Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Oct 2024)

Selection of Home Treatment and Identification of Low‐Risk Patients With Pulmonary Embolism Based on Simplified Pulmonary Embolism Severity Index Score in the Era of Direct Oral Anticoagulants

  • Ryusuke Nishikawa,
  • Yugo Yamashita,
  • Takeshi Morimoto,
  • Kazuhisa Kaneda,
  • Ryuki Chatani,
  • Yuji Nishimoto,
  • Nobutaka Ikeda,
  • Yohei Kobayashi,
  • Satoshi Ikeda,
  • Kitae Kim,
  • Moriaki Inoko,
  • Toru Takase,
  • Shuhei Tsuji,
  • Maki Oi,
  • Takuma Takada,
  • Kazunori Otsui,
  • Jiro Sakamoto,
  • Yoshito Ogihara,
  • Takeshi Inoue,
  • Shunsuke Usami,
  • Po‐Min Chen,
  • Kiyonori Togi,
  • Norimichi Koitabashi,
  • Seiichi Hiramori,
  • Kosuke Doi,
  • Hiroshi Mabuchi,
  • Yoshiaki Tsuyuki,
  • Koichiro Murata,
  • Kensuke Takabayashi,
  • Hisato Nakai,
  • Daisuke Sueta,
  • Wataru Shioyama,
  • Tomohiro Dohke,
  • Koh Ono,
  • Takeshi Kimura

DOI
https://doi.org/10.1161/JAHA.124.034953
Journal volume & issue
Vol. 13, no. 19

Abstract

Read online

Background The simplified Pulmonary Embolism Severity Index (sPESI) score could help identify low‐risk patients with pulmonary embolism for home treatment. However, the application of the sPESI score and selection for home treatment have not been fully evaluated in the direct oral anticoagulants era. Methods and Results The COMMAND VTE (Contemporary Management and Outcomes in Patients With Venous Thromboembolism) Registry‐2 is a multicenter registry enrolling consecutive patients with acute symptomatic venous thromboembolism. The current study population consists of 2496 patients with hemodynamically stable pulmonary embolism (2100 patients [84%] treated with direct oral anticoagulants), who were divided into 2 groups: sPESI scores of 0 and ≥1. We investigated the 30‐day mortality, home treatment prevalence, and factors predisposing to home treatment using the Kaplan‐Meier method and logistic regression model. Patients with an sPESI score of 0 accounted for 612 (25%) patients, and only 17% among 532 patients with out‐of‐hospital pulmonary embolism were treated at home. The cumulative 30‐day mortality was lower in patients with an sPESI score of 0 than the score of ≥1 (0% and 4.8%, log‐rank P<0.001). There was no patient with 30‐day mortality with an sPESI score of 0. Independent factors for home treatment among out‐of‐hospital pulmonary embolism patients with an sPESI score of 0 were no transient risk factors for venous thromboembolism, no cardiac biomarker elevation, and direct oral anticoagulants use in the acute phase. Conclusions The 30‐day mortality rate was notably low in an sPESI score of 0. Nevertheless, only a minority of patients with an sPESI score of 0 were treated at home between 2015 and 2020 after the introduction of direct oral anticoagulants for venous thromboembolismin Japan.

Keywords