High Risk of Return

Deep vein thrombosis and pulmonary embolism are considered different manifestations of the same disease process. The medical management of both conditions, known collectively as venous thromboembolism, has improved in the past decade, the authors note. Frederick A. Spencer, M.D., of McMaster University Medical Center, Hamilton, Ontario, Canada, and colleagues analyzed the medical records of 1,691 Worcester, Mass., residents (54 percent women, average age 65) who were diagnosed with venous thromboembolism in 1999, 2001 or 2003. Of those, 549 had pulmonary embolism and 1,142 had isolated deep vein thrombosis.

Over the three-year study, among the 549 patients who presented with pulmonary embolism, 31 (5.7 percent) had a recurrent clot in the lung, 75 (13.7 percent) had a recurrence of either type of venous thromboembolism and 82 (14.9 percent) experienced a major bleeding episode (i.e., so severe they required a transfusion). Among the 1,142 patients who presented with isolated deep vein thrombosis over the same period, 64 (5.6 percent) developed a pulmonary embolism, 217 (19 percent) had recurrent venous thromboembolism and 146 (12.8 percent) had a major bleeding episode.

Individuals with pulmonary embolism were more likely to die after one month (13 percent versus 5.4 percent), one year (26 percent versus 20.3 percent) and three years (35.3 percent versus 29.6 percent) than those with deep vein thrombosis. “Patients whose course was complicated by major bleeding were more likely to experience recurrent venous thromboembolism or to die at three years than those without these complications,” the authors write.

"Efforts are needed to identify patients most at risk for venous thrombosis–associated complications and to develop better anticoagulation strategies conducive to long-term use in the community setting", the researchers say.

MEDICA.de; Source: American Medical Association