Adjunctive Therapy and Mortality in Patients With Unstable Pulmonary Embolism
Mortality with adjunctive therapy in patients with unstable pulmonary embolism, defined as those in shock or on ventilator support, is sparsely studied and requires further investigation. This was a retrospective cohort study based on administrative data from the Nationwide Inpatient Sample, 2016. I...
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| Veröffentlicht in: | The American journal of cardiology 2020-06, Vol.125 (12), p.1913-1919 |
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| container_end_page | 1919 |
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| container_issue | 12 |
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| container_title | The American journal of cardiology |
| container_volume | 125 |
| creator | Stein, Paul D. Matta, Fadi Hughes, Patrick G. Hughes, Mary J. |
| description | Mortality with adjunctive therapy in patients with unstable pulmonary embolism, defined as those in shock or on ventilator support, is sparsely studied and requires further investigation. This was a retrospective cohort study based on administrative data from the Nationwide Inpatient Sample, 2016. In-hospital all-cause mortality in unstable patients with acute pulmonary embolism was assessed according to treatment. Patients were identified by International Classification of Diseases-10-Clinical Modification Codes. Most unstable patients, 85%, received only anticoagulants. Their mortality was 3,080 of 6,635 (46%) without an inferior vena cava (IVC) filter, and mortality was much less with an IVC filter, 285 of 1,185 (24%) (p |
| doi_str_mv | 10.1016/j.amjcard.2020.03.014 |
| format | Article |
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This was a retrospective cohort study based on administrative data from the Nationwide Inpatient Sample, 2016. In-hospital all-cause mortality in unstable patients with acute pulmonary embolism was assessed according to treatment. Patients were identified by International Classification of Diseases-10-Clinical Modification Codes. Most unstable patients, 85%, received only anticoagulants. Their mortality was 3,080 of 6,635 (46%) without an inferior vena cava (IVC) filter, and mortality was much less with an IVC filter, 285 of 1,185 (24%) (p <0.0001). Mortality with catheter-directed thrombolysis alone, 70 of 235 (30%), did not differ significantly from mortality with anticoagulants plus an IVC filter, p = 0.07, although a trend favored the latter. Intravenous thrombolytic therapy without an IVC filter showed a mortality of 295 of 695 (42%) which tended to be lower than mortality with anticoagulants alone (p = 0.06). The addition of an IVC filter to intravenous thrombolytic therapy resulted in a mortality of 20 of 165 (12%), which was the lowest mortality with any combination of adjunctive treatments. Intravenous thrombolytic therapy, however, was associated with more adverse effects of therapy than catheter-directed thrombolysis or anticoagulants.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2020.03.014</identifier><identifier>PMID: 32471550</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Age ; Anticoagulants ; Catheters ; Embolism ; Intravenous administration ; Medical instruments ; Mortality ; Patients ; Pulmonary embolisms ; Therapy ; Thrombolysis</subject><ispartof>The American journal of cardiology, 2020-06, Vol.125 (12), p.1913-1919</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><rights>2020. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c393t-aceb2c09d98bd159eec43fae3e0246bf36791283a091cdae15bc9bc76bf12fab3</citedby><cites>FETCH-LOGICAL-c393t-aceb2c09d98bd159eec43fae3e0246bf36791283a091cdae15bc9bc76bf12fab3</cites><orcidid>0000-0002-0073-6961 ; 0000-0003-1712-1549</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2425667784?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3548,27922,27923,45993,64383,64385,64387,72239</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32471550$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stein, Paul D.</creatorcontrib><creatorcontrib>Matta, Fadi</creatorcontrib><creatorcontrib>Hughes, Patrick G.</creatorcontrib><creatorcontrib>Hughes, Mary J.</creatorcontrib><title>Adjunctive Therapy and Mortality in Patients With Unstable Pulmonary Embolism</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Mortality with adjunctive therapy in patients with unstable pulmonary embolism, defined as those in shock or on ventilator support, is sparsely studied and requires further investigation. This was a retrospective cohort study based on administrative data from the Nationwide Inpatient Sample, 2016. In-hospital all-cause mortality in unstable patients with acute pulmonary embolism was assessed according to treatment. Patients were identified by International Classification of Diseases-10-Clinical Modification Codes. Most unstable patients, 85%, received only anticoagulants. Their mortality was 3,080 of 6,635 (46%) without an inferior vena cava (IVC) filter, and mortality was much less with an IVC filter, 285 of 1,185 (24%) (p <0.0001). Mortality with catheter-directed thrombolysis alone, 70 of 235 (30%), did not differ significantly from mortality with anticoagulants plus an IVC filter, p = 0.07, although a trend favored the latter. Intravenous thrombolytic therapy without an IVC filter showed a mortality of 295 of 695 (42%) which tended to be lower than mortality with anticoagulants alone (p = 0.06). The addition of an IVC filter to intravenous thrombolytic therapy resulted in a mortality of 20 of 165 (12%), which was the lowest mortality with any combination of adjunctive treatments. Intravenous thrombolytic therapy, however, was associated with more adverse effects of therapy than catheter-directed thrombolysis or anticoagulants.</description><subject>Age</subject><subject>Anticoagulants</subject><subject>Catheters</subject><subject>Embolism</subject><subject>Intravenous administration</subject><subject>Medical instruments</subject><subject>Mortality</subject><subject>Patients</subject><subject>Pulmonary embolisms</subject><subject>Therapy</subject><subject>Thrombolysis</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkEtLHTEUgEOx1KvtT6gE3HQz05NkXlkVEasFpS6ULkMeZzDDPG6TjHD_vZF77aIbV4fD-c7rI-Qrg5IBa74PpZ4Gq4MrOXAoQZTAqg9kw7pWFkwycUQ2AMALySp5TE5iHHLKWN18IseCVy2ra9iQuws3rLNN_hnpwxMGvd1RPTt6t4SkR5921M_0XiePc4r0j09P9HGOSZsR6f06Tsusw45eTWYZfZw-k4-9HiN-OcRT8vjz6uHyprj9ff3r8uK2sEKKVGiLhluQTnbGsVoi2kr0GgUCrxrTi6aVjHdCg2TWaWS1sdLYNpcY77URp-Tbfu42LH9XjElNPlocRz3jskbFK-g41MDbjJ7_hw7LGuZ8XaZ43TRt21WZqveUDUuMAXu1DX7KrykG6tW3GtTBt3r1rUCo7Dv3nR2mr2ZC96_rTXAGfuwBzDqePQYVbXZp0fmANim3-HdWvAAfMJP2</recordid><startdate>20200615</startdate><enddate>20200615</enddate><creator>Stein, Paul D.</creator><creator>Matta, Fadi</creator><creator>Hughes, Patrick G.</creator><creator>Hughes, Mary J.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0073-6961</orcidid><orcidid>https://orcid.org/0000-0003-1712-1549</orcidid></search><sort><creationdate>20200615</creationdate><title>Adjunctive Therapy and Mortality in Patients With Unstable Pulmonary Embolism</title><author>Stein, Paul D. ; 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| subjects | Age Anticoagulants Catheters Embolism Intravenous administration Medical instruments Mortality Patients Pulmonary embolisms Therapy Thrombolysis |
| title | Adjunctive Therapy and Mortality in Patients With Unstable Pulmonary Embolism |
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