Purpose of review: To summarize recent studies that have quantified the incidence of death due to late thromboembolic disease among patients initially diagnosed with acute unprovoked pulmonary embolism. These findings will aid clinicians who must weigh the risk versus the benefits of long-term anticoagulant therapy.
Recent findings: The incidence of death due to fatal acute recurrent pulmonary embolism following 3-6 months of anticoagulant therapy is approximately 0.2-0.4% per year, depending in part on the presence or absence of chronic comorbidity. In addition, up to 1-3% of all patients with pulmonary embolism are diagnosed with chronic thromboembolic pulmonary hypertension within 3 years of the index event. Patients with acute pulmonary embolism who develop acute pulmonary hypertension greater than 50 mmHg that does not resolve in the first few weeks are at highest risk for progression, particularly if the event is recurrent pulmonary embolism.
Summary: The incidence of death due to recurrent pulmonary embolism or significantly debilitating or fatal thromboembolic pulmonary hypertension in the first 3 years after anticoagulant treatment is discontinued is approximately 1-3%. In patients in whom the risk of fatal or disabling hemorrhage is lower, the benefits of chronic anticoagulation may outweigh the risks.