMITY ARTERY THROMBOSIS USING INTRAVENOUS ALTEPLASE: A CASE REPORT. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2019. [DOI: 10.33706/jemcr.551134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
BACKGROUND Previous clinical trials have addressed that rivaroxaban is effective for the treatment of patients with pulmonary embolism (PE). This study will systematically assess its efficacy and safety for PE. METHODS We will carry out this study by searching the following electronic databases from inception to March 1, 2019 without language restrictions: Cochrane Library, EMBASE, PUBMED, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. In addition, we will also search clinical trial registries, dissertations, and conference abstracts to avoid any missing potential studies. All randomized controlled trials of rivaroxaban for patients with PE will be fully considered. Two researchers will independently perform literature selection, data collection, and methodological quality assessment. If it is appropriate, outcome data will be pooled by using a fixed-effect model or random-effect model, and meta-analysis will be considered for operation. RESULTS All efficacy and safety of rivaroxaban for PE will be assessed through all primary and secondary outcomes. The primary outcomes are all-cause mortality and major bleeding. The secondary outcomes are recurrent venous thromboembolism, duration of hospital stay, quality of life, patient satisfaction, and adverse events. CONCLUSION The findings of this study will summarize updated evidence on the efficacy and safety of rivaroxaban for patients with PE. ETHICS AND DISSEMINATION It is not necessary to inquire ethical approval for this study, because it will not analyze any individual patient data. The results of this study will be published through peer-reviewed journals. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019126095.
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Affiliation(s)
- Juan Jia
- Department of Respiratory Medicine
| | | | - Ning Xu
- Department of Critical Medicine, Yulin No. 2 Hospital, Yulin, Shaanxi, China
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Bhattarai M, Hudali T, Robinson R, Al-Akchar M, Vogler C, Chami Y. Impact of oral anticoagulants on 30-day readmission: a study from a single academic centre. BMJ Evid Based Med 2019; 24:10-14. [PMID: 30279159 DOI: 10.1136/bmjebm-2018-111026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 12/17/2022]
Abstract
Researchers are extensively searching for modifiable risk factors including high-risk medications such as anticoagulation to avoid rehospitalisation. The influence of oral anticoagulant therapy on hospital readmission is not known. We investigated the impact of warfarin and direct oral anticoagulants (DOACs) on all cause 30-day hospital readmission retrospectively in an academic centre. We study the eligible cohort of 1781 discharges over 2-year period. Data on age, gender, diagnoses, 30-day hospital readmission, discharge medications and variables in the HOSPITAL score (Haemoglobin level at discharge, Oncology at discharge, Sodium level at discharge, Procedure during hospitalisation, Index admission, number of hospital Admissions, Length of stay) and LACE index (Length of stay, Acute/emergent admission, Charlson comorbidity index score, Emergency department visits in previous 6 months), which have higher predictability for readmission were extracted and matched for analysis. Warfarin was the most common anticoagulant prescribed at discharge (273 patients) with a readmission rate of 20% (p<0.01). DOACs were used by 94 patients at discharge with a readmission rate of 4% (p=0.219). Multivariate logistic regression showed an increased risk of readmission with warfarin therapy (OR 1.36, p=0.045). Logistic regression did not show DOACs to be a risk factor for hospital readmission. Our data suggests that warfarin therapy is a risk factor for all-cause 30-day hospital readmission. DOAC therapy is not found to be associated with a higher risk of hospital readmission. Warfarin anticoagulation may be an important target for interventions to reduce hospital readmissions.
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Affiliation(s)
- Mukul Bhattarai
- Division of General Internal Medicine, Department of Internal Medicine, School of Medicine, Southern Illinois University, Springfield, Illinois, USA
| | - Tamer Hudali
- Division of General Internal Medicine, Department of Internal Medicine, School of Medicine, Southern Illinois University, Springfield, Illinois, USA
| | - Robert Robinson
- Division of General Internal Medicine, Department of Internal Medicine, School of Medicine, Southern Illinois University, Springfield, Illinois, USA
| | - Mohammad Al-Akchar
- Division of General Internal Medicine, Department of Internal Medicine, School of Medicine, Southern Illinois University, Springfield, Illinois, USA
| | - Carrie Vogler
- Department of Pharmacy Practice, Southern Illinois University Edwardsville School of Pharmacy, Edwardsville, Illinois, USA
| | - Youssef Chami
- Division of Cardiovascular Medicine, Department of Internal Medicine, School of Medicine, Southern Illinois University, Springfield, Illinois, USA
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