Long-term outcome of pulmonary embolism

Author(s): Guy Meyer, Benjamin Planquette and Olivier Sanchez

The risk of death after an episode of acute pulmonary embolism is less than 5%, provided that the patient is hemodynamically stable and free of major underlying disease. In unselected patients, pulmonary embolism and recurrent disease are responsible for a minority of deaths. Recurrent thromboembolism occurs in less than 5% of patients receiving anticoagulant therapy. The recurrence rate is higher during the first few months after termination of anticoagulant therapy, declining thereafter. At 10 years after the initial episode, the cumulative risk of recurrence is approximately 30%. In patients with a history of pulmonary embolism, recurrences are more likely to take the form of a new pulmonary embolism than deep venous thrombosis. Chronic thromboembolic pulmonary hypertension occurs in less than 5% of patients after pulmonary embolism, but most patients have persistent perfusion defects on lung scans several months after the initial episode. The significance of these findings remains unclear.