title: Prognostic importance of central thrombus in hemodynamically stable patients with pulmonary embolism.
abstract: BACKGROUND
  The association between mortality and localization of central thrombus in hemodynamically stable patients with pulmonary embolism (PE) is unclear. Sufficient data are not available to help clinicians to select between low molecular weight heparin (LMWH), unfractionated heparin (UFH) and thrombolytics for the management of central thrombus. The present study aims to investigate whether central thrombus in the pulmonary artery affects 30-day mortality rate, and to compare the outcomes of different treatment approaches in patients with central thrombus.
  
  
  METHODS
  This multi-central, prospective, observational study included 874 hemodynamically stable patients with PE confirmed by multidetector computed tomography scan. The localization of the emboli was evaluated and categorized as central (saddle or at least one main pulmonary artery), lobar or distal. The primary study outcome was 30-day all-cause mortality.
  
  
  RESULTS
  Localization of the emboli was central in 319 (36.5%) patients, lobar in 264 (30.2%) and distal in 291 (33.2%) patients. Seventy-four (8.5%) patients died during the 30-day follow-up period. All-cause mortality rate was 11.9%, 6.8% and 6.2% in patients with central, lobar, and distal emboli, respectively (p < 0.001). Multivariate analysis did not show that hemodynamically stable central thrombus was an independent predictor of mortality. Additionally, mortality rate was not significantly different between UFH, LMWH and thrombolytic therapy groups.
  
  
  CONCLUSIONS
  The present study showed that central thrombus was not an independent predictor of mortality in hemodynamically stable PE patients. LMWH and UFH were similarly effective in the treatment of this patient group.
authors.affiliation: Ankara Atatürk Training and Research Hospital, Department of Pulmonary Medicine, Ankara, Turkey. asenturk1967@yahoo.com.
authors.forename: Aysegul
authors.initials: A
authors.lastname: Senturk
authors.forename: Savas
authors.initials: S
authors.lastname: Ozsu
authors.forename: Serap
authors.initials: S
authors.lastname: Duru
authors.forename: Ebru
authors.initials: E
authors.lastname: Cakır
authors.forename: Sevinc Sarinc
authors.initials: SS
authors.lastname: Ulaslı
authors.forename: Ezgi
authors.initials: E
authors.lastname: Demirdogen
authors.forename: Servet
authors.initials: S
authors.lastname: Kayhan
authors.forename: Aygul
authors.initials: A
authors.lastname: Guzel
authors.forename: Fatih
authors.initials: F
authors.lastname: Yakar
authors.forename: Serdar
authors.initials: S
authors.lastname: Berk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006439:Hemodynamics; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D012307:Risk Factors; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight
keywords: anticoagulation; central thrombus; mortality; multidetector computed tomography; pulmonary embolism