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Death from, with, and without pulmonary embolism

  • Stefano Barco
    Correspondence
    Corresponding author at: Clinical of Angiology, University Hospital Zurich, Rämistrasse 100, RAE C 04, 8091 Zurich, Switzerland.
    Affiliations
    Clinic of Angiology, University Hospital Zurich, Rämistrasse 100, RAE C 04, 8091 Zurich, Switzerland

    Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
    Search for articles by this author
  • Tim Sebastian
    Affiliations
    Clinic of Angiology, University Hospital Zurich, Rämistrasse 100, RAE C 04, 8091 Zurich, Switzerland
    Search for articles by this author
Published:February 09, 2020DOI:https://doi.org/10.1016/j.ejim.2020.01.029
      Sudden death can be the initial presentation of pulmonary embolism and early fatality is substantial among patients who present with haemodynamic instability [
      • Konstantinides S.V.
      • Meyer G.
      • Becattini C.
      • et al.
      ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS).
      ,
      • Huisman M.V.
      • Barco S.
      • Cannegieter S.C.
      • et al.
      Pulmonary embolism.
      ]. Death from pulmonary embolism, namely with pulmonary embolism starting the chain of medical events leading to death, remains a major contributor to cardiovascular mortality in Europe [
      • Barco S.
      • Mahmoudpour S.H.
      • Valerio L.
      • et al.
      Trends in mortality related to pulmonary embolism in the European Region, 2000-15: analysis of vital registration data from the WHO Mortality Database.
      ] and the United States [
      • Wendelboe A.M.
      • Raskob G.E.
      Global Burden of Thrombosis Epidemiologic Aspects.
      ]. Raising general awareness, a broader implementation of available preventive and diagnostic strategies, better criteria to identify higher risk patients, and safer reperfusion regimens represent unmet needs to reduce global pulmonary embolism-related mortality [
      • Huisman M.V.
      • Barco S.
      • Cannegieter S.C.
      • et al.
      Pulmonary embolism.
      ,
      • Barco S.
      • Vicaut E.
      • Klok F.A.
      • et al.
      Improved identification of thrombolysis candidates amongst intermediate-risk pulmonary embolism patients: implications for future trials.
      ,
      • Jimenez D.
      • Lobo J.L.
      • Fernandez-Golfin C.
      • et al.
      Effectiveness of prognosticating pulmonary embolism using the ESC algorithm and the Bova score.
      ,
      • Hirsh J.
      • Eikelboom J.W.
      • Chan N.C
      Fifty years of research on antithrombotic therapy: achievements and disappointments.
      ,
      • Barco S.
      • Konstantinides S.V.
      Optimizing the personalized, risk-adjusted management of pulmonary embolism: an integrated clinical trial programme.
      ]. A clear definition of pulmonary embolism-related death will improve our ability to interpret the results of epidemiological studies and put the utility of interventions into the right perspective [
      • Kraaijpoel N.
      • Tritschler T.
      • Guillo E.
      • Girard P.
      • Le Gal G
      Definitions, adjudication, and reporting of pulmonary embolism-related death in clinical studies: a systematic review.
      ].
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