DOI QR코드

DOI QR Code

Risk factors associated with provoked pulmonary embolism

  • Gjonbrataj, Endri (Department of Internal Medicine, Keimyung University School of Medicine) ;
  • Kim, Ji Na (Department of Internal Medicine, Daegu Fatima Hospital) ;
  • Gjonbrataj, Juarda (Department of Internal Medicine, Keimyung University School of Medicine) ;
  • Jung, Hye In (Department of Internal Medicine, Keimyung University School of Medicine) ;
  • Kim, Hyun Jung (Department of Internal Medicine, Keimyung University School of Medicine) ;
  • Choi, Won-Il (Department of Internal Medicine, Keimyung University School of Medicine)
  • Received : 2015.04.26
  • Accepted : 2015.08.13
  • Published : 2017.01.01

Abstract

Background/Aims: This study aimed to investigate the risk factors associated with provoked pulmonary embolism (PE). Methods: This retrospective cohort study included 237 patients with PE. Patients that had transient risk factors at diagnosis were classified as having provoked PE, with the remaining patients being classified as having unprovoked PE. The baseline clinical characteristics and factors associated with coagulation were compared. We evaluated the risk factors associated with provoked PE. Results: Of the 237 PE patients, 73 (30.8%) had provoked PE. The rate of respiratory failure and infection, as well as the disseminated intravascular coagulation score and ratio of right ventricular diameter to left ventricular diameter were significantly higher in patients with provoked PE than in those with unprovoked PE. The protein and activity levels associated with coagulation, including protein C antigen, protein S antigen, protein S activity, anti-thrombin III antigen, and factor VIII, were significantly lower in patients with provoked PE than in those with unprovoked PE. Multivariate analysis showed that infection (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.4 to 7.4) and protein S activity (OR, 0.97; 95% CI, 0.95 to 0.99) were significantly associated with provoked PE. Conclusions: Protein S activity and presence of infection were important factors associated with provoked PE. We should pay attention to the presence of infection in patients with provoked PE.

Keywords

References

  1. Lindblad B, Eriksson A, Bergqvist D. Autopsy-verified pulmonary embolism in a surgical department: analysis of the period from 1951 to 1988. Br J Surg 1991;78:849-852. https://doi.org/10.1002/bjs.1800780725
  2. Sandler DA, Martin JF. Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis? J R Soc Med 1989;82:203-205. https://doi.org/10.1177/014107688908200407
  3. Bagot CN, Arya R. Virchow and his triad: a question of attribution. Br J Haematol 2008;143:180-190. https://doi.org/10.1111/j.1365-2141.2008.07323.x
  4. Kucher N. Clinical practice: deep-vein thrombosis of the upper extremities. N Engl J Med 2011;364:861-869. https://doi.org/10.1056/NEJMcp1008740
  5. Lapner ST, Kearon C. Diagnosis and management of pulmonary embolism. BMJ 2013;346:f757. https://doi.org/10.1136/bmj.f757
  6. British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax 2003;58:470-483. https://doi.org/10.1136/thorax.58.6.470
  7. Howard LS, Hughes RJ. NICE guideline: management of venous thromboembolic diseases and role of thrombophilia testing. Thorax 2013;68:391-393. https://doi.org/10.1136/thoraxjnl-2012-202376
  8. Carson JL, Kelley MA, Duff A, et al. The clinical course of pulmonary embolism. N Engl J Med 1992;326:1240-1245. https://doi.org/10.1056/NEJM199205073261902
  9. Christiansen SC, Cannegieter SC, Koster T, Vandenbroucke JP, Rosendaal FR. Thrombophilia, clinical factors, and recurrent venous thrombotic events. JAMA 2005;293:2352-2361. https://doi.org/10.1001/jama.293.19.2352
  10. Klok FA, Mos IC, Broek L, et al. Risk of arterial cardiovascular events in patients after pulmonary embolism. Blood 2009;114:1484-1488. https://doi.org/10.1182/blood-2009-05-220491
  11. Sorensen HT, Mellemkjaer L, Steffensen FH, Olsen JH, Nielsen GL. The risk of a diagnosis of cancer after primary deep venous thrombosis or pulmonary embolism. N Engl J Med 1998;338:1169-1173. https://doi.org/10.1056/NEJM199804233381701
  12. Kearon C, Ginsberg JS, Anderson DR, et al. Comparison of 1 month with 3 months of anticoagulation for a first episode of venous thromboembolism associated with a transient risk factor. J Thromb Haemost 2004;2:743-749. https://doi.org/10.1046/j.1538-7836.2004.00698.x
  13. Levine MN, Hirsh J, Gent M, et al. Optimal duration of oral anticoagulant therapy: a randomized trial comparing four weeks with three months of warfarin in patients with proximal deep vein thrombosis. Thromb Haemost 1995;74:606-611. https://doi.org/10.1055/s-0038-1649783
  14. Schulman S, Rhedin AS, Lindmarker P, et al. A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism: duration of Anticoagulation Trial Study Group. N Engl J Med 1995;332:1661-1665. https://doi.org/10.1056/NEJM199506223322501
  15. Prandoni P, Lensing AW, Buller HR, et al. Deep-vein thrombosis and the incidence of subsequent symptomatic cancer. N Engl J Med 1992;327:1128-1133. https://doi.org/10.1056/NEJM199210153271604
  16. Pinede L, Ninet J, Duhaut P, et al. Comparison of 3 and 6 months of oral anticoagulant therapy after a first episode of proximal deep vein thrombosis or pulmonary embolism and comparison of 6 and 12 weeks of therapy after isolated calf deep vein thrombosis. Circulation 2001;103:2453-2460. https://doi.org/10.1161/01.CIR.103.20.2453
  17. Cushman M, Tsai AW, White RH, et al. Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. Am J Med 2004;117:19-25. https://doi.org/10.1016/j.amjmed.2004.01.018
  18. Huisman MV, Klok FA. Diagnostic management of acute deep vein thrombosis and pulmonary embolism. J Thromb Haemost 2013;11:412-422. https://doi.org/10.1111/jth.12124
  19. Chong LY, Fenu E, Stansby G, Hodgkinson S; Guideline Development Group. Management of venous thromboembolic diseases and the role of thrombophilia testing: summary of NICE guidance. BMJ 2012;344:e3979. https://doi.org/10.1136/bmj.e3979
  20. van der Meer RW, Pattynama PM, van Strijen MJ, et al. Right ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism. Radiology 2005;235:798-803. https://doi.org/10.1148/radiol.2353040593
  21. Ghuysen A, Ghaye B, Willems V, et al. Computed tomographic pulmonary angiography and prognostic significance in patients with acute pulmonary embolism. Thorax 2005;60:956-961. https://doi.org/10.1136/thx.2005.040873
  22. Taylor FB Jr, Toh CH, Hoots WK, Wada H, Levi M; Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH). Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost 2001;86:1327-1330. https://doi.org/10.1055/s-0037-1616068
  23. Levi M. Current understanding of disseminated intravascular coagulation. Br J Haematol 2004;124:567-576. https://doi.org/10.1046/j.1365-2141.2003.04790.x
  24. D'Angelo A, Vigano-D'Angelo S, Esmon CT, Comp PC. Acquired deficiencies of protein S: protein S activity during oral anticoagulation, in liver disease, and in disseminated intravascular coagulation. J Clin Invest 1988;81:1445-1454. https://doi.org/10.1172/JCI113475
  25. Bucciarelli P, Rosendaal FR, Tripodi A, et al. Risk of venous thromboembolism and clinical manifestations in carriers of antithrombin, protein C, protein S deficiency, or activated protein C resistance: a multicenter collaborative family study. Arterioscler Thromb Vasc Biol 1999;19:1026-1033. https://doi.org/10.1161/01.ATV.19.4.1026
  26. Koster T, Blann AD, Briet E, Vandenbroucke JP, Rosendaal FR. Role of clotting factor VIII in effect of von Willebrand factor on occurrence of deep-vein thrombosis. Lancet 1995;345:152-155. https://doi.org/10.1016/S0140-6736(95)90166-3
  27. Wells PS, Langlois NJ, Webster MA, Jaffey J, Anderson JA. Elevated factor VIII is a risk factor for idiopathic venous thromboembolism in Canada: is it necessary to define a new upper reference range for factor VIII? Thromb Haemost 2005;93:842-846.
  28. Broekmans AW, Bertina RM, Reinalda-Poot J, et al. Hereditary protein S deficiency and venous thrombo-embolism: a study in three Dutch families. Thromb Haemost 1985;53:273-277. https://doi.org/10.1055/s-0038-1661292
  29. Levi M, Schultz M, van der Poll T. Disseminated intravascular coagulation in infectious disease. Semin Thromb Hemost 2010;36:367-377. https://doi.org/10.1055/s-0030-1254046
  30. Engesser L, Broekmans AW, Briet E, Brommer EJ, Bertina RM. Hereditary protein S deficiency: clinical manifestations. Ann Intern Med 1987;106:677-682. https://doi.org/10.7326/0003-4819-106-5-677

Cited by

  1. Bilateral Massive Pulmonary Embolism on Disseminated Intravascular Coagulation (DIVC) after Severe Postpartum Haemorrhage vol.8, pp.3, 2017, https://doi.org/10.4236/ojanes.2018.83009
  2. The Optimal Duration and Selection of Anti-coagulants after First Episode of Unprovoked Venous Thromboembolism vol.4, pp.1, 2017, https://doi.org/10.14345/ceth.18001
  3. Comparison of the D-dimer concentration in pregnant women with or without pulmonary thromboembolism vol.9, pp.8, 2017, https://doi.org/10.4103/jfmpc.jfmpc_1070_19
  4. Features of in-hospital clinical course of pulmonary embolism in patients of different age groups vol.19, pp.5, 2017, https://doi.org/10.15829/1728-8800-2020-2423
  5. Rivaroxaban treatment for young patients with pulmonary embolism (Review) vol.20, pp.2, 2017, https://doi.org/10.3892/etm.2020.8791
  6. Patients Undergoing Primary Total Joint Arthroplasty with Primary Hypercoagulable States vol.13, pp.2, 2017, https://doi.org/10.1111/os.12901