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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EThe objective of the PADIS-PE study was to determine whether patients with 1 episode of unprovoked pulmonary embolism would benefit from an additional 18 months of oral anticoagulant treatment. Age, residual perfusion defects, and residual deep vein thrombosis were found to be independent risk factors associated with recurrent venous thromboembolism.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Epulmonary embolism\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Erisk factors\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Erecurrent venous thromboembolism\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ewarfarin\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ethrombotic disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EPatients who have experienced an unprovoked pulmonary embolism (PE) may experience recurrence after stopping anticoagulant therapy, but the optimal duration of anticoagulation treatment is unclear. The primary objective of the double-blind multicenter PADIS-PE study [Couturaud F et al. \u003Cem\u003EJAMA\u003C\/em\u003E. 2015] was to evaluate the efficacy and safety of an additional 18 months of oral anticoagulant treatment following an initial 6 months of therapy. The ability to classify patients according to risk of recurrence is also of benefit given the risks associated with anticoagulation therapy. Another objective of the study was to identify such risk factors. Findings from the study were presented by Francis Couturaud, MD, PhD, European Brittany University, Brest, France.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EIn the PADIS-PE study, 371 patients with their first unprovoked PE received 6 months of vitamin K antagonist treatment and were randomized to an additional 18 months of warfarin treatment (n\u2005=\u2005184) or placebo (n\u2005=\u2005187). At randomization, blood samples were taken, and patients underwent a ventilation\/perfusion (V\/Q) lung scan, echocardiography, and compression ultrasound of the legs. Patients were evaluated at the end of the 18-month treatment period and followed for an additional 2 years.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EDuring 18 months of treatment, the primary outcome (composite of recurrent symptomatic venous thromboembolism [VTE] and major bleeding at 18 months) occurred in 3.3% of warfarin-treated patients vs 13.5% of placebo-treated patients (HR, 0.22; 95% CI, 0.09 to 0.55; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.001). Recurrent symptomatic VTE occurred in 1.7% of warfarin-treated patients and 13.5% of those receiving placebo (HR, 0.11; 95% CI, 0.03 to 0.37; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.0001). Major bleeds were not significantly different between the 2 groups (2.2% warfarin, 0.5% placebo; HR, 4.07; 95% CI, 0.45 to 36.38; \u003Cem\u003EP\u2005\u003C\/em\u003E=\u2005.18). Over the entire study period, there were no statistically significant differences between the 2 treatment groups in composite events (20.8% warfarin vs 24.0% placebo; HR, 0.74; 95% CI, 0.47 to 1.17; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.19), recurrent symptomatic VTE (17.9% warfarin vs 22.1% placebo; HR, 0.67; 95% CI, 0.41 to 1.08; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.10), or major bleeds (3.5 warfarin vs 3.0 placebo; HR, 1.12; 95% CI, 0.38 to 4.10; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.71).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EOne of the secondary objectives was to determine risk factors for recurrent symptomatic VTE during the 42-month follow-up period. Symptomatic recurrent VTEs were defined as follows: nonfatal recurrent PE (clinical suspicion of PE with positive V\/Q lung scan, spiral computed tomography angiography, pulmonary angiography, or new noncompressibility of a proximal vein on ultrasound), fatal recurrent VTE (autopsy or unexplained sudden death), and symptomatic recurrent deep vein thrombosis (DVT; clinical suspicion of DVT and noncompressibility of a new segment of a proximal vein on ultrasound). Univariate analysis and a multivariate model were used to identify risk factors for recurrent VTE.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAge, residual perfusion defect at study inclusion, and residual DVT at study inclusion were identified as independent risk factors associated with recurrent VTE based on multivariate analysis (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). On the basis of these findings, Dr Couturaud noted that it may be useful to perform a V\/Q lung scan and lower limb ultrasound after 6 months of anticoagulation to help determine a patient\u2019s risk of recurrent VTE if treatment is discontinued.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16842\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16842\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16842\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EMultivariate Analysis (Adjusted for Treatment Effect)\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/21\/8.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlgde\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzlgde\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}