PMID- 28248408
OWN - NLM
STAT- MEDLINE
DCOM- 20180625
LR  - 20180625
IS  - 1898-018X (Electronic)
IS  - 1898-018X (Linking)
VI  - 24
IP  - 5
DP  - 2017
TI  - Prognostic importance of central thrombus in hemodynamically stable patients with 
      pulmonary embolism.
PG  - 508-514
LID - 10.5603/CJ.a2017.0021 [doi]
AB  - BACKGROUND: The association between mortality and localization of central 
      thrombus in hemodynamically stable patients with pulmonary embolism (PE) is 
      unclear. Sufficient data are not available to help clinicians to select between 
      low molecular weight heparin (LMWH), unfractionated heparin (UFH) and 
      thrombolytics for the management of central thrombus. The present study aims to 
      investigate whether central thrombus in the pulmonary artery affects 30-day 
      mortality rate, and to compare the outcomes of different treatment approaches in 
      patients with central thrombus. METHODS: This multi-central, prospective, 
      observational study included 874 hemodynamically stable patients with PE 
      confirmed by multidetector computed tomography scan. The localization of the 
      emboli was evaluated and categorized as central (saddle or at least one main 
      pulmonary artery), lobar or distal. The primary study outcome was 30-day 
      all-cause mortality. RESULTS: Localization of the emboli was central in 319 
      (36.5%) patients, lobar in 264 (30.2%) and distal in 291 (33.2%) patients. 
      Seventy-four (8.5%) patients died during the 30-day follow-up period. All-cause 
      mortality rate was 11.9%, 6.8% and 6.2% in patients with central, lobar, and 
      distal emboli, respectively (p < 0.001). Multivariate analysis did not show that 
      hemodynamically stable central thrombus was an independent predictor of 
      mortality. Additionally, mortality rate was not significantly different between 
      UFH, LMWH and thrombolytic therapy groups. CONCLUSIONS: The present study showed 
      that central thrombus was not an independent predictor of mortality in 
      hemodynamically stable PE patients. LMWH and UFH were similarly effective in the 
      treatment of this patient group.
FAU - Senturk, Aysegul
AU  - Senturk A
AD  - Ankara Ataturk Training and Research Hospital, Department of Pulmonary Medicine, 
      Ankara, Turkey. asenturk1967@yahoo.com.
FAU - Ozsu, Savas
AU  - Ozsu S
FAU - Duru, Serap
AU  - Duru S
FAU - Cakir, Ebru
AU  - Cakir E
FAU - Ulasli, Sevinc Sarinc
AU  - Ulasli SS
FAU - Demirdogen, Ezgi
AU  - Demirdogen E
FAU - Kayhan, Servet
AU  - Kayhan S
FAU - Guzel, Aygul
AU  - Guzel A
FAU - Yakar, Fatih
AU  - Yakar F
FAU - Berk, Serdar
AU  - Berk S
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
DEP - 20170301
PL  - Poland
TA  - Cardiol J
JT  - Cardiology journal
JID - 101392712
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/therapeutic use
MH  - Arterial Occlusive Diseases/diagnostic 
      imaging/*mortality/*physiopathology/therapy
MH  - Chi-Square Distribution
MH  - Computed Tomography Angiography/methods
MH  - Female
MH  - Fibrinolytic Agents/therapeutic use
MH  - *Hemodynamics
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multidetector Computed Tomography
MH  - Multivariate Analysis
MH  - Odds Ratio
MH  - Proportional Hazards Models
MH  - Pulmonary Artery/diagnostic imaging/*physiopathology
MH  - Pulmonary Embolism/diagnostic imaging/*mortality/*physiopathology/therapy
MH  - Risk Factors
MH  - Thrombolytic Therapy
MH  - Thrombosis/diagnostic imaging/*mortality/*physiopathology/therapy
MH  - Time Factors
MH  - Treatment Outcome
MH  - Turkey/epidemiology
MH  - Young Adult
OTO - NOTNLM
OT  - anticoagulation
OT  - central thrombus
OT  - mortality
OT  - multidetector computed tomography
OT  - pulmonary embolism
EDAT- 2017/03/02 06:00
MHDA- 2018/06/26 06:00
CRDT- 2017/03/02 06:00
PHST- 2016/09/17 00:00 [received]
PHST- 2016/12/05 00:00 [accepted]
PHST- 2017/02/15 00:00 [revised]
PHST- 2017/03/02 06:00 [pubmed]
PHST- 2018/06/26 06:00 [medline]
PHST- 2017/03/02 06:00 [entrez]
AID - VM/OJS/J/48792 [pii]
AID - 10.5603/CJ.a2017.0021 [doi]
PST - ppublish
SO  - Cardiol J. 2017;24(5):508-514. doi: 10.5603/CJ.a2017.0021. Epub 2017 Mar 1.