Treatment and Outcomes of Acute Pulmonary Embolism and Deep Venous Thrombosis: The Cardiovascular Research Network Venous Thromboembolism (CVRN VTE) Study.

Fang, Margaret C; Fan, Dongjie; Sung, Sue Hee; Witt, Daniel M; Schmelzer, John R; Williams, Marc S; Yale, Steven H; Baumgartner, Christine; Go, Alan S (2019). Treatment and Outcomes of Acute Pulmonary Embolism and Deep Venous Thrombosis: The Cardiovascular Research Network Venous Thromboembolism (CVRN VTE) Study. The American journal of medicine, 132(12), 1450-1457.e1. Elsevier 10.1016/j.amjmed.2019.05.040

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BACKGROUND

Few studies describe both inpatient and outpatient treatment and outcomes of patients with acute venous thromboembolism in the US.

METHODS

A multi-institutional cohort of patients diagnosed with confirmed pulmonary embolism and/or deep venous thrombosis during years 2004 through 2010 was established from four large, US-based integrated healthcare delivery systems. Computerized databases were accessed and medical records reviewed to collect information on patient demographics, clinical risk factors, initial antithrombotic treatment, and vital status. Multivariable Cox regression models were used to estimate the risk of death at 90days.

RESULTS

The cohort comprised 5497 adults with acute venous thromboembolism. Pulmonary embolism was predominantly managed in the hospital setting (95.0%) while 54.5% of patients with lower extremity thrombosis were treated as outpatients. Anticoagulant treatment differed according to thromboembolism type: 2715 (93.7%) of patients with pulmonary embolism and 1634 (87.4%) of patients with lower extremity thrombosis were discharged on anticoagulants, compared to 288 (80.7%) patients with upper extremity thrombosis and 70 (55.6%) patients with other thrombosis. While 4.5% of patients died during the index episode, 15.4% died within 90days. Pulmonary embolism was associated with a higher 90-day death risk than lower extremity thrombosis (adjusted hazard ratio [aHR] 1.23 [1.04-1.47]) as was not being discharged on anticoagulants (aHR 5.56 [4.76-6.67]).

CONCLUSIONS

In this multicenter, community-based study of patients with acute venous thromboembolism, anticoagulant treatment and outcomes varied by thromboembolism type. Although case-fatality during the acute episode was relatively low, 15.4% of people with thromboembolism died within 90days of the index diagnosis.

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