scholarly journals Validation of simplified PESI score for identification of low-risk patients with pulmonary embolism: From the COMMAND VTE Registry

2018 ◽  
Vol 9 (4) ◽  
pp. 262-270 ◽  
Author(s):  
Yugo Yamashita ◽  
Takeshi Morimoto ◽  
Hidewo Amano ◽  
Toru Takase ◽  
Seiichi Hiramori ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Hospital Discharge ◽  
Major Bleeding ◽  
Home Treatment ◽  
Low Risk ◽  
Early Hospital Discharge ◽  
Recurrent Venous Thromboembolism ◽  
Significant Difference ◽  
Risk Patients

Background: The simplified pulmonary embolism severity index (sPESI) score has been reported to be useful in predicting 30-day mortality for patients with pulmonary embolism, which helps the identification of low-risk patients for early hospital discharge or home treatment. However, therapeutic decision-making should also be based on the risks of adverse events other than mortality. Methods: The COMMAND VTE Registry is a multicentre registry enrolling consecutive patients with acute symptomatic venous thromboembolism in Japan between January 2010 and August 2014, and the current study population consisted of 1715 patients with pulmonary embolism. We calculated the sPESI score for each patient, and compared 30-day rates of mortality, recurrent venous thromboembolism and major bleeding between sPESI scores of 0 and 1 or greater. Results: Patients with a sPESI score of 0 accounted for 383 (22%) patients, and 110 (6.4%) patients died within 30 days. The cumulative 30-day incidence of mortality was lower in patients with a sPESI score of 0 than those with a sPESI score of 1 or greater (0.5% vs. 8.1%, log rank P<0.001). There was no significant difference in the cumulative 30-day incidence of recurrent venous thromboembolism between patients with a sPESI score of 0 and 1 or greater (1.3% vs. 2.8%, log rank P=0.11). The cumulative 30-day incidence of major bleeding was lower in patients with a sPESI score of 0 than those with a sPESI score of 1 or greater (1.1% vs. 4.0%, log rank P=0.005). Conclusions: In patients with a sPESI score of 0, the 30-day mortality, recurrent venous thromboembolism and major bleeding rates were reasonably low. The sPESI score could be useful to identify candidates for early hospital discharge or home treatment.

Treatment of acute pulmonary embolism as outpatients or following early discharge

2008 ◽  
Vol 100 (05) ◽  
pp. 756-761 ◽  
Author(s):  
Muhammad Janjua ◽  
Aaref Badshah ◽  
Fadi Matta ◽  
Liviu G. Danescu ◽  
Abdo Y. Yaekoub ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Major Bleeding ◽  
Acute Pulmonary Embolism ◽  
Cost Effective ◽  
Early Discharge ◽  
Low Risk ◽  
Exclusion Criteria ◽  
Average Hospital ◽  
Risk Patients ◽  
Acute Pe

SummaryThe purpose of this systematic review is to test the hypothesis that carefully selected low-risk patients with acute pulmonary embolism (PE) can safely be treated entirely as outpatients or after early hospital discharge.Included articles were required to describe inclusion or exclusion criteria and outcome of patients treated for PE.Early hospital discharge was defined as an average hospital stay ≤3 days.Six investigations included patients with PE who were treated entirely as outpatients; two investigations included patients with PE who were treated after early discharge. All investigations included only low-risk patients or patients with small or medium sized PE. Outcome after 3-46 months in patients treated entirely as outpatients showed recurrent PE in 0% to 6.2% of patients, major bleeding in 0% to 2.8% with one death from an intracerebral bleed. Definite death from PE did not occur, but there was one possible death from PE. Outcome in three months in patients treated after early discharge showed no instances of recurrent PE. Major bleeding occurred in 0% to 3.7% of patients.There were no deaths from PE, but there was one death from bleeding. In conclusion, outpatient therapy of acute PE is probably safe in low-risk,carefully selected compliant patients who have access to outpatient care if necessary. Such outpatient treatment would be cost-effective.

Home treatment of patients with low-risk pulmonary embolism with the oral factor Xa inhibitor rivaroxaban

2016 ◽  
Vol 116 (07) ◽  
pp. 191-197 ◽  
Author(s):  
Stefano Barco ◽  
Mareike Lankeit ◽  
Harald Binder ◽  
Sebastian Schellong ◽  
Michael Christ ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Significant Proportion ◽  
Factor Xa ◽  
Early Discharge ◽  
Home Treatment ◽  
Low Risk ◽  
Hospital Treatment ◽  
Resource Utilisation ◽  
Factor Xa Inhibitor

SummaryPulmonary embolism (PE) is a potentially life-threatening acute cardiovascular syndrome. However, more than 95 % of patients are haemodynamically stable at presentation, and among them are patients at truly low risk who may qualify for immediate or early discharge. The Home Treatment of Pulmonary Embolism (HoT-PE) study is a prospective international multicentre single-arm phase 4 management (cohort) trial aiming to determine whether home treatment of acute lowrisk PE with the oral factor Xa inhibitor rivaroxaban is feasible, effective, and safe. Patients with confirmed PE, who have no right ventricular dysfunction or free floating thrombi in the right atrium or ventricle, are eligible if they meet none of the exclusion criteria indicating haemodynamic instability, serious comorbidity or any condition mandating hospitalisation, or a familial/social environment unable to support home treatment. The first dose of rivaroxaban is given in hospital, and patients are discharged within 48 hours of presentation. Rivaroxaban is taken for at least three months. The primary outcome is symptomatic recurrent venous thromboembolism or PE-related death within three months of enrolment. Secondary outcomes include quality of life and patient satisfaction, and health care resource utilisation compared to existing data on standard-duration hospital treatment. HoT-PE is planned to analyse 1,050 enrolled patients, providing 80 % power to reject the null hypothesis that the recurrence rate of venous thromboembolism is >3 % with α≤0.05. If the hypothesis of HoT-PE is confirmed, early discharge and out-of-hospital treatment may become an attractive, potentially cost-saving option for a significant proportion of patients with acute PE.

Incidence and risk factors associated with venous thromboembolism following primary total hip arthroplasty in low-risk patients when using aspirin for prophylaxis

2021 ◽  
pp. 112070002199453
Author(s):  
Thomas A Howard ◽  
Caitlin S Judd ◽  
Gordon T Snowden ◽  
Robert J Lambert ◽  
Nick D Clement
Keyword(s):  
Venous Thromboembolism ◽  
Economic Status ◽  
Low Risk ◽  
Vte Prophylaxis ◽  
Factors Associated ◽  
Total Hip ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Significant Difference ◽  
Risk Patients

Aims: The primary aim was to assess the incidence of venous thromboembolism (VTE) following total hip replacements (THR) in a low-risk patient group when using 150 mg aspirin as the pharmacological component of VTE prophylaxis on discharge. The secondary aim was to identify factors associated with an increased risk of a VTE event in this low-risk group. Patients and methods: Retrospective review of a consecutive cohort of patients undergoing THR during a 63-month period. Patient demographics, socio-economic status, ASA grade, type of anaesthetic, length of surgery and BMI were recorded. A diagnosis of VTE was assigned to symptomatic patients with positive imaging for a deep vein thrombosis (DVT) and/or a pulmonary embolism (PE) within 8 weeks of surgery. Multivariate logistic regression modeling was used to identify factors associated with VTE after THR. Results: 3880 patients underwent THR during the study period, of which 2740 (71%) were low risk and prescribed aspirin for VTE prophylaxis. There were 34 VTE events, of which 15 were DVTs and 18 were PEs, with 1 patient diagnosed with both. The incidence of VTE was 1.2%, with no VTE-related deaths. Patients incurring a VTE postoperatively were more likely to be male (odds ratio [OR] 2.06, p = 0.022), of older age (OR 0.43, p = 0.047) and were more likely to be socially deprived (OR 0.32, p = 0.006). There was no significant difference with patients given low-molecular-weight heparin (LMWH) as an inpatient prior to discharge on aspirin ( p = 0.806), nor any difference with the type of anaesthetic used during surgery ( p = 0.719) Conclusions: Aspirin is a relatively safe and effective choice for VTE prophylaxis in low-risk patients undergoing THR. Male sex and age >70 years were twice as likely to sustain a VTE and patients from the most deprived socio-economic background are 3 times as likely.

scholarly journals Risk of Recurrent Venous Thromboembolism and Major Bleeding in Cancer-Associated Incidental Pulmonary Embolism Amongst Treated and Untreated Patients: A Pooled Analysis of 926 Patients

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 590-590 ◽  
Author(s):  
T van der Hulle ◽  
P L den Exter ◽  
G Meyer ◽  
B Planquette ◽  
S Soler ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Individual Patient Data ◽  
Incidence Rates ◽  
Patient Data ◽  
Anticoagulant Treatment ◽  
Incidental Pulmonary Embolism ◽  
Recurrent Venous Thromboembolism ◽  
Recurrent Vte

Abstract Introduction Incidental pulmonary embolism (IPE) is defined as a pulmonary embolism diagnosed on a CT-scan performed for reasons other than a clinical suspicion of PE. Generally identified on staging scans, IPE has been estimated to occur in 3.1% of all cancer patients and is a growing challenge for clinicians and patients. Nevertheless, knowledge about the treatment and prognosis of cancer-associated IPE is scarce. In order to determine the outcome more accurately, and to identify clinical characteristics related to the prognosis, we pooled individual patient data from eleven observational studies and ongoing registries. Methods A systematic literature search aiming to identify studies reporting on patients diagnosed with cancer-associated IPE was performed. Authors of selected studies were invited to participate. Incidence rates of objectively diagnosed symptomatic recurrent venous thromboembolism (VTE), major bleeding and mortality during 6-month follow-up were pooled. Individual patient data was collected to perform subgroup analyses, for which all patients were considered as one cohort. Hazard ratios (HR) were adjusted for age, sex and cancer stage. Results Individual patient data of 926 cancer patients with IPE from 11 observational studies and ongoing registries were included (Table 1). The overall pooled 6-month risk of symptomatic recurrent VTE was 5.8% (95%CI 3.7-8.3), of major bleeding 4.7% (95%CI 3.0-6.8) and of mortality 37% (95%CI 28-47). The VTE recurrence risk was comparable in patients treated with VKA and LMWH with incidence rates of 6.4% (95%CI 2.2-12) and 6.2% (95%CI 3.5-9.6), HR 0.89 (95%CI 0.27-2.9). In contrast, this incidence rate was 12% (95%CI 4.7-23) in patients who were left untreated, HR 2.9 (95%CI 0.65-13; Figure 1). The risk of major bleeding was significantly higher in patients treated with VKA compared to those treated with LMWH, 13% (95%CI 6.4-20) versus 3.9% (95%CI 2.3-5.9), HR of 3.2 (95%CI 1.4-7.4) (Figure 2). The 6-month mortality was 37% (95%CI 29-44) in patients treated with LMWH, 28% (95%CI 18-40) in those treated with VKA and 47% (95%CI 28-66) amongst untreated patients. The all-cause mortality at 6 months was significantly higher for patients with a central thrombus (either central or lobar) compared to those with a more peripheral IPE (either segmental or subsegmental); 42% (95%CI 33-52) versus 30% (95%CI 25-36, HR 1.8 (95%CI 1.4-2.3). Conclusions The most important finding of this study is the 12% 6-month risk of symptomatic recurrent VTE in patients with cancer-associated IPE who did not receive anticoagulant treatment, which is more than double the risk of patients who were anticoagulated. These numbers recall the effect size of anticoagulants used in symptomatic PE and support the judicious initiation of anticoagulant treatment in cancer-associated IPE. The association between more centrally-located thrombi and mortality following IPE is a new finding that parallels outcomes for symptomatic PE, and one which may further support similar management. Regarding the choice of anticoagulant, VKA were associated with a significantly higher risk of major bleeding than LMWH, with a comparable risk of recurrent VTE. The findings of this observational study should be preferably confirmed in a randomized trial. Figure 1: Figure 1:. The 6-month risk of recurrent venous thromboembolism related to anticoagulant treatment. Figure 2: The 6-month risk of major bleeding related to anticoagulant treatment. Figure 2:. The 6-month risk of major bleeding related to anticoagulant treatment. Abstract 590. Table 1: Baseline characteristics Treatment All patients n=926 (100%) LMWH n=732 (79%) VKA n=100 (11%) No treatment n=53 (6%) Other treatment n=41 (4%) Mean age (SD) 65 (12) 64 (12) 68 (12) 65 (14) 68 (13) Male sex, n (%) 491 (53) 378 (52) 60 (60) 31 (58) 22 (54) Cancer stage, n (%) Metastatic 501 (54) 400 (55) 56 (56) 33 (62) 12 (29) Non-metastatic 192 (21) 143 (20) 34 (34) 12 (23) 3 (7.3) Unspecified 233 (25) 189 (26) 10 (10) 8 (15) 26 (63) Cancer type, n (%) Lung 176 (19) 135 (18) 16 (16) 18 (34) 7 (17) Colorectal 185 (20) 150 (20) 20 (20) 9 (17) 6 (15) Other gastrointestinal 187 (20) 147 (20) 15 (15) 13 (25) 12 (29) Breast 65 (7.0) 52 (7.1) 10 (10) 1 (1.9) 2 (4.9) Gynaecological 64 (6.9) 56 (7.7) 5 (5.0) 0 (0) 3 (7.3) Other 206 (22) 155 (21) 31 (31) 10 (19) 10 (24) Haematological 43 (4.6) 37 (5.1) 3 (3.0) 2 (3.8) 1 (2.4) Largest artery involved, n (%) Central 292 (32) 230 (31) 30 (30) 11 (21) 21 (51) Peripheral 495 (53) 395 (54) 62 (62) 29 (55) 9 (22) Unspecified 139 (15) 107 (15) 8 (8.0) 13 (25) 11 (27) Disclosures No relevant conflicts of interest to declare.

Efficacy and Safety of Weight-Adjusted Extended Duration Tinzaparin for Prevention of Post-Operative Venous Thromboembolism after Bariatric Surgery

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1130-1130
Author(s):  
Deborah M. Siegal ◽  
Pankaj Handa ◽  
Emma Kolesar ◽  
Mehran Anvari ◽  
Maria Tiboni ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Hospital Discharge ◽  
Major Bleeding ◽  
Outcome Data ◽  
Advisory Board ◽  
Efficacy And Safety ◽  
Vein Thrombosis ◽  
Extended Duration

Abstract Background: Patients having bariatric surgery are at moderate-to-high risk for post-operative venous thromboembolism (VTE), with pulmonary embolism representing the most common cause of post-operative death. The optimal dosing and duration of anticoagulant prophylaxis is uncertain. Aim: To evaluate the efficacy and safety of extended-duration, weight-adjusted tinzaparin for post-operative thromboprophylaxis after bariatric surgery. Methods: Retrospective cohort of 793 bariatric surgery patients who received routine post-operative weight-adjusted tinzaparin, 4,500-14,000 IU daily (75 IU/kg, rounded to the nearest pre-filled syringe) for 7 days after hospital discharge. The primary efficacy and safety outcomes were the frequency of VTE and major bleeding, respectively, within 30 days of surgery in patients receiving at least 1 dose of tinzaparin. Results: 793 patients who underwent bariatric surgery from 2009 to 2012 were reviewed. There were 44 (5.5%) patients excluded from analyses: need for therapeutic-dose anticoagulation (n=16); no post-operative tinzaparin (n=27); surgery aborted (n=1). There were 646 and 645 patients included in the 30-day efficacy and safety analyses, respectively (mean age, 44.6 years [SD 9.7], median body mass index, 47.1 kg/m2 [range: 19.4-81.0]). An additional 106 patients had outcome data only during hospital admission. VTE occurred in 1/645 patients (0.3%; pulmonary embolism) after hospital discharge and in 1/752 patients (0.1%; superior mesenteric vein thrombosis) in hospital. Major bleeding occurred in 12/645 patients (1.9%). Trough anti-Xa levels measured 7-10 days post-operatively were undetectable in 143/190 (75.3%) patients. In the other 47 patients the median trough anti-Xa level was 0.12 IU (range: 0.10-0.41). Conclusions: Weight-adjusted, extended-duration tinzaparin appears effective and safe for post-operative thromboprophylaxis after bariatric surgery. There was no drug accumulation with large doses of tinzaparin. Disclosures Siegal: Interactive Forums Inc.: Other: created educational slides; Daiichi Sankyo: Other: participated in an advisory board; Boerhinger Ingelheim: Other: participated in an advisory board; Portola Pharmaceuticals: Other: participated in an advisory board. Douketis:Bayer: Consultancy; Actelion: Consultancy; Biotie: Other: Advisory board; Sanofi-Aventis: Honoraria; The Medicines Company: Other: Advisory board; Janssen: Consultancy; Daiichi-Sankyo: Consultancy; Bristol-Myers Squibb: Consultancy, Honoraria; Pfizer: Honoraria; Boehringer Ingelheim: Consultancy, Honoraria.

External Validation of a Clinical and Claims-Based Approach for Predicting 90-Day Post-Pulmonary Embolism Outcomes Among US Veterans

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 533-533
Author(s):  
Neela K Kumar ◽  
Erin R Weeda ◽  
Philip S Wells ◽  
Frank Peacock ◽  
Gregory J Fermann ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Hospital Mortality ◽  
Major Bleeding ◽  
Predictive Value ◽  
Research Funding ◽  
Claims Data ◽  
Severity Index ◽  
Low Risk ◽  
Equity Ownership

Abstract Background: Both the simplified Pulmonary Embolism Severity Index (sPESI) and the multivariable In-hospital Mortality for Pulmonary embolism using Claims daTa (IMPACT) rule classify patients' risk of early post-pulmonary embolism (PE) complications. Objective: To externally validate sPESI and IMPACT for predicting 90-day all-cause mortality and readmission rates among PE patients treated within the Veterans Health Administration (VHA). Methods: We used VHA data from 10/1/2010-9/30/2015 to identify adult patients with: (1) ≥1 inpatient diagnosis for acute PE (International Classification of Diseases-9th Revision-Clinical Modification codes=415.1x), (2) continuous medical and pharmacy enrollment for ≥12-months prior to the index PE (baseline period), (3) a minimum of 90-days of post-event follow-up or until death (whichever came first), and (4) ≥1 claim for an anticoagulant during the index PE stay. Patients were excluded if they had a claim for PE or an anticoagulant during the baseline period. We classified patients as low-risk for early post-PE complications if their sPESI score=0 or their absolute in-hospital mortality risk estimated by IMPACT was <1.5% (the latter calculated using the formula: 1/(1 + exp(-x); where x = −5.833 + [0.026*age] + [0.402*myocardial infarction] + [0.368*chronic lung disease] + [0.464*stroke] + [0.638*prior major bleeding] + [0.298*atrial fibrillation] + [1.06 1*cognitive impairment] + [0.554*heart failure] + [0.364*renal failure] + [0.484*liver disease] + [0.523*coagulopathy] + [1.068*cancer]). Sensitivity, specificity, negative and positive predictive value (NPV and PPV) for all-cause mortality, all-cause readmission, and readmission for recurrent venous thromboembolism (VTE) or major bleeding at 90-days were reported with 95% confidence intervals (CIs) for sPESI and IMPACT tools. Results: Of6,746 eligible PE patients, 851 (12.6%) died and 1,359 (20.1%) were readmitted for any reason within 90-days. Hospitalization for recurrent VTE and major bleeding occurred in 375 (5.6%) and 116 (1.7%), respectively.sPESI classified 1,918 (28.4%) as low-risk, while 1,024 (15.2%) were low-risk per IMPACT. Both tools displayed sensitivity >90% and NPVs >96% for all-cause 90-day mortality, but low specificity and PPVs (Table). IMPACT's sensitivity for all-cause readmission was numerically higher than sPESI, but both had comparable NPVs. Similar trends were observed for accuracy in predicting readmissions due to recurrent VTE or major bleeding. Conclusion: In this external validation study utilizing VHA data, IMPACT classified patients for 90-day post-PE outcomes with similar accuracy as sPESI. While not recommended for prospective clinical decision-making, IMPACT appears useful for identification of PE patients at low-risk for early mortality or readmission in retrospective claims-based studies. Table. Test characteristics for sPESI and IMPACT for 90-day post-pulmonary embolism outcomes CI= confidence interval; IMPACT=In-hospital Mortality for Pulmonary embolism using Claims data; NPV=negative predictive value; PPV=positive predictive value; sPESI=simplified Pulmonary Embolism Severity Index; VTE=venous thromboembolism Table. Test characteristics for sPESI and IMPACT for 90-day post-pulmonary embolism outcomes CI= confidence interval; IMPACT=In-hospital Mortality for Pulmonary embolism using Claims data; NPV=negative predictive value; PPV=positive predictive value; sPESI=simplified Pulmonary Embolism Severity Index; VTE=venous thromboembolism Disclosures Kumar: Johnson & Johnson: Employment. Wells:Itreas: Other: Served on a Writing Committee; Janssen Pharmaceuticals: Consultancy; Bayer Healthcare: Other: Speaker Fees and Advisory Board; BMS/Pfizer: Research Funding. Peacock:Comprehensive Research Associates LLC: Equity Ownership; Cardiorentis: Consultancy, Research Funding; The Medicine's Company: Consultancy, Research Funding; Banyan: Research Funding; Emergencies in Medicine LLC: Equity Ownership; Abbott: Research Funding; Alere: Consultancy, Research Funding; Prevencio: Consultancy; Janssen: Consultancy, Research Funding; Portola: Consultancy, Research Funding; Pfizer: Research Funding; Roche: Research Funding; ZS Pharma: Consultancy, Research Funding; Ischemia Care: Consultancy; Phillips: Consultancy. Fermann:Janssen Pharmaceuticals: Other: Advisory Board, Speakers Bureau; Pfizer: Research Funding. Wang:Janssen Pharmaceuticals: Research Funding. Baser:Janssen Pharmaceuticals: Research Funding. Schein:Johnson & Johnson: Employment, Equity Ownership, Other: Own in excess of $10,000 of J&J stock. Crivera:Johnson & Johnson: Employment, Equity Ownership, Other: Owns excess of $10,000 in stock. Coleman:Boehringer-Ingelheim Pharmaceuticals, inc.: Consultancy, Research Funding; Bayer Pharmaceuticals AG: Consultancy, Research Funding; Janssen Pharmaceuticals: Consultancy, Research Funding.

Risk Stratification for the Development of Venous Thromboembolism in Hospitalized Patients with Cancer

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4728-4728 ◽  
Author(s):  
Arabesque Parker ◽  
Erica A. Peterson ◽  
Agnes Y. Y. Lee ◽  
Carine de Wit ◽  
Marc Carrier ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Risk Stratification ◽  
Board Of Directors ◽  
Cancer Patients ◽  
Major Bleeding ◽  
Research Funding ◽  
Low Risk ◽  
Advisory Committees ◽  
Risk Patients

Abstract Introduction: No method of venous thromboembolism (VTE) risk stratification exists for hospitalized cancer patients. The Khorana score is a validated tool in outpatients with cancer. The objective of this study was to assess the Khorana score for predicting development of VTE in cancer patients during admission to hospital. Methods: We conducted a retrospective analysis of data collected from healthcare records of consecutive, medically-ill cancer patients hospitalized between January and June 2010 in 3 academic medical centers in Canada. Objectively diagnosed symptomatic VTE during hospitalization, anticoagulant thromboprophylaxis (TP), and Khorana score variables were collected for every patient. Patients receiving therapeutic anticoagulation at admission, and those with incomplete data were excluded. The risk of VTE based on Khorana score category was evaluated using logistic regression. Continuous data were compared using a Student's t-test and expressed using the means and standard deviations. Categorical data were compared using the Pearson Chi-square test and were expressed as percentages. Statistical significance was defined as alpha less than 0.05. Results: 1398 patients were included. Mean age was 61.6 years, 51.2% were male, and mean BMI was 25.9 kg/m2. The most frequent tumor types were non-small cell lung carcinoma (12.7%) followed by lymphoma (10.9%). The median length of stay was 6 days (range 0-114 days). The most frequent reasons for hospitalization were chemotherapy (22.3%) followed by pain and palliation (21.4%). 34.5% received anticoagulant TP (n = 483/1398). The incidence of VTE was 2.9% (41/1398) overall, 5.4% (9/166) in high, 3.2% (26/817) in moderate, and 1.4% (6/415) in low Khorana score risk groups. High risk patients were significantly more likely than low risk patients to have VTE (p=0.016; OR 3.9, 95% CI 1.4-11.2). There was no difference in VTE incidence between patients who received anticoagulant TP and those who did not (3.5% vs 2.6%, p = 0.345). Patients with high risk Khorana score were more likely to receive anticoagulant TP than those with low risk Khorana score (46.4% vs. 23.9%, p <0.001, OR 2.8, 95% CI 1.9-4.0). Total incidence of major bleeding was 1.8% (25/1398). There was no difference in major bleeding between patients who received anticoagulant TP and those who did not (1.7% vs. 1.9%, p = 0.787). Conclusion: The Khorana score is predictive of VTE development in cancer patients who are hospitalized for medical illness and may be a useful tool for tailoring inpatient anticoagulant prophylaxis. Disclosures Lee: LEO: Consultancy, Honoraria; Bayer: Consultancy, Honoraria; Bristol Myers-Squibb: Consultancy, Honoraria, Research Funding; Pfizer: Consultancy, Honoraria. Carrier:BMS: Research Funding; Leo Pharma: Research Funding. Wu:Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Leo Pharma: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

scholarly journals Contemporary Clinical Management and Course of ACUTE Pulmonary Embolism: The COPE Study

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3230-3230
Author(s):  
Cecilia Becattini ◽  
Giancarlo Agnelli ◽  
Aldo P Maggioni ◽  
Francesco Dentali ◽  
Andrea Fabbri ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Risk Stratification ◽  
Major Bleeding ◽  
Acute Pulmonary Embolism ◽  
Low Risk ◽  
Intermediate Risk ◽  
Bayer Healthcare ◽  
Risk Patients ◽  
Acute Pe

Abstract Background. New management strategies, risk stratification procedures and treatments have become available over the last years for patients with acute pulmonary embolism (PE), leading to changes in clinical practice and potentially influencing patient's course and outcome. Methods: The COntemporary management of Pulmonary Embolism (COPE) is an academical prospective, non-interventional, multicentre study in patients with confirmed acute symptomatic PE. In-hospital and 30-day mortality were the co-primary study outcomes. At first evaluation, patients were categorized at low-risk (simplified PESI [sPESI]=0), intermediate-risk (further classified based presence/absence of increased levels and right ventricle dysfunction [RVD] at echocardiography) and high-risk (shock or cardiac arrest). Results. Among 5213 study patients, PE was confirmed by computed tomography in 96.3% and at least one test for risk stratification was obtained in more than 80% (81% echocardiography, 83% troponin, 56% brain natriuretic peptide/NT-pro BNP). Among 4885 patients entering the Emergency Department for acute PE, 1.2% were managed as outpatients and 5.8% by short-observation. In-hospital, 289 patients underwent reperfusion (5.5%); at discharge, 6.7% received a vitamin K antagonist and 75.6% a direct oral anticoagulant. Median duration of hospitalization was 7 days (IQR 5-12 days). Overall in-hospital mortality was 3.4% (49% due to PE, 16% cancer and 4.5% major bleeding) and 30-day mortality 4.8% (36% PE, 28% cancer and 4% major bleeding). In-hospital major bleeding was 2.6%. Death at 30 days occurred in 22.6% of 177 high-risk patients, in 6% of the 3281 intermediate-risk and in 0.5% of 1702 low-risk patients. Time to death at 30 days in patients at low, intermediate and high risk for death is reported in the Figure. Conclusions: COPE is the largest ever cohort of patients with acute PE. In this contemporary scenario, the majority of patients received CT for diagnosis, at least one test for risk stratification and direct oral anticoagulants as long-term treatment. Short term death remains not negligible in patients with high and intermediate-risk PE. Figure 1 Figure 1. Disclosures Becattini: Bristol Myers Squibb: Honoraria; Daiichi Sankyo: Honoraria; Bayer HealthCare: Honoraria. Agnelli: Bristol Myers Squibb: Honoraria; Pfizer: Honoraria; Daiichi Sankyo: Honoraria; Bayer HealthCare: Honoraria. Dentali: Daiichi Sankyo: Honoraria; Bayer: Honoraria; Sanofi: Honoraria; Pfizer: Honoraria; Bristol-Myers Squibb: Honoraria; Novartis: Honoraria; Boehringer: Honoraria; Alfa Sigma: Honoraria.

scholarly journals Is the Pulmonary Embolism Severity Index Being Routinely Used in Clinical Practice?

Thrombosis ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Ali Shafiq ◽  
Hamza Lodhi ◽  
Zaheer Ahmed ◽  
Ata Bajwa
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Risk Groups ◽  
Severity Index ◽  
Low Risk ◽  
Significant Difference ◽  
Risk Patients ◽  
Acute Pe

Background. The Pulmonary Embolism Severity Index (PESI) score can risk-stratify patients with PE but its widespread use is uncertain. With the PESI, we compared length of hospital stay between low, moderate, and high risk PE patients and determined the number of low risk PE patients who were discharged early. Methods. PE patients admitted to St. Joseph Mercy Oakland Hospital from January 2005 to August 2010 were screened. PESI score stratified acute PE patients into low (<85), moderate (86–105), and high (>105) risk categories and their length of hospital stay was compared. Patients with low risk PE discharged early (≤3 days) were calculated. Results. Among 315 PE patients, 51.7% were at low risk. No significant difference in hospital stay between low (7.11 ± 3 d) and moderate (6.88 ± 2.9 d) risk, p > 0.05, as well as low and high risk (7.28 ± 3.0 d), p > 0.05, was found. 9% of low risk patients were discharged ≤ 3 days. Conclusions. There was no significant difference in length of hospital stay between low and high risk groups and only a small number of low risk patients were discharged from the hospital early suggesting that risk tools like PESI may not have a widespread use.

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