Identification of Low-Risk Patients with Acute Symptomatic Pulmonary Embolism for Outpatient Therapy

Trujillo‐Santos, Javier; Riera‐Mestre, Antoni; Jiménez, David; Micco, Pierpaolo Di; Bascuñana, J.; Vela, J.; Peris, Luísa; Malfante, Pablo; Monréal, Manuel

doi:10.1513/annalsats.201504-202oc

Cited by 25 publications

(32 citation statements)

References 17 publications

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“…Maestre et al 26 used an international registry of 18 707 patients with PE (RIETE) to derive a new score to examine 10-day composite outcome of recurrent PE, major bleeding or death. This score (RIETE score) was compared with PESI and sPESI.…”

Section: Inclusion and Exclusion Criteria For Op Management Or Early mentioning

confidence: 99%

“…On multivariate analysis, age >75 years, recent bleeding, cancer, creatinine levels >1.2 mg/dL, anaemia or PE itself were independently associated with an increased risk of major bleeding. The same registry was used to derive a scoring system for early adverse outcomes (the composite outcome included all-cause mortality, recurrent PE and major bleeding) within 10 days of acute PE 26 . Within the 18 707 cohort, of whom 95.1% had been managed as IPs, major bleeding was reported in 203 (1.09%).…”

Section: Assessment Of Bleeding Riskmentioning

confidence: 99%

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British Thoracic Society Guideline for the initial outpatient management of pulmonary embolism (PE)

Howard

Barden

Condliffe

et al. 2018

Thorax

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Section: Inclusion and Exclusion Criteria For Op Management Or Early mentioning

confidence: 99%

Section: Assessment Of Bleeding Riskmentioning

confidence: 99%

British Thoracic Society Guideline for the initial outpatient management of pulmonary embolism (PE)

Howard

Barden

Condliffe

et al. 2018

Thorax

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“…PE-related death or complications) if aiming to identify candidates for thrombolytic therapy, and on an assessment of overall prognosis (e.g. by the use of the sPESI [2] or the RIETE score [21]) if aiming to identify candidates for home treatment. Of course, before final therapeutic decisions can be made, the respective treatment-related risks (e.g.…”

Section: Normotensive Patients With Acute Pe N=843mentioning

confidence: 99%

Prognostic impact of copeptin in pulmonary embolism: a multicentre validation study

Hellenkamp¹,

Pruszczyk

Jiménez

et al. 2018

Eur Respir J

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To externally validate the prognostic impact of copeptin, either alone or integrated in risk stratification models, in pulmonary embolism (PE), we performed a analysis of 843 normotensive PE patients prospectively included in three European cohorts.Within the first 30 days, 21 patients (2.5%, 95% CI 1.5-3.8) had an adverse outcome and 12 (1.4%, 95% CI 0.7-2.5) died due to PE. Patients with copeptin ≥24 pmol·L had a 6.3-fold increased risk for an adverse outcome (95% CI 2.6-15.5, p<0.001) and a 7.6-fold increased risk for PE-related death (95% CI 2.3-25.6, p=0.001). Risk classification according to the 2014 European Society of Cardiology (ESC) guideline algorithm identified 248 intermediate-high-risk patients (29.4%) with 5.6% (95% CI 3.1-9.3) at risk of adverse outcomes. A stepwise biomarker-based risk assessment strategy (based on high-sensitivity troponin T, N-terminal pro-brain natriuretic peptide and copeptin) identified 123 intermediate-high-risk patients (14.6%) with 8.9% (95% CI 4.5-15.4) at risk of adverse outcomes. The identification of patients at higher risk was even better when copeptin was measured on top of the 2014 ESC algorithm in intermediate-high-risk patients (adverse outcome OR 11.1, 95% CI 4.6-27.1, p<0.001; and PE-related death OR 13.5, 95% CI 4.2-43.6, p<0.001; highest risk group all other risk groups). This identified 85 patients (10.1%) with 12.9% (95% CI 6.6-22.0) at risk of adverse outcomes and 8.2% (95% CI 3.4-16.2) at risk of PE-related deaths.Copeptin improves risk stratification of normotensive PE patients, especially when identifying patients with an increased risk of an adverse outcome.

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“…Anticoagulation should be initiated immediately in all patients who present with suspected PE, unless contraindicated [16]. If PE is subsequently excluded, anticoagulation can be discontinued.…”

Section: Initial Anticoagulationmentioning

confidence: 99%

“…If PE is subsequently excluded, anticoagulation can be discontinued. In patients with confirmed PE, anticoagulation should continue for at least 3 months [16].…”

Section: Initial Anticoagulationmentioning

confidence: 99%

Management of pulmonary embolism

Lazović

Zugic

2018

Med pregl

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Introduction. Pulmonary embolism is a common condition with high morbidity and mortality, particularly if misdiagnosed or untreated. It has non-specific clinical manifestations, often presenting with symptoms similar to other cardiovascular or common respiratory diseases. Dyspnea is the most common symptom. The main goals of pulmonary embolism therapy are to stop blood clots from getting bigger and prevent formation of new clots. The aim of this article was to review the clinical presentation, incidence, diagnostic algorithms and prevention of pulmonary embolism. Management of pulmonary embolism. The management of pulmonary embolism depends on patients' hemodynamic stability (hemodynamically stabile and hemodynamically unstable patients), as well as on specific conditions (population who cannot receive the same therapy as the previously mentioned patients). The management is largely focused on medical therapy of pulmonary embolism, as the first line therapy (emergency) and then on medical options for this disease. Special attention was given to urgent intravenous thrombolytic therapy in hemodynamically unstable patients, considering that these patients are the most vitally compromised, in shock and with high mortality rate. The initial treatment in hemodynamically stable patients consists of low molecular weight heparin and unfractionated heparin, which is later replaced by long term oral anticoagulation therapy. Its duration depends on the nature of the basic disease. Some populations cannot receive any thrombolytic therapy (pregnant women, patients suffering from malignant diseases and heparin-induced thrombocytopenia). These patients may receive low molecular weight heparin, unfractionated heparin and warfarin; patients with malignant diseases receive lifelong anticoagulation therapy; argatroban or lepirudin are used in the management of heparin-induced thrombocytopenia. Conclusion. Prevention of pulmonary embolism is lifesaving. It includes prophylactic medical regimens and "mechanical" supportive therapy (elastic graduated compression stockings, inferior vena cava filters).

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Identification of Low-Risk Patients with Acute Symptomatic Pulmonary Embolism for Outpatient Therapy

Abstract: We built a new score, based on widely available variables, that can be used to identify patients with PE at low risk of short-term complications, assisting in triage and potentially shortening duration of hospital stay.

Cited by 25 publications

References 17 publications

British Thoracic Society Guideline for the initial outpatient management of pulmonary embolism (PE)

British Thoracic Society Guideline for the initial outpatient management of pulmonary embolism (PE)

Prognostic impact of copeptin in pulmonary embolism: a multicentre validation study

Management of pulmonary embolism

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