Acute Pulmonary Embolism in Emergency Department Patients Despite Therapeutic Anticoagulation

The Western Journal of Emergency Medicine
Michelle Y LiuDavid R Vinson

Abstract

Emergency department (ED) patients with acute pulmonary embolism (PE) despite therapeutic anticoagulation at the time of diagnosis are uncommonly encountered and present a diagnostic and management challenge. Their characterization and outcomes are poorly described. We sought to describe the prevalence and characteristics of therapeutically anticoagulated patients among a population of patients with acute PE in a community setting and to describe treatment changes and 30-day outcomes. From a large retrospective cohort of adults with acute, objectively-confirmed PE across 21 EDs between 01/2013 and 04/2015, we identified patients who arrived on direct oral or injectable anticoagulants, or warfarin with an initial ED international normalized ratio (INR) value ≥2.0. Patients were excluded from the larger cohort if they had received a diagnosis of venous thromboembolism (VTE) in the prior 30 days. We gathered demographic and clinical variables from electronic health records and structured manual chart review. We report discharge anticoagulation regimens and major 30-day adverse outcomes. Among 2,996 PE patients, 36 (1.2%) met study criteria. Mean age was 63 years. Eleven patients (31%) had active cancer and 25 (69%) were high risk ...Continue Reading

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Citations

Nov 14, 2018·Annals of Internal Medicine·David R VinsonUNKNOWN eSPEED Investigators of the KP CREST Network
May 19, 2020·The Western Journal of Emergency Medicine·David R VinsonDustin G Mark
Mar 27, 2020·Journal of Investigative Medicine High Impact Case Reports·Said Hajouli

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