Risk assessment and management strategies in older patients with acute pulmonary embolism.

IF 5.5 2区 医学 Q1 HEMATOLOGY Journal of Thrombosis and Haemostasis Pub Date : 2024-10-23 DOI:10.1016/j.jtha.2024.10.015
Dieuwke Luijten, Denise Abbel, Suzanne C Cannegieter, Jeroen Eikenboom, Paul L den Exter, Jacobijn Gussekloo, Menno V Huisman, Thijs E van Mens, Lara Tahir, Stella Trompet, Simon P Mooijaart, Frederikus A Klok
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Abstract

Introduction: Managing older patients with acute pulmonary embolism (PE) is challenging due to their underrepresentation in clinical trials, comorbidities and increased complication risk. This study evaluates risk assessment and management outcomes in older PE patients focussing on home and reperfusion treatment.

Methods: A retrospective analysis was conducted on patients aged ≥70 years diagnosed with acute PE at an academic medical centre (2015-2022).

Results: 242 patients with a mean age of 77 years were included. All 59 patients with negative Hestia criteria were discharged ≤24h, and in total 81 patients (35%) received home treatment. Among these 14-day mortality and recurrent venous-thromboembolism were 0% and major bleeding occurred in 1.3% (one patient, 95%CI 0.11-6.1). European Society of Cardiology (ESC) risk-classification showed 9 low-risk PE (3.9%), 199 intermediate-risk (87%), and 20 high-risk PE patients (8.8). In 5 of the 20 high-risk patients, hypotension was mainly caused by another condition, i.e. sepsis. Eight high-risk patients received reperfusion therapy. Fourteen-day mortality was 51% in high-risk patients (95%CI 27-71); 5 out of 8 patients receiving reperfusion treatment died within 5 days. Patients with an Acute Presenting Older Patient (APOP) score of ≥45% had higher 14-day mortality (28%; 95%CI 12-46) compared to <45% (3.2%; 95%CI 0.85-8.3; HR 10.2; 95%CI 2.6-39).

Conclusion: Selecting for home treatment using Hestia was safe for older PE patients in our cohort. Mortality in the high-risk group was high also when receiving reperfusion treatment. The ESC risk-classification and APOP score identified patients at higher mortality risk, suggesting their potential utility in clinical decision-making.

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老年急性肺栓塞患者的风险评估和管理策略。
简介:由于老年急性肺栓塞(PE)患者在临床试验中的代表性不足、合并症和并发症风险增加,管理老年急性肺栓塞患者具有挑战性。本研究评估了老年肺栓塞患者的风险评估和管理结果,重点是家庭治疗和再灌注治疗:结果:共纳入 242 例患者,平均年龄 77 岁。所有59名Hestia标准阴性的患者均在24小时内出院,共有81名患者(35%)接受了家庭治疗。其中,14 天死亡率和复发性静脉血栓栓塞率均为 0%,大出血发生率为 1.3%(一名患者,95%CI 0.11-6.1)。欧洲心脏病学会(ESC)的风险分类显示,低风险 PE 患者为 9 人(3.9%),中风险患者为 199 人(87%),高风险 PE 患者为 20 人(8.8%)。在这 20 名高风险患者中,有 5 名患者的低血压主要是由败血症等其他疾病引起的。8 名高风险患者接受了再灌注治疗。高危患者的 14 天死亡率为 51%(95%CI 27-71);8 名接受再灌注治疗的患者中有 5 人在 5 天内死亡。与结论相比,急性发病老年患者(APOP)评分≥45%的患者14天死亡率更高(28%;95%CI 12-46):在我们的队列中,选择使用 Hestia 进行家庭治疗对老年 PE 患者是安全的。在接受再灌注治疗时,高风险组的死亡率也很高。ESC风险分级和APOP评分可识别死亡率风险较高的患者,这表明它们在临床决策中具有潜在的实用性。
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来源期刊
Journal of Thrombosis and Haemostasis
Journal of Thrombosis and Haemostasis 医学-外周血管病
CiteScore
24.30
自引率
3.80%
发文量
321
审稿时长
1 months
期刊介绍: The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.
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