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Major bleeding rates after pulmonary embolism, DVT unacceptable

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Patients with isolated deep vein thrombosis or pulmonary embolism have high rates of successive pulmonary embolism or recurrent venous thromboembolism, according to a community-based study.

Researchers at the University of Massachusetts and McMaster University Medical Center in Ontario performed the Worcester Venous Thromboembolism Study to compare outcomes in a community setting of patients with deep vein thrombosis and pulmonary embolism. The researchers collected data from 1,691 residents of Worcester, Mass. who had an acute venous thromboembolism episode at any point during 1999, 2001 and 2003.

The rate of recurrent pulmonary embolism (5.7%) and venous thromboembolism (13.7%) was similar in patients with pulmonary embolism (n=549), compared with those with DVT (n=1,142) whose pulmonary embolism recurrence and venous thromboembolism recurrence rates were 5.6% and 19%. A major bleeding episode occurred in 82 patients with pulmonary embolism (14.9%), compared with 146 with DVT (12.8%). Two-hundred twenty-six patients with pulmonary embolism (41.7%) died during follow-up, compared with 411 patients with DVT (36%).

According to the researchers, rates of major bleeding events after pulmonary embolism and DVT, along with recurrent venous thromboembolism, are unacceptably high. – by Stacey L. Adams

Arch Intern Med. 2008;168:425-430.

Contrary to previous studies, this study found that the recurrence rates of pulmonary embolism were similar in patients regardless of whether the initial event was a pulmonary embolism or a DVT. Rates of major bleeding were two-fold higher in this study compared to recent randomized studies of venous thromboembolism treatment. However, no data were collected on anticoagulation management practices. The significant mortality associated with venous thromboembolism (25% at one year) in this study may be due to comorbidities as over 50% of the study population was older than 65 years of age (and 1/3 were over 75 years of age).

– Raj Kasthuri, MD

Assistant Professor, Division of Hematology and Oncology
Department of Medicine, University of North Carolina at Chapel Hill