Interv Akut Kardiol. 2024;23(2-3):75-80 | DOI: 10.36290/kar.2024.019

Strategy of anticoagulation therapy in outpatients with acute pulmonary embolism

Petra Vysočanová

Interní kardiologická klinika, Fakultní nemocnice Brno a Lékařská fakulta Masarykovy univerzity, Brno

Pulmonary embolism (PE) is the most feared clinical presentation of venous thromboembolism (VTE). Outpatient physicians encounter patients with PE who have either been recently discharged from hospital or are treated for PE on an outpatient basis, i.e., completely without hospitalisation or are discharged within the first 24 to 48 hours. Outpatient treatment of pulmonary embolism (PE) is feasible according to expert recommendations and supported by data from clinical trials showing good safety and efficacy of this procedure. For the correct selection of patients with a low risk of complications of PE, not only their stratification to determine the risk of PE (sPESI, Hestia criteria) is necessary, but also education of patients about the severity of the disease, its treatment options, and possible pitfalls in out-of-hospital treatment. The patient must know in which situation to contact the doctor and how to do it. If these rules are followed, it is possible to increase the number of patients treated at home, while maintaining their safety, improving their quality of life, and reducing the risks associated with hospitalisation (e.g., reducing the risk of infection) and thus reducing the burden on healthcare facilities (both financial and inpatient). For all patients who have had PE, the length of anticoagulation treatment is a crucial issue. The estimated length of anticoagulation at the time of diagnosis is only a guide. For each patient, the risk of recurrent PE and bleeding should be reassessed before discontinuing anticoagulation therapy. Treatment with direct oral anticoagulants (DOACs) is now preferred, allowing safe and well-tolerated therapy even in the home setting. There is still a group of patients where warfarin or long-term LMWH need to be administered. In these patients, often multimorbid ones, the type and duration of anticoagulant treatment need to be determined individually, preferably during hospitalisation in collaboration with other specialists.

Keywords: plicní embolie, antikoagulační léčba, ambulantní léčba, žilní tromboembolická enemoc, riziková stratifikace.

Received: October 29, 2024; Accepted: October 29, 2024; Published: December 12, 2024  Show citation