Key result
Preemptive anticoagulation for suspected pulmonary embolism was uncommon, occurring in only 7.4% of patients, and was not influenced by pretest probability.
Why the study?
Preemptive anticoagulation is guideline-recommended for patients with intermediate to high pretest risk of PE, but its real-world use stratified by risk assessment score needed description.
What is the rate of preemptive anticoagulation use in patients undergoing CTPA for suspected pulmonary embolism, and is it influenced by pretest risk scores?
Cohort (n=392)
No
What is the rate of preemptive anticoagulation use in patients undergoing CTPA for suspected pulmonary embolism, and is it influenced by pretest risk scores?
The use of preemptive anticoagulation for suspected pulmonary embolism is uncommon and not influenced by validated clinical prediction tools, highlighting a gap between guideline recommendations and clinical practice.
Low preemptive anticoagulation use unrelated to risk score warrants caution in suspected PE; leaves open guideline adherence and clinical impact.
BACKGROUND: Pulmonary embolism (PE) is a life-threatening disease where preemptive anticoagulation is recommended by guidelines for patients with intermediate to high pretest risk of PE. AIMS: The primary objective of our study was to describe the use of preemptive anticoagulation from the emergency department (ED) or inpatient wards stratified by risk assessment score. METHODS: We performed a retrospective observational cohort study of consecutive patients undergoing computed tomography pulmonary angiography (CTPA) for investigation of PE. Patients were classified as either ED patients or hospital ward patients based on where the CTPA was requested. The pretest risk of PE was calculated using the Revised Geneva Score (RGS) and patients were divided into low and intermediate to high risk. RESULTS: A total of 392 consecutive patients who underwent CTPA at Monash Health were reviewed. There were 108 (27.6%) patients who were categorised as low risk (RGS 0-3) and 284 (72.4%) categorised as intermediate to high risk (RGS >3). There were 29 (7.4%) patients overall who received preemptive anticoagulation. Diagnostic yield of CTPA in the ED was low, with only four of 144 (2.8%) CTPA scans positive for PE. The yield of CTPA was higher in ward patients, with 63 of 248 (25.4%) being diagnostic of PE. CONCLUSIONS: The use of preemptive anticoagulation for suspected PE was uncommon and was not influenced by the pretest probability of PE as determined by a validated clinical prediction tool. This may reflect concerns regarding haemorrhagic complications without any clear evidence of benefit. Diagnostic yield of CTPA performed in the ED was low.
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Woo et al. (2023) conducted a cohort in suspected pulmonary embolism (n=392). Preemptive anticoagulation was evaluated on use of preemptive anticoagulation from the emergency department (ED) or inpatient wards stratified by risk assessment score. Preemptive anticoagulation for suspected pulmonary embolism was uncommon, occurring in only 7.4% of patients, and was not influenced by pretest probability.
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