Quality of initial anticoagulant treatment and risk of CTEPH after acute pulmonary embolism

The pathophysiology of chronic thromboembolic pulmonary hypertension (CTEPH) is not fully understood. Poor-quality anticoagulation may contribute to a higher risk of CTEPH after acute pulmonary embolism (PE), partly explaining the transition from acute PE to CTEPH. We assessed the association betwee...

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Published in:PloS one 2020-04, Vol.15 (4), p.e0232354
Main Authors: Boon, Gudula J A M, Rein, Nienke van, Bogaard, Harm Jan, Ende-Verhaar, Yvonne M, Huisman, Menno V, Kroft, Lucia J M, Meer, Felix J M van der, Meijboom, Lilian J, Symersky, Petr, Vonk Noordegraaf, Anton, Klok, Frederikus A
Format: Article
Language:English
Subjects:
Anticoagulants
Control methods
Diagnosis
Echocardiography
Embolism
Embolisms
Health aspects
Hypertension
Medical diagnosis
Medical imaging
Medicine and Health Sciences
Patients
Pulmonary arteries
Pulmonary embolism
Pulmonary embolisms
Pulmonary hypertension
Regression analysis
Research and Analysis Methods
Studies
Thromboembolism
Thrombosis
Time
Vitamins
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Summary:The pathophysiology of chronic thromboembolic pulmonary hypertension (CTEPH) is not fully understood. Poor-quality anticoagulation may contribute to a higher risk of CTEPH after acute pulmonary embolism (PE), partly explaining the transition from acute PE to CTEPH. We assessed the association between the time in therapeutic range (TTR) of vitamin-K antagonist (VKA) treatment and incidence of CTEPH after a PE diagnosis. Case-control study in which the time spent in, under and above therapeutic range was calculated in 44 PE patients who were subsequently diagnosed with CTEPH (cases). Controls comprised 150 consecutive PE patients in whom echocardiograms two years later did not show pulmonary hypertension. All patients were treated with VKA for at least 6 months after the PE diagnosis. Time in (TTR), under and above range were calculated. Mean differences between cases and controls were estimated by linear regression. Mean TTR during the initial 6-month treatment period was 72% in cases versus 78% in controls (mean difference -6%, 95%CI -12 to -0.1), mainly explained by more time above the therapeutic range in the cases. Mean difference of time under range was 0% (95%CI -6 to 7) and 2% (95CI% -3 to 7) during the first 3 and 6 months, respectively. In a multivariable model, adjusted odds ratios (ORs) for CTEPH were around unity considering different thresholds for 'poor anticoagulation', i.e. TTR
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0232354