Department of Internal Medicine, Hospital Universitario del Vinalopo, Elche, Spain.
Medicine Department, Universidad Catolica San Antonio de Murcia, Murcia, Spain.
Eur J Clin Invest. 2022 Jul;52(7):e13774. doi: 10.1111/eci.13774. Epub 2022 Mar 27.
Syncope has been shown to be a risk factor of bleeding in patients receiving thrombolytic therapy for acute pulmonary embolism (PE). Whether syncope predicts bleeding in a broader population of patients with PE remains unknown.
We used the RIETE registry data to assess whether initial presentation with syncope could predict bleeding in PE patients receiving anticoagulant therapy, and to explore the association between presence of syncope and timing and site of major bleeding events.
Among 45,765 patients with acute PE from March 2001 to January 2021, 6760 (14.8%) had syncope. Patients with syncope were older and more likely to have hypotension, tachycardia, hypoxaemia or elevated troponin levels than those without syncope. They also were more likely to receive thrombolytics. During the first 90 days, 1097 patients (2.4%) suffered major bleeding (gastrointestinal 335, hematoma 271 and intracranial 163) and 3611 died (158 had fatal bleeding). Patients with syncope had a higher rate of major bleeding (odds ratio [OR]: 1.63; 95% CI: 1.41-1.89) and a nonsignificantly higher rate of fatal bleeding (OR: 1.47; 95% CI: 0.99-2.17) than those without syncope. Multivariable analysis confirmed that patients with syncope were at increased risk for major bleeding (adjusted hazard ratio [aHR]: 1.34; 95% CI: 1.15-1.55). On sensitivity analysis, the increased risk for major bleeding was confirmed in patients initially receiving anticoagulant therapy without thrombolytics at 7 days (aHR: 1.47; 95% CI: 1.13-1.91) and 90 days (aHR: 1.33; 95%CI: 1.13-1.56).
Syncope is a predictor of major bleeding events in patients with PE, even among those receiving anticoagulation monotherapy.
晕厥已被证明是急性肺栓塞（PE）患者接受溶栓治疗后出血的危险因素。晕厥是否能预测更广泛的 PE 患者人群中的出血情况仍不清楚。
我们使用 RIETE 登记数据来评估初始表现为晕厥是否可预测接受抗凝治疗的 PE 患者的出血情况，并探讨晕厥的存在与大出血事件的时间和部位之间的关联。
在 2001 年 3 月至 2021 年 1 月期间的 45765 例急性 PE 患者中，有 6760 例（14.8%）发生晕厥。与无晕厥的患者相比，有晕厥的患者年龄更大，更有可能出现低血压、心动过速、低氧血症或肌钙蛋白水平升高。他们也更有可能接受溶栓治疗。在最初的 90 天内，有 1097 例患者（2.4%）发生大出血（胃肠道 335 例，血肿 271 例，颅内 163 例），3611 例患者死亡（158 例发生致命性出血）。有晕厥的患者发生大出血的比例较高（优势比 [OR]：1.63；95%CI：1.41-1.89），致命性出血的比例虽略有升高，但无统计学意义（OR：1.47；95%CI：0.99-2.17）。多变量分析证实，有晕厥的患者发生大出血的风险增加（调整后的危险比 [aHR]：1.34；95%CI：1.15-1.55）。在敏感性分析中，在最初未接受溶栓治疗而仅接受抗凝治疗的患者中，7 天（aHR：1.47；95%CI：1.13-1.91）和 90 天（aHR：1.33；95%CI：1.13-1.56）时，大出血的风险增加得到了确认。
晕厥是 PE 患者发生大出血事件的预测指标，即使在接受抗凝单药治疗的患者中也是如此。
