Management of Pulmonary Embolism: A Single-Center Experience.

This article details the experience at a single center with the evolving trends in management of pulmonary embolism (PE). Treatment is guided by proper identification and risk stratification. Direct oral anticoagulants are now the preferred method for outpatient management of PE, especially in low-risk populations, in which they were used for 56% of discharge medications. PE response teams have grown in popularity and are activated for intermediate and high-risk PE to determine whether advanced therapies are warranted. Intermediate-risk patients were mostly treated with anticoagulation, but approximately 22% received ultrasound-assisted thrombolysis with EKOS. High-risk PE is the most fatal and required advanced therapies in more than 70% of the patients, and 51% received some form of thrombolytic therapy. Objective: Pulmonary embolism (PE) is the third leading cause of cardiovascular death. The objective of this study was to examine the current management of pulmonary embolism at a single academic institution. Methods: With institutional review board approval, we conducted a retrospective chart review of 805 encounters among 775 patients presenting with acute PE from January 1, 2016 to June 30, 2019. We used American Heart Association guidelines for PE risk stratification. Results: In total, 409 patients were given the low-risk designation, 377 of these patients (92%) were anticoagulated with heparin or enoxaparin, and 32 patients (8%) were given a direct oral anticoagulant alone. There were two in-hospital mortalities (0.5%) in the low-risk group; 322 patients were in the true intermediate-risk category (ie, did not progress to high risk), and 320 patients received anticoagulation with heparin or enoxaparin (99.4%). Seventy-three patients (22%) received catheter-directed thrombolysis. There were eight in-hospital mortalities (2.5%) among the intermediate-risk group; eight intermediate-risk patients progressed to high-risk during their hospital stay, resulting in 6 in-hospital mortalities (75%) in this group. There were 66 patients designated as high-risk upon presentation. Sixty patients (91%) received heparin for anticoagulation and 47 patients (71%) required advanced therapies. Fourteen high-risk patients (21%) had bleeding complications, and there were 26 (39%) in-hospital mortalities. Conclusions: The management of PE has evolved, and proper risk stratification is key. Largely speaking, low- and intermediate-risk patients can be treated with anticoagulation, whereas patients with severe right ventricular strain and hemodynamic instability may require more advanced therapies. [ABSTRACT FROM AUTHOR]