Predictors and Causes of Long-Term Mortality in Elderly Patients with Acute Venous Thromboembolism: A Prospective Cohort Study

Faller, Nicolas; Limacher, Andreas; Méan, Marie; Righini, Marc; Aschwanden, Markus; Beer, Jürg H.; Frauchiger, Beat; Osterwalder, Josef Johann; Kucher, Nils; Lämmle, Bernhard; Cornuz, Jacques; Angelillo‐Scherrer, Anne; Matter, Christian M.; Husmann, Marc; Borggrefe, Martin; Staub, Daniel; Mazzolai, Lucia; Hügli, Olivier; Rodondi, Nicolas; Aujesky, Drahomir

doi:10.1016/j.amjmed.2016.09.008

Cited by 84 publications

(88 citation statements)

References 31 publications

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“…Several studies have shown that D-dimer is a good diagnostic test for diverse thrombotic conditions, such as ischemic stroke (Nezu et al, 2018), venous thromboembolism (Faller et al, 2017), pulmonary embolism (van der Hulle et al, 2013), and aortic dissection (Mussa et al, 2016). In addition to its high diagnostic value for thrombotic disease, recent studies have also reported its relationship with short-term and long-term prognosis of these diseases (Kim et al, 2015;Vele et al, 2016;Faller et al, 2017). Additionally, several studies have shown an association in the general population (Di Castelnuovo et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

“…D-dimer, a specific degradation product of cross-linked fibrin, represents the coagulation and fibrinolytic system activation (Suzuki et al, 2009). It is now commonly used in the diagnosis of pulmonary embolism (van der Hulle et al, 2013), deep vein thrombosis (Faller et al, 2017), acute coronary syndrome (Bayes-Genis et al, 2000), and acute aortic dissection (Akutsu et al, 2005;Suzuki et al, 2009;Shao et al, 2014). For acute aortic dissection, the mechanisms of coagulation and fibrinolytic system activation might be (1) coagulant material from the aortic wall released into the circulation and (2) an accumulation of clotting factors at the site of the lesion, secondary to the local exposition of tissue factors from the torn arterial wall (Ten Cate et al, 1975).…”

Section: Introductionmentioning

confidence: 99%

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Association Between D-dimer and Early Adverse Events in Patients With Acute Type A Aortic Dissection Undergoing Arch Replacement and the Frozen Elephant Trunk Implantation: A Retrospective Cohort Study

et al. 2020

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In the present study, we investigated the associations between D-dimer levels at admission and early adverse events in patients with acute type A aortic dissection undergoing arch replacement and the frozen elephant trunk (FET). Methods: We retrospectively analyzed data of patients with acute type A aortic dissection undergoing aortic arch surgery and FET from July 2017 to December 2018 at Beijing Anzhen Hospital. D-dimer levels were evaluated within 24 h of admission. Multivariate Cox regression analysis was used to determine independent predictors of early postoperative adverse events. Results: A total of 347 patients were included in the study. The average age of the patients was 48.07 ± 10.56 years, with male predominance (79.25%). The incidence of 90-day postoperative adverse events was 18.7%, consisting of 14.7% mortality and 4.0% permanent neurological dysfunction (PND). The median D-dimer level was 1.95 ug/ml (interquartile range, 0.77-3.16 ug/ml). Multivariable Cox regression analysis revealed that D-dimer level was independently associated with 90-day postoperative adverse events after adjustment for confounding factors (hazard ratio = 1.19 per 10 ug/ml increase in D-dimer, 95% confidence interval: 1.01-1.41; P = 0.039). Kaplan-Meier analysis revealed that the highest tertile (median 6.27 ug/ml) had more 90-day postoperative adverse events compared with the median and lowest tertiles (P = 0.0014). Sub-analysis found that the association remained unchanged.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association Between D-dimer and Early Adverse Events in Patients With Acute Type A Aortic Dissection Undergoing Arch Replacement and the Frozen Elephant Trunk Implantation: A Retrospective Cohort Study

et al. 2020

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“…Data from cohort studies indicate that risk factors associated with an increased risk of all-cause death, beyond cancer and presentation as severe PE, include age (hazard ratio [HR]: 1.32 per decade), low physical activity level (HR: 1.92), diabetes mellitus (HR: 1.50), anemia (HR: 1.48), and polypharmacy (HR: 1.41). 30 Therefore, from a global healthcare perspective, measures to improve survival after VTE, in addition to improvement in anticoagulant therapy, should include an integral patient management, streamlining the treatment of other relevant comorbidities, applying proven measures to reduce global CV risk, and promoting healthy lifestyles. 31,32 With respect to deaths by type of anticoagulant we found that in comparison with warfarin, the NOAC did not reduce all-cause mortality, CV mortality, or non-CV mortality.…”

Section: Discussionmentioning

confidence: 99%

“…35 Finally, our metaanalysis is based on data from selected populations from clinical trials, 36 but causes of death are consistent with those reported in unselected populations in standard practice. 30…”

Section: Discussionmentioning

confidence: 99%

Causes of Death in Patients with Venous Thromboembolism Anticoagulated with Direct Oral Anticoagulants: A Systematic Review and Meta-Analysis

Gómez-Outes

Terleira-Fernández

Suárez-Gea

et al. 2018

Semin Thromb Hemost

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Death is more frequent than nonfatal recurrent venous thromboembolism (VTE) and major bleeding after acute VTE. The analysis of the causes of death is fundamental to explore new strategies to reduce mortality rates in these patients. The authors performed a meta-analysis to analyze mortality and independently adjudicated causes of death in anticoagulated patients due to VTE, and to evaluate potential differences between different anticoagulant schemes. They searched MEDLINE and CENTRAL, from January 1, 2000, to January 31, 2017, and performed additional searches in Web sites of regulatory agencies, clinical trial registers, and conference proceedings. Two investigators independently selected studies and extracted the data. Study quality was assessed with the Cochrane Collaboration's tool for assessing the risk of bias in randomized studies. Seven prospective randomized trials in 29,844 patients (22,025 patient-year follow-up) were included, comparing dabigatran, rivaroxaban, apixaban, and edoxaban with the standard anticoagulant treatment of VTE. A total of 718 patients died during the follow-up (3.4% per year; 95% confidence interval [CI]: 2.3-4.8). The most frequent causes of death were cancer (42%), followed by VTE (20%), infections (13%), hemorrhage (6%), heart disease (4%), and stroke (2%). There were no differences in the overall survival and causes of death according to the anticoagulant type. Concomitant active cancer during the study was significantly associated with death (odds ratio: 15.2; 95% CI: 9.2-25.1). Cancer is the leading cause of death in contemporary VTE trials. Interventions beyond anticoagulation, particularly in patients with active cancer, are needed.

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“…Faller and colleagues also performed a prospective multicenter cohort study in older patients, in which 991 patients with acute venous thromboembolism (VTE) and aged >65 years were followed up for a median period of 30 months. 39 Overall, 206 patients (21%) died during follow-up. The frequency of hs-cTnT concentrations above the 99th percentile URL (i.e., >14 ng/L) was 69% compared with 46% in those who survived (p < 0.001).…”

Section: Review Of Clinical Evidence Of the Role Of Hs-ctn In Pulmonamentioning

confidence: 99%

Measurement of High-Sensitivity Cardiac Troponin in Pulmonary Embolism: Useful Test or a Clinical Distraction

Lippi

Favaloro

Kavsak

2019

Semin Thromb Hemost

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The ability to predict death or other unfavorable outcomes after an acute pulmonary embolism (PE) is challenging, with current available risk score models having relatively unsatisfactory prognostic performance in this area. For example, the simplified pulmonary embolism severity index (sPESI), the most frequently used stratification tool, misclassifies a significant percentage of low- and high-risk patients. This gap in care, along with the increasing clinical availability of high-sensitivity cardiac troponin (hs-cTn) laboratory tests and the recent emphasis on detecting myocardial injury, may foster further evaluation of hs-cTn testing in patients with acute PE. Our analysis of the current scientific literature on hs-cTn in patients with acute PE identified that hs-cTn testing may provide valuable information for predicting future adverse outcomes and mortality, independently from baseline clinical risk assessment. Although the risk of an adverse event is indeed higher in patients with higher sPESI scores, cTns retain their prognostic value also in those at low risk, suggesting that a combination of hs-cTn with sPESI may provide an incremental value over assessment of either variable alone. Accordingly, the future development of updated risk stratification models, with the inclusion of laboratory tests such as hs-cTn, may represent an enhanced approach for risk stratification in patients with acute PE. Additional research, however, is needed to verify whether the combination of cTns, specifically as measured with hs-cTn assays, with other biomarkers may further improve the current capacity to efficiently manage patients with acute PE.

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Predictors and Causes of Long-Term Mortality in Elderly Patients with Acute Venous Thromboembolism: A Prospective Cohort Study

Cited by 84 publications

References 31 publications

Association Between D-dimer and Early Adverse Events in Patients With Acute Type A Aortic Dissection Undergoing Arch Replacement and the Frozen Elephant Trunk Implantation: A Retrospective Cohort Study

Association Between D-dimer and Early Adverse Events in Patients With Acute Type A Aortic Dissection Undergoing Arch Replacement and the Frozen Elephant Trunk Implantation: A Retrospective Cohort Study

Causes of Death in Patients with Venous Thromboembolism Anticoagulated with Direct Oral Anticoagulants: A Systematic Review and Meta-Analysis

Measurement of High-Sensitivity Cardiac Troponin in Pulmonary Embolism: Useful Test or a Clinical Distraction

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