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Poster Networking

Venous Thromboembolism

PB0929 - Treatment of acute pulmonary embolism in older patients: focus on deviations from guideline recommendation for home treatment and reperfusion treatment

Monday, June 24, 2024
13:45 – 14:45 ICT
Room: Exhibition Hall

    Presenting Author(s)

  • Dieuwke Luijten, MD, PhD cadidate

    Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Center
    Leiden, Zuid-Holland, Netherlands

    • Co-Author(s)

  • DA

    Denise Abbel

    MSc
    Department of Internal Medicine – section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
    Leiden, Zuid-Holland, Netherlands

  • Suzanne C. Cannegieter

    MD, PhD, prof
    Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
    Leiden, Zuid-Holland, Netherlands

  • Jeroen Eikenboom

    MD, PhD, prof
    Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
    Leiden, Zuid-Holland, Netherlands

  • Pd

    Paul L. den Exter

    Hematologist
    Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
    Leiden, Zuid-Holland, Netherlands

  • JG

    Jacobijn Gussekloo

    MD, PhD, prof
    Department of Internal Medicine – section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
    Leiden, Zuid-Holland, Netherlands

  • MH

    Menno V. Huisman

    Professor of Medicine
    Department of Medicine – Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Dutch Thrombosis Network, The Netherlands.
    Leiden, Zuid-Holland, Netherlands

  • Tv

    Thijs E. van Mens

    MD, PhD
    Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Center
    Leiden, Zuid-Holland, Netherlands

  • LT

    Lara Tahir

    BSc
    Department of Internal Medicine – section of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
    Leiden, Zuid-Holland, Netherlands

  • ST

    Stella Trompet

    PhD
    Department of Internal Medicine – section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
    Leiden, Zuid-Holland, Netherlands

  • SM

    Simon Mooijaart

    MD, PhD, prof
    Department of Internal Medicine – section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
    Leiden, Zuid-Holland, Netherlands

  • Erik Klok, MD, PhD, FESC

    Leiden University Medical Center

Background: Treating older patients with acute pulmonary embolism (PE) is challenging as these patients are often underrepresented in clinical trials, have comorbidities interfering with treatment and are at high-risk for complications.

Aims: In this cohort study we evaluated treatment and outcomes in older PE patients and deviations from the current guideline recommendations.

Methods: We retrospectively collected data on 194 patients aged ≥70 years diagnosed with acute PE at the emergency department or < 24 hours after presentation at the Leiden University Medical Center between 2015-2021. We evaluated mortality in relation to patients’ European Society of Cardiology (ESC) risk-classification and Acute Presenting Older Patient (APOP) score (outcome presents the %-risk of mortality or functional decline).

Results: 3.8% had low-risk, 83% intermediate-risk, and 7.5% high-risk PE (table-1). 27% of the total cohort was treated at home: all low-risk patients as well as 25% of intermediate-risk patients were admitted < 24 hours. Mortality or recurrent venous-thromboembolism within 14-days was both 0% for patients receiving home treatment, one patient (2.1% 95%CI 0.17-9.9) had a major bleeding (day-7, hematuria from renal cell carcinoma). Six of the 14 high-risk patients received reperfusion therapy. The main reason for refraining from reperfusion treatment was presence of comorbidities contributing to hemodynamic instability (i.e. sepsis). Mortality within 14-days was 59% in high-risk patients (95%CI 27-81; figure-1A); 5 out of 6 patients receiving reperfusion treatment died within 5-days. Patients with an APOP score of ≥45% had a higher 90-day mortality (37% [95%CI 16-58] compared to a score < 45% (17% [95%CI 8.5-27], HR 3.9 [95%CI 1.6-9.5], figure-1B).

Conclusion(s): Home treatment of low and carefully selected intermediate-risk older PE patients was safe. Mortality in the high-risk group was high even in patients receiving reperfusion treatment. Both the ESC risk-classification as the APOP score identified patients at higher mortality and are of potential interest for clinical decision making.