Preemptive Anticoagulation of Patients with a High Pretest Probability of Pulmonary Embolism: Are Guidelines Followed?
Chest. 2017 Nov 15;:
Authors: Willoughby L, Adams DM, Evans RS, Lloyd JF, Stevens SM, Woller SC, Bledsoe JR, Aston VT, Wilson EL, Elliott CG
Abstract
BACKGROUND: Guidelines suggest anticoagulation of patients with high pretest probability of pulmonary embolism (PE) while awaiting diagnostic test results (preemptive anticoagulation). Data relevant to the practice of preemptive anticoagulation are not available.
METHODS: We reviewed 3,500 consecutive patients who underwent CT pulmonary angiography (CTPA) at 2 emergency departments (ED). We classified the pretest probability for PE using the Revised Geneva Score (RGS) as low (RGS 0-3), intermediate (RGS 4-10), or high (RGS 11-18). We classified patients with high pretest probability of PE as receiving preemptive anticoagulation if therapeutic anticoagulation was given before CTPA completion. Patients with a high bleeding risk and those receiving treatment for deep vein thrombosis (DVT) before CTPA were excluded from the preemptive anticoagulation analysis. We compared the time elapsed between ED registration and CTPA completion for patients with low, intermediate, and high pretest probability for PE RESULTS: We excluded 3 of 3,500 patients because CTPA preceded ED registration. Of the remaining 3,497 patients, 167 (4.8%) had a high pretest probability for PE. After excluding 29 patients for high bleeding risk and 21 patients who were treated for DVT prior to CTPA, only 2 of 117 (1.7%) patients with high pretest probability for PE received preemptive anticoagulation. Furthermore, 37 of the remaining 115 patients (32%) with a high pretest probability for PE had a preexisting indication for anticoagulation but did not receive preemptive anticoagulation. The time from ED registration to CTPA completion did not differ based upon the pretest probability of PE.
CONCLUSION: Physicians rarely utilize preemptive anticoagulation in patients with high pretest probability for PE. Clinicians do not expedite CTPA examinations for patients with a high pretest probability for PE.
PMID: 29154971 [PubMed - as supplied by publisher]