Selection of Home Treatment and Identification of Low-Risk Patients With Pulmonary Embolism Based on Simplified Pulmonary Embolism Severity Index Score in the Era of Direct Oral Anticoagulants.

Autor: Nishikawa R; Department of Cardiovascular Medicine, Graduate School of Medicine Kyoto University Kyoto Japan., Yamashita Y; Department of Cardiovascular Medicine, Graduate School of Medicine Kyoto University Kyoto Japan., Morimoto T; Department of Clinical Epidemiology Hyogo College of Medicine Nishinomiya Japan., Kaneda K; Department of Cardiovascular Medicine, Graduate School of Medicine Kyoto University Kyoto Japan., Chatani R; Department of Cardiovascular Medicine Kurashiki Central Hospital Kurashiki Japan., Nishimoto Y; Department of Cardiology Hyogo Prefectural Amagasaki General Medical Center Amagasaki Japan., Ikeda N; Division of Cardiovascular Medicine Toho University Ohashi Medical Center Tokyo Japan., Kobayashi Y; Department of Cardiovascular Center Osaka Red Cross Hospital Osaka Japan., Ikeda S; Department of Cardiovascular Medicine Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan., Kim K; Department of Cardiovascular Medicine Kobe City Medical Center General Hospital Kobe Japan., Inoko M; Cardiovascular Center Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan., Takase T; Department of Cardiology Kinki University Hospital Osaka Japan., Tsuji S; Department of Cardiology Japanese Red Cross Wakayama Medical Center Wakayama Japan., Oi M; Department of Cardiology Japanese Red Cross Otsu Hospital Otsu Japan., Takada T; Department of Cardiology Tokyo Women's Medical University Tokyo Japan., Otsui K; Department of General Internal Medicine Kobe University Hospital Kobe Japan., Sakamoto J; Department of Cardiology Tenri Hospital Tenri Japan., Ogihara Y; Department of Cardiology and Nephrology Mie University Graduate School of Medicine Tsu Japan., Inoue T; Department of Cardiology Shiga General Hospital Moriyama Japan., Usami S; Department of Cardiology Kansai Electric Power Hospital Osaka Japan., Chen PM; Department of Cardiology Osaka Saiseikai Noe Hospital Osaka Japan., Togi K; Division of Cardiology, Nara Hospital Kinki University Faculty of Medicine Ikoma Japan., Koitabashi N; Department of Cardiovascular Medicine Gunma University Graduate School of Medicine Maebashi Japan., Hiramori S; Department of Cardiology Kokura Memorial Hospital Kokura Japan., Doi K; Department of Cardiology National Hospital Organization Kyoto Medical Center Kyoto Japan., Mabuchi H; Department of Cardiology Koto Memorial Hospital Higashiomi Japan., Tsuyuki Y; Division of Cardiology Shimada General Medical Center Shimada Japan., Murata K; Department of Cardiology Shizuoka City Shizuoka Hospital Shizuoka Japan., Takabayashi K; Department of Cardiology Hirakata Kohsai Hospital Hirakata Japan., Nakai H; Department of Cardiovascular Medicine Sugita Genpaku Memorial Obama Municipal Hospital Obama Japan., Sueta D; Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan., Shioyama W; Department of Cardiovascular Medicine Shiga University of Medical Science Otsu Japan., Dohke T; Division of Cardiology Kohka Public Hospital Koka Japan., Ono K; Department of Cardiovascular Medicine, Graduate School of Medicine Kyoto University Kyoto Japan., Kimura T; Department of Cardiology Hirakata Kohsai Hospital Hirakata Japan.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2024 Oct; Vol. 13 (19), pp. e034953. Date of Electronic Publication: 2024 Sep 30.
DOI: 10.1161/JAHA.124.034953
Abstrakt: Background: The simplified Pulmonary Embolism Severity Index (sPESI) score could help identify low-risk patients with pulmonary embolism for home treatment. However, the application of the sPESI score and selection for home treatment have not been fully evaluated in the direct oral anticoagulants era.
Methods and Results: The COMMAND VTE (Contemporary Management and Outcomes in Patients With Venous Thromboembolism) Registry-2 is a multicenter registry enrolling consecutive patients with acute symptomatic venous thromboembolism. The current study population consists of 2496 patients with hemodynamically stable pulmonary embolism (2100 patients [84%] treated with direct oral anticoagulants), who were divided into 2 groups: sPESI scores of 0 and ≥1. We investigated the 30-day mortality, home treatment prevalence, and factors predisposing to home treatment using the Kaplan-Meier method and logistic regression model. Patients with an sPESI score of 0 accounted for 612 (25%) patients, and only 17% among 532 patients with out-of-hospital pulmonary embolism were treated at home. The cumulative 30-day mortality was lower in patients with an sPESI score of 0 than the score of ≥1 (0% and 4.8%, log-rank P <0.001). There was no patient with 30-day mortality with an sPESI score of 0. Independent factors for home treatment among out-of-hospital pulmonary embolism patients with an sPESI score of 0 were no transient risk factors for venous thromboembolism, no cardiac biomarker elevation, and direct oral anticoagulants use in the acute phase.
Conclusions: The 30-day mortality rate was notably low in an sPESI score of 0. Nevertheless, only a minority of patients with an sPESI score of 0 were treated at home between 2015 and 2020 after the introduction of direct oral anticoagulants for venous thromboembolismin Japan.
Databáze: MEDLINE
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