PMID- 29513729
OWN - NLM
STAT- MEDLINE
DCOM- 20180628
LR  - 20240316
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 13
IP  - 3
DP  - 2018
TI  - The incidence of acute pulmonary embolism following syncope in 
      anticoagulant-naive patients: A retrospective cohort study.
PG  - e0193725
LID - 10.1371/journal.pone.0193725 [doi]
LID - e0193725
AB  - BACKGROUND: A recently published, large prospective study showed unexpectedly 
      high prevalence of acute pulmonary embolism (APE) among patients hospitalized for 
      syncope. In such a case, a high incidence of recurrent pulmonary embolism is 
      expected among patients who were discharged without APE workup. OBJECTIVES: To 
      determine the incidence of symptomatic APE among patients hospitalized for a 
      first episode of syncope and discharged without APE workup or anticoagulation. 
      METHODS: This retrospective cohort study included patients hospitalized at Rambam 
      Health Care Campus between January 2006 and February 2017 with a primary 
      admission diagnosis of syncope, who were not investigated for APE and were not 
      taking anticoagulants. The patients were followed up for up to three years after 
      discharge. The occurrence of venous thromboembolism (VTE) during the follow-up 
      period was documented. RESULTS: The median follow-up duration was 33 months. 
      1,126 subjects completed a three-year follow-up. During this period, 38 patients 
      (3.38%) developed VTE, 17 (1.51%) of them had APE. The cumulative incidence of 
      VTE and APE was 1.9% (95% CI 1.3%-2.5%) and 0.9% (95% CI 0.4%-1.3%) respectively. 
      Only seven subjects developed APE during the first year of follow-up. The median 
      times from the event of syncope to the development of APE and VTE were 18 and 19 
      months respectively. CONCLUSIONS: The cumulative incidence of VTE during a 
      three-year follow-up period after an episode of syncope is low. In the absence of 
      clinical suspicion, a routine diagnostic workup for APE in patients with syncope 
      cannot be recommended.
FAU - Epstein, Danny
AU  - Epstein D
AUID- ORCID: 0000-0001-7032-7007
AD  - Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel.
FAU - Berger, Gidon
AU  - Berger G
AD  - Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel.
AD  - Division of Pulmonary Medicine, Rambam Health Care Campus, Haifa, Israel.
FAU - Barda, Noam
AU  - Barda N
AD  - Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel 
      Aviv, Israel.
FAU - Marcusohn, Erez
AU  - Marcusohn E
AD  - Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel.
FAU - Barak-Corren, Yuval
AU  - Barak-Corren Y
AD  - Predictive Medicine Group, Boston Children's Hospital, Boston, United States of 
      America.
AD  - Shaare Tzedek Medical Center, Jerusalem, Israel.
FAU - Muhsen, Khitam
AU  - Muhsen K
AD  - Department of Epidemiology and Preventive Medicine, School of Public Health, 
      Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
FAU - Balicer, Ran D
AU  - Balicer RD
AD  - Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel 
      Aviv, Israel.
AD  - Epidemiology Department, Ben Gurion University of the Negev, Be'er Sheba, Israel.
FAU - Azzam, Zaher S
AU  - Azzam ZS
AD  - Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel.
AD  - The Rappaport's Faculty of Medicine, The Technion Institute, Haifa, Israel.
LA  - eng
PT  - Journal Article
DEP - 20180307
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Pulmonary Embolism/*complications/*epidemiology
MH  - Retrospective Studies
MH  - Survival Analysis
MH  - Syncope/*complications/*epidemiology/therapy
PMC - PMC5841762
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2018/03/08 06:00
MHDA- 2018/06/29 06:00
PMCR- 2018/03/07
CRDT- 2018/03/08 06:00
PHST- 2017/12/16 00:00 [received]
PHST- 2018/02/19 00:00 [accepted]
PHST- 2018/03/08 06:00 [entrez]
PHST- 2018/03/08 06:00 [pubmed]
PHST- 2018/06/29 06:00 [medline]
PHST- 2018/03/07 00:00 [pmc-release]
AID - PONE-D-17-43926 [pii]
AID - 10.1371/journal.pone.0193725 [doi]
PST - epublish
SO  - PLoS One. 2018 Mar 7;13(3):e0193725. doi: 10.1371/journal.pone.0193725. 
      eCollection 2018.