Prospective study of the frequency and outcomes of patients with suspected pulmonary embolism administered heparin prior to confirmatory imaging

Jeffrey Kline, Michael R. Marchick, Christopher Kabrhel, D. Mark Courtney

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives: The administration of empiric systemic anticoagulation (ESA) before confirmatory radiographic testing in patients with suspected pulmonary embolism (PE) may improve outcomes, but no data have been published regarding current practice. We describe the use of ESA in a large prospective cohort of emergency department (ED) patients and report the outcomes of those treated with ESA compared with patients not receiving ESA. Methods: 12-center, noninterventional study of ED patients who presented with symptoms concerning for PE. Clinical data including pretest probability and decision to start ESA were recorded at point of care by attending physicians. Patients were followed for adverse in-hospital outcomes and recurrence of venous thromboembolism. Results: ESA was initiated 342/7932 (4.3%) of enrolled patients, including 142/618 (23%) patients with high pretest probability. Patients receiving ESA had more abnormal vital signs and were more likely to have a history of venous thromboembolism than those who did not receive ESA. Overall, 481/7,932 (6.1%) had PE diagnosed, 72/481 (15.0%) with PE had ESA, and 72/342 (21%) of ESA patients had PE. Three patients (0.9%, 95%CI: 0.2-2.5%) who received ESA suffered hemorrhagic complications compared with 38 patients (0.5%, 95%CI: 0.4-0.7%) who did not receive ESA. Conclusions: In this multicenter sample, ED physicians administered ESA to a small, generally more acutely ill subset of patients with high pretest probability of PE, and very few had hemorrhagic complications. ESA was not associated with any clear difference in outcomes. More study is needed to clarify the risk versus benefit of ESA.

Original languageEnglish (US)
JournalThrombosis Research
Volume129
Issue number4
DOIs
StatePublished - Apr 2012
Externally publishedYes

Fingerprint

Pulmonary Embolism
Heparin
Prospective Studies
Hospital Emergency Service
Venous Thromboembolism
Point-of-Care Systems
Physicians
Vital Signs
Recurrence

Keywords

  • Decision-making
  • Empiric anticoagulation
  • Pulmonary embolism
  • Venous thromboembolism

ASJC Scopus subject areas

  • Hematology

Cite this

Prospective study of the frequency and outcomes of patients with suspected pulmonary embolism administered heparin prior to confirmatory imaging. / Kline, Jeffrey; Marchick, Michael R.; Kabrhel, Christopher; Courtney, D. Mark.

In: Thrombosis Research, Vol. 129, No. 4, 04.2012.

Research output: Contribution to journalArticle

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abstract = "Objectives: The administration of empiric systemic anticoagulation (ESA) before confirmatory radiographic testing in patients with suspected pulmonary embolism (PE) may improve outcomes, but no data have been published regarding current practice. We describe the use of ESA in a large prospective cohort of emergency department (ED) patients and report the outcomes of those treated with ESA compared with patients not receiving ESA. Methods: 12-center, noninterventional study of ED patients who presented with symptoms concerning for PE. Clinical data including pretest probability and decision to start ESA were recorded at point of care by attending physicians. Patients were followed for adverse in-hospital outcomes and recurrence of venous thromboembolism. Results: ESA was initiated 342/7932 (4.3{\%}) of enrolled patients, including 142/618 (23{\%}) patients with high pretest probability. Patients receiving ESA had more abnormal vital signs and were more likely to have a history of venous thromboembolism than those who did not receive ESA. Overall, 481/7,932 (6.1{\%}) had PE diagnosed, 72/481 (15.0{\%}) with PE had ESA, and 72/342 (21{\%}) of ESA patients had PE. Three patients (0.9{\%}, 95{\%}CI: 0.2-2.5{\%}) who received ESA suffered hemorrhagic complications compared with 38 patients (0.5{\%}, 95{\%}CI: 0.4-0.7{\%}) who did not receive ESA. Conclusions: In this multicenter sample, ED physicians administered ESA to a small, generally more acutely ill subset of patients with high pretest probability of PE, and very few had hemorrhagic complications. ESA was not associated with any clear difference in outcomes. More study is needed to clarify the risk versus benefit of ESA.",
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