Anemia increases PE mortality risk

3 July 2009

MedWire News: Pulmonary embolism (PE) patients with low levels of hemoglobin (Hb) have a greater risk of dying than their counterparts without anemia, research suggests.

David Jiménez Castro (Ramón y Cajal Hospital, Madrid, Spain) and co-workers suggest that measuring Hb levels could be a simple test for identifiying patients unsuitable for partial or full outpatient PE treatment.

The team examined the impact of anemia on acute PE outcome in 764 patients with a mean Hb of 12.9 g/dl and were divided into quartiles of <11.7 g/dl (n=188), 11.7–12.9 g/dl (n=193), 13.0–14.1 g/dl (n=186), and >14.1 g/dl (n=197).

As reported in the journal Thrombosis and Haemostasis, lower levels of Hb were associated with recent bleeding, impaired hemodynamics, and a higher creatinine level.

In addition, patients in the two lower quartiles for Hb were significantly more likely to be female, have cancer, and require an inferior vena cava filter than those in the higher quartiles.

Moreover, 3-month survival rates increased with Hb levels, with rates of 75%, 86%, 90%, and 91% for patients in the lowest to highest quartiles, respectively.

After adjusting for factors that affect PE prognosis, low Hb level significantly predicted all-cause mortality with a hazard ratio (HR) of 0.86 for each 1-g/dl decrease in Hb, even after excluding patients with cancer (HR=0.81).

Anemic patients also had an increased risk for fatal PE (HR=1.19), Castro et al say.

The team conclude that their research “warrants investigation to understand the interactions between Hb, PE, and mortality.”

“Eventually, investigators may wish to conduct randomized, placebo-controlled studies to determine the effects of treatment of anaemia on survival of patients with PE,” they suggest.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Thromb Haemost 2009; 102: 153–158