title: The natural course of hemodynamically stable pulmonary embolism: Clinical outcome and risk factors in a large prospective cohort study.
abstract: BACKGROUND
  Pulmonary embolism (PE) is a potentially fatal disease with risks of recurrent venous thrombotic events (venous thromboembolism [VTE]) and major bleeding from anticoagulant therapy. Identifying risk factors for recurrent VTE, bleeding, and mortality may guide clinical decision making.
  
  
  OBJECTIVE
  To evaluate the incidence of recurrent VTE, hemorrhagic complications, and mortality in patients with PE, and to identify risk factors and the time course of these events.
  
  
  METHODS
  We evaluated consecutive patients with PE derived from a prospective management study, who were followed for 3 months, treated with anticoagulants, and underwent objective diagnostic testing for suspected recurrent VTE or bleeding.
  
  
  RESULTS
  Of 673 patients with complete follow-up, 20 patients (3.0%; 95% confidence interval [CI], 1.8 to 4.6%) had recurrent VTE. Eleven of 14 patients with recurrent PE had a fatal PE (79%; 95% CI, 49 to 95%), occurring mostly in the first week after diagnosis of initial PE. In 23 patients (3.4%; 95% CI, 2.2 to 5.1%), a hemorrhagic complication occurred, 10 of which were major bleeds (1.5%; 95% CI, 0.7 to 2.7%), and 2 were fatal (0.3%; 95% CI, 0.04 to 1.1%). During the 3-month follow-up, 55 patients died (8.2%; 95% CI, 6.2 to 10.5%). Risk factors for recurrent VTE were immobilization for > 3 days and being an inpatient; having COPD or malignancies were risk factors for bleeding. Higher age, immobilization, malignancy, and being an inpatient were risk factors for mortality.
  
  
  CONCLUSIONS
  Recurrent VTE occurred in a small percentage of patients treated for an acute PE, and the majority of recurrent PEs were fatal. Immobilization, hospitalization, age, COPD, and malignancies were risk factors for recurrent VTE, bleeding, and mortality. Close monitoring may be indicated in these patients, precluding them from out-of-hospital start of treatment.
authors.affiliation: Vascular Unit, Department of General Internal Medicine and Endocrinology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands. M.Nijkeuter@lumc.nl
authors.forename: Mathilde
authors.initials: M
authors.lastname: Nijkeuter
authors.forename: Maaike
authors.initials: M
authors.lastname: Söhne
authors.forename: Lidwine W
authors.initials: LW
authors.lastname: Tick
authors.forename: Pieter Willem
authors.initials: PW
authors.lastname: Kamphuisen
authors.forename: Mark H H
authors.initials: MH
authors.lastname: Kramer
authors.forename: Laurens
authors.initials: L
authors.lastname: Laterveer
authors.forename: Anja A
authors.initials: AA
authors.lastname: van Houten
authors.forename: Marieke J H A
authors.initials: MJ
authors.lastname: Kruip
authors.forename: Frank W G
authors.initials: FW
authors.lastname: Leebeek
authors.forename: Harry R
authors.initials: HR
authors.lastname: Büller
authors.forename: Menno V
authors.initials: MV
authors.lastname: Huisman
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D012008:Recurrence; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
chemical_list: D000925:Anticoagulants