Real-World Patterns and Outcomes of Anticoagulation Therapy in Pulmonary Embolism: An Observational Dual-Centre...

Pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. Guidelines favor direct oral anticoagulants (DOACs) over vitamin K antagonists (VKAs), but real-world Croatian data are scarce.

A prospective dual-center registry included 773 patients discharged with acute PE between 2013 and 2024. Clinical, laboratory, and socioeconomic data were collected. The primary outcome was all-cause mortality; secondary outcomes were recurrent venous thromboembolism (VTE) and major bleeding.

DOAC users were younger, with higher education and income, than VKA or heparin patients. Median follow-up was 1106 days. Mortality reached 60.3% with VKA, 26.0% with DOAC, and 84.1% with heparin (p < 0.001). VTE recurrence did not differ significantly. Major bleeding occurred in 9.3% of VKA versus 2.9% of DOAC patients (p = 0.003). Adjusted analysis showed a lower mortality risk with DOAC versus VKA (HR 0.62, 95% CI 0.48-0.80, p < 0.001), while heparin predicted higher mortality (HR 3.63, 95% CI 2.54-5.21, p < 0.001). Higher PESI class independently increased mortality and recurrence.

In the first Croatian PE cohort, DOACs were linked to reduced mortality and bleeding risk compared with VKAs, with similar recurrence. Clinical, socioeconomic, and policy factors strongly influenced prescribing patterns and outcomes.