eCite Digital Repository

High mortality in patients presenting with acute pulmonary embolism and elevated INR not on anticoagulant therapy

Citation

Wong, CCY and Ng, ACC and Lau, JK and Chow, V and Chen, V and Ng, ACT and Yong, ASC and Sindone, AP and Marwick, TH and Kritharides, L, High mortality in patients presenting with acute pulmonary embolism and elevated INR not on anticoagulant therapy, Thrombosis and Haemostasis, 115, (6) pp. 1191-1199. ISSN 0340-6245 (2016) [Refereed Article]

Copyright Statement

Copyright 2016 Schattauer

DOI: doi:10.1160/TH15-11-0869

Abstract

The prognostic significance of patients presenting with pulmonary embolism (PE) and elevated International Normalised Ratio (INR) not on anticoagulant therapy has not been described. We investigated whether these patients had higher mortality compared to patients with normal INR. A retrospective study of patients admitted to a tertiary hospital with acute PE from 2000 to 2012 was undertaken, with study outcomes tracked using a state-wide death registry. Patients were excluded if they were taking anticoagulants or had inadequate documentation of their INR and medication status. Of the 1,039 patients identified, 94 (9 %) had an elevated INR (> 1.2) in the absence of anticoagulant use. These patients had higher mortality at six months follow-up (26 % vs 6 %, p< 0.001) compared to controls (INR ≤ 1.2). An INR > 1.2 at diagnosis was an independent predictor of death at six months post-PE (hazard ratio [HR] 2.9, 95 % confidence interval [CI] 1.8-4.7, p< 0.001). The addition of INR to a multivariable model that included the simplified pulmonary embolism severity index (sPESI), chest pain, and serum sodium led to a significant net reclassification improvement estimated at 8.1 %. The final model's C statistic increased significantly by 0.04 (95 % CI 0.01-0.08, p=0.03) to 0.83 compared to sPESI alone (0.79). In summary, patients presenting with acute PE and elevated INR while not on anticoagulant therapy appear to be at high risk of death. Future validation studies in independent cohorts will clarify if this novel finding can be usefully incorporated into clinical decision making in patients with acute PE.

Item Details

Item Type:Refereed Article
Keywords:International Normalised Ratio, anticoagulant, mortality, prognosis, pulmonary embolism
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Marwick, TH (Professor Tom Marwick)
ID Code:111537
Year Published:2016
Web of Science® Times Cited:2
Deposited By:Menzies Institute for Medical Research
Deposited On:2016-09-21
Last Modified:2017-11-03
Downloads:0

Repository Staff Only: item control page