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Profiles of patients with venous thromboembolic disease in the emergency department and their medium-term prognosis: data from the ESPHERIA registry

Carriel Mancilla J, Jiménez Hernández S, Martín-Sánchez FJ, Jiménez D, Lecumberri R, Alonso Valle H, Beddar Chaib F, Ruiz-Artacho P

Unidad de Hospitalización, Hospital de Emergencias Enfermera Isabel Zendal, Madrid, Spain. Unidad de Urgencias, Hospital Clínic, Barcelona, Spain. Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital San Carlos, Madrid. Facultad de Medicina, Universidad Complutense de Madrid. Madrid, Spain. Servicio de Neumología, Hospital Ramón y Cajal, Madrid, Spain. Departamento de Medicina, Universidad de Alcalá (IRYCIS), Alcalá de Henares, Madrid, Spain. CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain. Servicio de Hematología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. CIBER-CV, Pamplona, Navarra, Spain. Servicio de Urgencias, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain. Grupo Salud Comunitaria del Instituto de Investigación Sanitaria Valdecilla (IDIVAL). Servicio de Urgencias, Hospital de Soria, Soria, Spain. Departamento de Medicina Interna, Clínica Universidad de Navarra, Madrid, Spain. Interdisciplinar Teragnosis and Radiosomics (INTRA) Research Group, Universidad de Navarra, Spain.

Objectives. To assess the 180-day prognosis for patients of different profiles diagnosed with venous thromboembolism (VTE) in emergency departments (EDs). Secondary aims were to assess all-cause mortality and readmission rates and to describe the clinical characteristics and forms of presentation of deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) in each patient profile.
Method. Secondary analysis of data from the ESPHERIA registry (Spanish acronym for Risk Profile of Patients with VTE Attended in Spanish Emergency Departments), which includes consecutive patients with symptomatic VTE treated in 53 EDs. The cases were divided according to 4 profiles: 1) unprovoked DVT, 2) DVT provoked by transient risk factors, 3) patients with cancer, and 4) patients with low cardiopulmonary reserve. The primary outcome was a composite of 180-day all-cause mortality or readmission.
Results. We studied 773 patients: 450 (58.2%) were classified as profile 1, 128 (16.6%) as profile 2, 115 (14.9%) as profile 3, and 80 (10.3%) as profile 4. We found differences between the 4 profiles in demographics, comorbidity, clinical presentation, type of DVT and location, management, and outcomes. One hundred ninety-five patients (25.2%) had at least one of the adverse events included in the composite within 180 days: 69 (8.9%) died and 179 (23.2%) were readmitted. Hazard ratios (HR) indicated that DVT with low cardiopulmonary reserve (HR, 1.73; 95% CI, 1.12‚Äď2.68; P = .01)) or DVT with cancer (HR, 3.10; 95% CI, 2.22‚Äď4.34; P < .001) were the profiles that were independently associated with the 180-day composite outcome.
Conclusions. Classifying patients with DVT according to 4 profiles (unprovoked, provoked by transient risk factors, associated with cancer, and associated with low cardiopulmonary reserve) when making the diagnosis is useful for assessing prognosis for all-cause mortality or readmission within 180 days. This classification could be useful for
establishing a care and follow-up plan when discharging patients with DVT from the ED.

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