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The Risk for Fatal Pulmonary Embolism after Discontinuing Anticoagulant Therapy for Venous Thromboembolism

James D. Douketis, MD; Chu Shu Gu, MSc; Sam Schulman, MD, PhD; Angelo Ghirarduzzi, MD; Vittorio Pengo, MD; and Paolo Prandoni, MD, PhD
[+] Article and Author Information

From McMaster University, Hamilton, Ontario, Canada; Karolinska University Hospital, Stockholm, Sweden; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; and University of Padua, Padua, Italy.


Acknowledgment: The authors thank Drs. Jeffrey S. Ginsberg, Frederick A. Spencer, and Richard H. White for their helpful reviews of this manuscript.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: James D. Douketis, MD, St. Joseph's Healthcare, Room F-544, 50 Charlton Avenue East, Hamilton, Ontario, Canada, L8N 4A6; e-mail, jdouket@mcmaster.ca.

Current Author Addresses: Dr. Douketis: St. Joseph's Healthcare, Room F-544, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada.

Mr. Gu: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario L8V 1C3, Canada.

Dr. Schulman: Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.

Dr. Ghirarduzzi: Department of Internal Medicine, Angiology Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.

Dr. Pengo: Department of Cardiothoracic and Vascular Sciences, University of Padua, Padua, Italy.

Dr. Prandoni: Department of Medical and Surgical Sciences, Thromboembolism Unit, University of Padua, Padua, Italy.

Author Contributions: Conception and design: J.D. Douketis, S. Schulman, P. Prandoni.

Analysis and interpretation of the data: J.D. Douketis, C.S. Gu, S. Schulman, A. Ghirarduzzi, V. Pengo, P. Prandoni.

Drafting of the article: J.D. Douketis, C.S. Gu.

Critical revision of the article for important intellectual content: J.D. Douketis, S. Schulman, P. Prandoni.

Final approval of the article: J.D. Douketis, C.S. Gu, S. Schulman, A. Ghirarduzzi, V. Pengo, P. Prandoni.

Provision of study materials or patients: S. Schulman, A. Ghirarduzzi, V. Pengo, P. Prandoni.

Statistical expertise: C.S. Gu.

Collection and assembly of data: S. Schulman, A. Ghirarduzzi, V. Pengo, P. Prandoni.


Ann Intern Med. 2007;147(11):766-774. doi:10.7326/0003-4819-147-11-200712040-00007
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We aimed to provide reliable and precise estimates of the annual risk for fatal PE and the case-fatality rate of recurrent disease after discontinuation of anticoagulant therapy for a first episode of symptomatic VTE. Our data are based on an inception cohort of more than 2000 patients who were followed, on average, for 4.5 years after discontinuing anticoagulant therapy. We found that the risk for death from PE after stopping anticoagulation is 0.19 to 0.49 events per 100 person-years and the case-fatality rate of recurrent VTE is 4% to 9%. The lower bounds of these estimates correspond to a rigorous definition of fatal PE. The upper bound includes difficult-to-confirm cases of possible fatal PE.

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Figures

Grahic Jump Location
Figure 1.
Time course of any fatal pulmonary embolism (PE) after discontinuing anticoagulant therapy, according to the cause of venous thromboembolism.

DVT = deep venous thrombosis.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Time course of any fatal pulmonary embolism after discontinuing anticoagulant therapy, according to the cause of venous thromboembolism.
Grahic Jump Location

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Summary for Patients

Risk for Fatal Pulmonary Embolism after Discontinuing Anticoagulation

The summary below is from the full report titled “The Risk for Fatal Pulmonary Embolism after Discontinuing Anticoagulant Therapy for Venous Thromboembolism.” It is in the 4 December 2007 issue of Annals of Internal Medicine (volume 147, pages 766-774). The authors are J.D. Douketis, C.S. Gu, S. Schulman, A. Ghirarduzzi, V. Pengo, and P. Prandoni.

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