Pulmonary embolism (PE) management that does not adhere to guidelines for indications related to anticoagulation, thrombolytics and inferior vena cava filters is associated with worse patient outcomes, according to new research published in the European Respiratory Journal.
A total of 2,096 patients with confirmed PE were included in the study, which had a prospective observational cohort design. Two investigators independently analysed each patient's chart and classified the management as adherent or non-adherent; 1,688 patients received care that adhered to management guidelines, while 408 patients received non-adherent management.
The researchers then compared all-cause mortality, PE-related mortality, recurrent venous thromboembolism (VTE) and major bleeding events during the first month of follow-up after diagnosis in patients whose care adhered to guidelines versus patients whose care did not.
The data showed that patients receiving non-adherent management were significantly more likely to experience all-cause or PE-related mortality during follow-up; risk of death from any cause among patients with non-adherent management was 2-times higher, and the risk of PE-specific death was about 5-times higher than in patients with adherent management.
Non-adherent management was also a significant independent predictor of recurrent VTE and major bleeding. Using cohort data of 34,380 PE patients from the RIETE registry, the prognostic significance of non-adherent management in patients with acute symptomatic PE was confirmed.
Clinicians most commonly did not adhere to management guidelines when patients were haemodynamically compromised, and when patients had an increased risk of bleeding.
The authors conclude that management that does not adhere to evidence-based guidelines related to anticoagulation, use of thrombolytics and use of inferior vena cava filters frequently occurred, and was associated with worse outcomes in patients with acute PE.
A potentially limiting factor to this study is the observational and non-randomised design, and that the conclusions are limited to the specific indications that the researchers used for defining deviation from management guidelines.