Abstract Number: OC 10.1
Meeting: ISTH 2020 Congress
Background: Pulmonary vascular obstruction, measured by the pulmonary vascular obstruction index (PVOI), has been associated with an increased risk of venous thromboembolism (VTE) recurrence. But results are not entirely consistent, and PVOI classification cut-offs vary among studies.
Aims: The primary objective of this work is to assess if elevated PVOI is an independent risk factor of VTE recurrence after a first PE episode, and to estimate which PVOI cut-off values would be the most discriminating for predicting VTE recurrence.
Methods: We pooled individual data from 3 studies within the F-CRIN INNOVTE network: a randomized clinical trial and two cohort studies. PVOI was measured in percentage by ventilation/perfusion lung scan at the time of index PE (initial PVOI), and after initial anticoagulation therapy (residual PVOI). VTE recurrence was defined as objectively confirmed PE or deep vein thrombosis. Associations between PVOI (initial and residual) and VTE recurrence were jointly estimated using a multivariate Cox proportional hazards regression model. To manage confounding, the model was further stratified on the study, and adjusted on anticoagulant therapy duration. Optimal PVOI thresholds were estimated by 10-fold cross-validation, using areas under curve (AUC) computed from time-dependant receiver-operating characteristic (ROC) curves.
Results: The total number of patients was 922. Median duration of follow-up was 42 months (IQR: 38-60). VTE recurrence occurred in 149 patients (4.2 events per 100 person-years). Most discriminating cut-offs were initial PVOI >35% (AUC: 0.71, CI95%: 0.71-0.71), and residual PVOI >5% (AUC: 0.69, CI95%: 0.68-0.69). Initial PVOI >35% and residual PVOI >5% were significantly associated with the risk of VTE recurrence (HR: 1.61, CI95% 1.07-2.43 and HR: 1.63, CI95%: 1.06-2.50, respectively).
Conclusions: After a first PE episode, initial PVOI >35% and residual PVOI >5% were found to be independent predictors of VTE recurrence. In the future, those results could help detect more accurately patients with high risk of VTE recurrence.
To cite this abstract in AMA style:Chaux R, Sanchez O, Couturaud F, Meneveau N, Presles E, Chopard R, Bertoletti L, Mismetti P, Laporte S, Ollier E. Association between Initial and Residual Pulmonary Vascular Obstruction and Venous Thromboembolism Recurrence, a Pooled Analysis [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/association-between-initial-and-residual-pulmonary-vascular-obstruction-and-venous-thromboembolism-recurrence-a-pooled-analysis/. Accessed September 24, 2021.
« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/association-between-initial-and-residual-pulmonary-vascular-obstruction-and-venous-thromboembolism-recurrence-a-pooled-analysis/