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PLoS One. 2018 Mar 7;13(3):e0193725. doi: 10.1371/journal.pone.0193725. eCollection 2018.

The incidence of acute pulmonary embolism following syncope in anticoagulant-naïve patients: A retrospective cohort study.

Author information

1
Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel.
2
Division of Pulmonary Medicine, Rambam Health Care Campus, Haifa, Israel.
3
Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.
4
Predictive Medicine Group, Boston Children's Hospital, Boston, United States of America.
5
Shaare Tzedek Medical Center, Jerusalem, Israel.
6
Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
7
Epidemiology Department, Ben Gurion University of the Negev, Be'er Sheba, Israel.
8
The Rappaport's Faculty of Medicine, The Technion Institute, Haifa, Israel.

Abstract

BACKGROUND:

A recently published, large prospective study showed unexpectedly high prevalence of acute pulmonary embolism (APE) among patients hospitalized for syncope. In such a case, a high incidence of recurrent pulmonary embolism is expected among patients who were discharged without APE workup.

OBJECTIVES:

To determine the incidence of symptomatic APE among patients hospitalized for a first episode of syncope and discharged without APE workup or anticoagulation.

METHODS:

This retrospective cohort study included patients hospitalized at Rambam Health Care Campus between January 2006 and February 2017 with a primary admission diagnosis of syncope, who were not investigated for APE and were not taking anticoagulants. The patients were followed up for up to three years after discharge. The occurrence of venous thromboembolism (VTE) during the follow-up period was documented.

RESULTS:

The median follow-up duration was 33 months. 1,126 subjects completed a three-year follow-up. During this period, 38 patients (3.38%) developed VTE, 17 (1.51%) of them had APE. The cumulative incidence of VTE and APE was 1.9% (95% CI 1.3%-2.5%) and 0.9% (95% CI 0.4%-1.3%) respectively. Only seven subjects developed APE during the first year of follow-up. The median times from the event of syncope to the development of APE and VTE were 18 and 19 months respectively.

CONCLUSIONS:

The cumulative incidence of VTE during a three-year follow-up period after an episode of syncope is low. In the absence of clinical suspicion, a routine diagnostic workup for APE in patients with syncope cannot be recommended.

PMID:
29513729
PMCID:
PMC5841762
DOI:
10.1371/journal.pone.0193725
[Indexed for MEDLINE]
Free PMC Article

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