Emergency Medicine Research, Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28323-2861, USA.
Thromb Res. 2012 Apr;129(4):e25-8. doi: 10.1016/j.thromres.2012.01.005. Epub 2012 Jan 28.
The administration of empiric systemic anticoagulation (ESA) before confirmatory radiographic testing in patients with suspected pulmonary embolism (PE) may improve outcomes, but no data have been published regarding current practice. We describe the use of ESA in a large prospective cohort of emergency department (ED) patients and report the outcomes of those treated with ESA compared with patients not receiving ESA.
12-center, noninterventional study of ED patients who presented with symptoms concerning for PE. Clinical data including pretest probability and decision to start ESA were recorded at point of care by attending physicians. Patients were followed for adverse in-hospital outcomes and recurrence of venous thromboembolism.
ESA was initiated 342/7932 (4.3%) of enrolled patients, including 142/618 (23%) patients with high pretest probability. Patients receiving ESA had more abnormal vital signs and were more likely to have a history of venous thromboembolism than those who did not receive ESA. Overall, 481/7,932 (6.1%) had PE diagnosed, 72/481 (15.0%) with PE had ESA, and 72/342 (21%) of ESA patients had PE. Three patients (0.9%, 95%CI: 0.2-2.5%) who received ESA suffered hemorrhagic complications compared with 38 patients (0.5%, 95%CI: 0.4-0.7%) who did not receive ESA.
In this multicenter sample, ED physicians administered ESA to a small, generally more acutely ill subset of patients with high pretest probability of PE, and very few had hemorrhagic complications. ESA was not associated with any clear difference in outcomes. More study is needed to clarify the risk versus benefit of ESA.
疑似肺栓塞（PE）患者在进行确诊性影像学检查前进行经验性全身抗凝（ESA）治疗可能会改善预后，但目前尚无相关数据发表。本研究描述了在一个大型前瞻性急诊科（ED）患者队列中使用 ESA 的情况，并报告了接受 ESA 治疗与未接受 ESA 治疗患者的结局。
这是一项在 12 个中心进行的、针对出现疑似 PE 症状的 ED 患者的非干预性研究。在护理点，主治医生记录了包括预测前概率和开始 ESA 决策在内的临床数据。对患者进行住院期间不良结局和静脉血栓栓塞（VTE）复发的随访。
7932 例入组患者中，有 342 例（4.3%）接受了 ESA，其中 618 例（23%）高预测前概率患者接受了 ESA。与未接受 ESA 的患者相比，接受 ESA 的患者生命体征异常更多，且更有可能有 VTE 病史。总体而言，7932 例患者中有 481 例（6.1%）诊断为 PE，481 例中有 72 例（15.0%）接受了 ESA，342 例 ESA 患者中有 72 例（21%）患有 PE。与未接受 ESA 的患者相比，接受 ESA 的患者中有 3 例（0.9%，95%CI：0.2-2.5%）发生了出血性并发症，而未接受 ESA 的患者中有 38 例（0.5%，95%CI：0.4-0.7%）发生了出血性并发症。
在这个多中心样本中，ED 医生对具有高预测前概率 PE 的、一般更急性疾病的较小亚组患者给予了 ESA，且极少数患者出现了出血性并发症。ESA 治疗与结局无明显差异相关。需要进一步研究来明确 ESA 的风险获益比。
