Chest
Original Research: Venous ThromboembolismThe Natural Course of Hemodynamically Stable Pulmonary Embolism: Clinical Outcome and Risk Factors in a Large Prospective Cohort Study
Section snippets
Study Design
Consecutive patients with PE confirmed by helical CT were included. They were derived from a large, prospective management study using a diagnostic algorithm that consisted of a clinical decision rule, a d-dimer test, and helical CT.6Outpatients as well as inpatients were eligible. Exclusion criteria of this management study were as follows: treatment with therapeutic doses of unfractionated or low-molecular-weight heparin for > 24 h; life expectancy < 3 months; pregnancy; geographic
Study Patients
Between November 2002 and September 2004, a total of 3,503 patients with clinically suspected PE were screened, of whom 197 patients (5.6%) were excluded because of predefined exclusion criteria or refused informed consent: > 24 h of low-molecular-weight heparin (n = 50), life expectancy < 3 months (n = 47), pregnancy (n = 26), geographic inaccessibility precluding follow-up (n = 20), and other reasons (n = 41). In addition, 13 patients refused informed consent.6In 674 patients (20%), PE was
Discussion
We evaluated the clinical outcome of a large prospective cohort of patients with symptomatic, confirmed PE and aimed to assess an accurate incidence of recurrent VTE, mortality, and hemorrhagic complications during 3 months of anticoagulant treatment (Table 5). Moreover, we aimed to identify risk factors for these events and to determine the time course within 3 months of the start of treatment.
There are two important conclusions to be drawn from our analysis. First, a recurrent thromboembolic
Appendix
Members of the writing group of the Christopher Study, in alphabetical order, are as follows: Arne van Belle, MD, Harry R. Büller, MD, Menno V. Huisman, MD, Peter M. Huisman, MD, Karin Kaasjager, MD, Pieter Willem Kamphuisen, MD, Mark Kramer, MD, Marieke J.H.A. Kruip, MD, Johanna M. Kwakkel-van Erp, MD, Frank W.G. Leebeek, MD, Mathilde Nijkeuter, MD, Martin H. Prins, MD, Maaike Söhne, MD, Lidwine W. Tick MD.
Acknowledgments
M. Nijkeuter and M.V. Huisman had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
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This study was supported in part by unrestricted grants from the participating hospitals.
None of the authors have any conflicts of interest to disclose.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).