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AlSheef M, Alshammari FT, Alhawish MK, Alghamdi AG, Alqudhybi AF, Abu-Shaheen A. Clinical epidemiology of venous thromboembolic disease: An institutional registry. Front Cardiovasc Med 2022; 9:928094. [PMID: 35958419 PMCID: PMC9361013 DOI: 10.3389/fcvm.2022.928094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionVenous thromboembolism (VTE) is a major health concern, with an annual incidence of ~1 in 1,000. The epidemiology of VTE in Saudi Arabia has not been adequately described yet. Therefore, this study aimed to assess the clinical characteristics, risk factors, diagnostic methods, management, and clinical outcomes of patients with VTE.MethodsThis study was based on a VTE registry created over ten years at King Fahad Medical City (KFMC) in Riyadh, Saudi Arabia. All adult inpatients and outpatients referred to the thrombosis unit of the KFMC with clinically suspected VTE including pulmonary embolism (PE) and deep vein thrombosis (DVT) were enrolled. Data were collected using a standardized case report form, which included demographic and clinical characteristics, risk factors, diagnostic methods, management, and outcomes.ResultsA total of 1,008 patients were recruited. Most patients were women (73.2%), and more than half of all patients had unprovoked VTE (58%). Among the provoked cases, the most frequent cause was surgery (29.8%), followed by hospitalization (24.2%). There was a significant statistical association between provoked status and sex, family history of VTE, smoking, recent hospitalization within 3 months for a medical condition, the site of VTE, and underlying peripheral vascular disease and varicose veins (all p < 0.05). The majority (88.3%) of patients with deep vein thrombosis was hospitalized for ≤3 days (n = 433, 79.9%), while fewer than half of the patients with PE needed hospitalization (45.3%). Thrombolytic therapy was administered to 14.1% (n = 142) of patients, and catheter-directed thrombolysis was performed in 1.0% (n = 10) of patients. The odds of mortality for provoked VTE were 3.20 times higher than those of unprovoked VTE [2.12–4.83; p-value < 0.001].ConclusionUnprovoked VTE was more common than provoked VTE in the Saudi Arabian cohort, implying hereditary predisposition. Furthermore, male sex, family history of VTE, prior history of VTE, type of VTE, underlying obesity, history of trauma, surgery, hospitalization, pregnancy, and 3–6 months of anticoagulation therapy were the most critical risk factors for VTE recurrence. The treatment patterns and clinical results were comparable to those reported in the literature.
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Affiliation(s)
- Mohammed AlSheef
- King Fahad Medical City, Riyadh, Saudi Arabia
- *Correspondence: Mohammed AlSheef
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Zhai Z, Wang D, Lei J, Yang Y, Xu X, Ji Y, Yi Q, Chen H, Hu X, Liu Z, Mao Y, Zhang J, Shi J, Zhang Z, Wu S, Gao Q, Tao X, Xie W, Wan J, Zhang Y, Zhang S, Zhen K, Zhang Z, Fang B, Wang C. Trends in risk stratification, in-hospital management and mortality of patients with acute pulmonary embolism: an analysis from China pUlmonary thromboembolism REgistry Study (CURES). Eur Respir J 2021; 58:13993003.02963-2020. [PMID: 33986031 DOI: 10.1183/13993003.02963-2020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 03/21/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Similar trends of management and in-hospital mortality of acute pulmonary embolism (PE) have been reported in European and American populations. However, these tendencies were not clear in Asian countries. OBJECTIVES We retrospectively analyzed the trends of risk stratification, management and in-hospital mortality for patients with acute PE through a multicenter registry in China (CURES). METHODS Adult patients with acute symptomatic PE were included between 2009 and 2015. Trends in disease diagnosis, treatment and death in hospital were fully analyzed. Risk stratification was retrospectively classified by hemodynamical status and the simplified Pulmonary Embolism Severity Index (sPESI) score according to the 2014 European Society of Cardiology/European Respiratory Society guidelines. RESULTS Among overall 7438 patients, the proportions with high (hemodynamically instability), intermediate (sPESI≥1) and low (sPESI=0) risk were 4.2%, 67.1% and 28.7%, respectively. Computed tomographic pulmonary angiography was the widely employed diagnostic approach (87.6%) and anticoagulation was the frequently adopted initial therapy (83.7%). Between 2009 and 2015, a significant decline was observed for all-cause mortality (from 3.1% to 1.3%, adjusted P for trend=0.0003), with a concomitant reduction in use of initial systemic thrombolysis (from 14.8% to 5.0%, P for trend<0.0001). The common predictors for all-cause mortality shared by hemodynamically stable and unstable patients were co-existing cancer, older age, and impaired renal function. CONCLUSIONS The considerable reduction of mortality over years was accompanied by changes of initial treatment. These findings highlight the importance of risk stratification-guided management throughout the nation.
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Affiliation(s)
- Zhenguo Zhai
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P. R. China .,National Center for Respiratory Medicine, Beijing, P. R. China.,National Clinical Research Center for Respiratory Disease, Beijing, P. R. China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
| | - Dingyi Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P. R. China.,National Center for Respiratory Medicine, Beijing, P. R. China.,National Clinical Research Center for Respiratory Disease, Beijing, P. R. China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China.,Data and Project Management Unit, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, P. R. China
| | - Jieping Lei
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P. R. China.,National Center for Respiratory Medicine, Beijing, P. R. China.,National Clinical Research Center for Respiratory Disease, Beijing, P. R. China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China.,Data and Project Management Unit, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, P. R. China
| | - Yuanhua Yang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China
| | - Xiaomao Xu
- Department of Pulmonary and Critical Care Medicine, Beijing Hospital, Beijing, P. R. China
| | - Yingqun Ji
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, P. R. China.,Department of Pulmonary and Critical Care Medicine, East Hospital, Tongji University, Shanghai, P. R. China
| | - Qun Yi
- Department of Pulmonary and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, P. R. China
| | - Hong Chen
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China
| | - Xiaoyun Hu
- Department of Pulmonary and Critical Care Medicine, First Hospital of Shanxi Medical University, Taiyuan, P. R. China
| | - Zhihong Liu
- Fuwai Hospital, Chinese Academy of Medical Science; National Center for Cardiovascular Diseases, Beijing, P. R. China
| | - Yimin Mao
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, P. R. China
| | - Jie Zhang
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, P. R. China
| | - Juhong Shi
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, P. R. China
| | - Zhu Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P. R. China.,National Center for Respiratory Medicine, Beijing, P. R. China.,National Clinical Research Center for Respiratory Disease, Beijing, P. R. China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
| | - Sinan Wu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P. R. China.,National Center for Respiratory Medicine, Beijing, P. R. China.,National Clinical Research Center for Respiratory Disease, Beijing, P. R. China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China.,Data and Project Management Unit, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, P. R. China
| | - Qian Gao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P. R. China.,National Center for Respiratory Medicine, Beijing, P. R. China.,National Clinical Research Center for Respiratory Disease, Beijing, P. R. China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
| | - Xincao Tao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P. R. China.,National Center for Respiratory Medicine, Beijing, P. R. China.,National Clinical Research Center for Respiratory Disease, Beijing, P. R. China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
| | - Wanmu Xie
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P. R. China.,National Center for Respiratory Medicine, Beijing, P. R. China.,National Clinical Research Center for Respiratory Disease, Beijing, P. R. China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
| | - Jun Wan
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P. R. China.,National Center for Respiratory Medicine, Beijing, P. R. China.,National Clinical Research Center for Respiratory Disease, Beijing, P. R. China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
| | - Yunxia Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P. R. China.,National Center for Respiratory Medicine, Beijing, P. R. China.,National Clinical Research Center for Respiratory Disease, Beijing, P. R. China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
| | - Shuai Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P. R. China.,National Center for Respiratory Medicine, Beijing, P. R. China.,National Clinical Research Center for Respiratory Disease, Beijing, P. R. China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
| | - Kaiyuan Zhen
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P. R. China.,National Center for Respiratory Medicine, Beijing, P. R. China.,National Clinical Research Center for Respiratory Disease, Beijing, P. R. China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China.,Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, P. R. China
| | - Zhonghe Zhang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, P. R. China
| | - Baomin Fang
- Department of Pulmonary and Critical Care Medicine, Beijing Hospital, Beijing, P. R. China
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P. R. China .,National Center for Respiratory Medicine, Beijing, P. R. China.,National Clinical Research Center for Respiratory Disease, Beijing, P. R. China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China.,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China.,Department of Respiratory Medicine, Capital Medical University, Beijing, P. R. China
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Cohen A, Jeyaindran S, Kim JY, Park K, Sompradeekul S, Tambunan KL, Tran H, Tsai IC, Ward C, Wong R. Treating pulmonary embolism in Pacific Asia with direct oral anticoagulants. Thromb Res 2015; 136:196-207. [PMID: 26139085 DOI: 10.1016/j.thromres.2015.05.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 05/17/2015] [Accepted: 05/21/2015] [Indexed: 01/21/2023]
Abstract
Pulmonary embolism (PE) is the principal preventable cause of in-hospital deaths. Prevalence of PE in Asians is uncertain but undoubtedly underestimated. Asians and Caucasians have similar non-genetic risk factors for PE, and there is mounting evidence that PE affects Asians much more commonly than previously supposed; incidence, especially among high-risk patients, may approach that in Caucasians. Furthermore, PE incidence in Asia is increasing, due to both increased ascertainment, and also population ageing and growing numbers of patients with predisposing risk factors. Despite being warranted, thromboprophylaxis for high-risk patients is not routine in Pacific Asian countries/regions. There also appears to be scope to implement venous thromboembolism (VTE) management guidelines more assiduously. Anticoagulants, primarily heparins and warfarin, have been the mainstays of VTE management for years; however, these agents have limitations that complicate routine use. The complexity of current guidelines has been another barrier to applying evidence-based recommendations in everyday practice. Updated management approaches have considerable potential to improve outcomes. New oral anticoagulants that are easier to administer, require no, or much less, monitoring or dose-adjustment and have a favourable risk/benefit profile compared with conventional modalities, may offer an alternative with the potential to simplify VTE management. However, more information is required on practical management and the occurrence and treatment of bleeding complications. Increasing recognition of the burden of PE and new therapeutic modalities are altering the VTE management landscape in Pacific Asia. Consequently, there is a need to further raise awareness and bridge gaps between the latest evidence and clinical practice.
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Affiliation(s)
- Alexander Cohen
- Department of Haematological Medicine, Guy's and St Thomas' NHS Foundation Trust, King's College London, United Kingdom.
| | | | - Jae Yeol Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kihyuk Park
- Division of Vascular Surgery, Daegu-Catholic University Hospital, South Korea
| | - Suree Sompradeekul
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Karmel L Tambunan
- Division of Hematology-Medical Oncology, Department of Internal Medicine, School of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Huyen Tran
- Clinical Haematology, The Alfred Hospital, Melbourne, Australia; Australian Centre for Blood Diseases, Monash University, Melbourne Australia
| | - I-Chen Tsai
- Department of Medical Imaging, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Christopher Ward
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital; Northern Blood Research Centre, Kolling Institute, University of Sydney, New South Wales, Australia
| | - Raymond Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, N.T. Hong Kong, China
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