Saddle PE prognosis comparable to proximal
MedWire News: Patients with saddle pulmonary embolism (PE) have a similar short-term prognosis to patients with proximal pulmonary embolism, study results show.
Saddle PE describes a thromboembolism at the level of the bifurcation of the pulmonary trunk, which extends into the right and left main pulmonary arteries, explain Phil Wells (Ottawa Hospital, Ontario, Canada) and colleagues.
They add that the management of saddle PE is controversial as some studies suggest that patients require aggressive treatment, such as surgical emoblectomy, whereas others indicate that saddle PE is not associated with worse clinical outcomes than are other types of PE.
To help guide clinicians to the most appropriate treatment, Wells and team compared 30-day outcomes of 31 saddle PE patients with those of 62 controls with proximal PE matched for age, gender, and the presence of cancer and hypotension.
More patients with saddle PE than controls presented with syncope (10% vs 3%) and concurrent DVT (61% vs 29%), but neither difference was statistically significant.
In addition, significantly more patients with saddle PE than controls presented with right ventricular dilation on computed tomography pulmonary angiography (59.4% vs 21.9%) and were admitted to hospital (93.4% vs 32.8%), yet these findings did not affect patient outcomes.
At 30 days, patients with saddle PE and controls with proximal PE had similar rates of all-cause mortality (6% vs 10%), PE-related mortality (0% vs 6%), major bleeding (3% vs 5%), and recurrent venous thromboembolism (6% vs 10%).
Of note, one patient with saddle PE received thrombolytic therapy versus none with proximal PE, and no patients underwent embolectomy.
"In the absence of hypotension, it is difficult to justify aggressive therapy such as thrombolysis or surgical embolectomy in this group of patients," Wells and co-authors conclude in the Journal of Thrombosis and Haemostasis.
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By Laura Dean