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Preemptive anticoagulation of pulmonary embolism
Christopher Woo1, Wei Sun1, Paul Thein1
1Department of Medicine, Monash Health, Melbourne, Victoria, Australia.
Internal Medicine Journal
|July 25, 2023
Summary
Preemptive anticoagulation for pulmonary embolism (PE) was rarely used, regardless of patient risk. This suggests concerns about bleeding risks may outweigh unproven benefits in suspected PE cases.
Area of Science:
- Emergency Medicine
- Cardiology
- Radiology
Background:
- Pulmonary embolism (PE) is a critical condition requiring prompt anticoagulation for high-risk patients.
- Current guidelines recommend preemptive anticoagulation based on pretest probability of PE.
Purpose of the Study:
- To evaluate the utilization of preemptive anticoagulation in suspected PE cases.
- To stratify anticoagulation use by emergency department (ED) versus inpatient wards and risk assessment scores.
Main Methods:
- Retrospective observational cohort study of 392 patients undergoing CT pulmonary angiography (CTPA).
- Patients categorized by risk using Revised Geneva Score (RGS) into low (0-3) and intermediate-to-high (>3) risk groups.
- Analysis of anticoagulation use based on location of CTPA request (ED vs. wards).
Main Results:
- Only 7.4% of patients received preemptive anticoagulation.
- Anticoagulation use was not associated with PE risk stratification (RGS).
- CTPA diagnostic yield was low in the ED (2.8%) but higher on wards (25.4%).
Conclusions:
- Preemptive anticoagulation for suspected PE is infrequently utilized and not guided by validated risk scores.
- Low utilization may stem from concerns about bleeding complications without proven efficacy.
- CTPA has a low diagnostic yield in the ED for suspected PE.
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