Internal Medicine

In-hospital mortality remains high for patients with PE despite changes in clinical practice

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Despite changes in clinical practice for the treatment of patients with acute pulmonary embolism (PE) due to new risk stratification and treatment strategies, including with direct oral anticoagulants, in-hospital mortality remains for intermediate and high-risk patients, according to a study.

In this prospective, non-interventional, multicenter study, researchers analyzed in-hospital and 30-day outcomes in 5213 patients with acute symptomatic PE. Computed tomography confirmed the diagnosis of PE in 96.3% of patients.

The majority of patients (92.1%) received parenteral anticoagulants while admitted, with 5.5% undergoing reperfusion. At discharge, most patients (75.6%) received direct oral anticoagulants and 6.7% received vitamin K antagonists.

The in-hospital mortality rate was 3.4% and the 30-day mortality was 4.8%. Amongst the 177 patients at high risk, 20.3% died in hospital. Among intermediate-risk patients (n = 3281) and low-risk patients (n = 1702), 4% and 0.5% died in-hospital, respectively.

Patients considered to be at intermediate risk with only a Simplified PESI (Pulmonary Embolism Severity Index) >0 had lower than those with right ventricular dysfunction on echocardiography and/or increased troponin.

Becattini C, Agnelli G, Maggioni AP, Dentali F, Fabbri A, Enea I, Pomero F, Ruggieri MP, Di Lenarda A, Cimini LA, Pepe G, Cozzio S, Lucci D, Gulizia MM. Contemporary management and clinical course of acute pulmonary embolism: The COPE study. Thromb Haemost. 2023;doi: 10.1055/a-2031-3859. Epub ahead of print. PMID: 36758612.