OC 40.2 - Outcomes of home treatment of acute pulmonary embolism in clinically relevant patient subgroups: A systematic review and individual-patient data meta-analysis

Monday, June 26, 2023

15:00 – 15:15 ET

Room: 517

Session Available As: Live-Stream and On-Demand

Presenting Author(s)

Dieuwke Luijten, MD, PhD candidate

Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands

Co-Author(s)

DD

Delphine Douillet

MD, PhD
Emergency Department, CHU Angers
Angers, Pays de la Loire, France
CT

Cecile Tromeur

MD, PhD
Centre Hospitalo-Universitaire de Brest, Département de Médecine Interne et Pneumologie, INSERM U1304, CIC INSERM 1412, Univ_Brest, Brest, FCRIN INNOVTE, France.
Brest, Bretagne, France
AP

Andrea Penaloza

MD, PhD
Emergency Department, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium.
Brussels, Brussels Hoofdstedelijk Gewest, Belgium
OH

Olivier Hugli

MD
INNOVTE Emergency Department, University Hospital of Lausanne
Lausanne, Vaud, Switzerland
Stefano Barco, MD, PhD, FESC (he/him/his)

MD, PhD
Department of Angiology, University Hospital of Zurich
Zurich, Zurich, Switzerland
JB

Joseph R. Bledsoe

MD
Department of Emergency, Medicine Intermountain Healthcare
Salt Lake City, Utah, United States
Pd

Paul L. den Exter

Internist - vascular medicine specialist
Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
Leiden, Zuid-Holland, Netherlands
CF

Carme Font

MD, PhD
Medical Oncology Service, Hospital Clinic; Barcelona, Spain
Barcelona, Catalonia, Spain
MH

Menno V. Huisman

MD, PhD
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands
Kyle E. Chang (he/him/his)

Medical Student Research Intern
Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School
Boston, Massachusetts, United States
JK

Jeffrey A. Kline

MD
Department of Emergency Medicine, Indiana University School of Medicine
Indianapolis, Indiana, United States
SK

Stavros Konstantinides

MD, PhD
Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University
Mainz, Rheinland-Pfalz, Germany
KL

Kim Luijken

PhD
Julius Center for HealthSciences and Primary Care, University Medical Center Utrecht, Utrecht University
Utrecht, Utrecht, Netherlands
RO

Remedios Otero

MD, PhD
Pneumology Department, Hospital Universitario Virgen del Rocío-IBIS-US_CIBERES
Seville, Andalucia, Spain
Olivier Sanchez, MD, PhD

Head of department
Université Paris Cité, Service de Pneumologie et Soins Intensifs, HEGP
Paris, France
DV

David R. Vinson

MD
Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center
Roseville, California, United States
Mv

Maarten van Smeden

PhD
Julius Center for HealthSciences and Primary Care, University Medical Center Utrecht, Utrecht University
Utrecht, Utrecht, Netherlands
Pierre-Marie Roy, MD, PhD (he/him/his)

MD, PhD
Service des urgences, Centre Hospitalo-Universitaire d’Angers, Institut MITOVASC, EA 3860, Université d'Angers, Angers, FCRIN INNOVTE, France.
Angers, Pays de la Loire, France
Erik Klok, MD, PhD, FESC

Leiden University Medical Center

Background: The simplified PESI score (sPESI) and Hestia criteria are validated tools to identify patients with low-risk pulmonary embolism (PE) who can be safely treated at home. How these tools perform in relevant patient subgroups, e.g. defined by age or comorbidities is unknown.

Aims: To evaluate the safety of home-treatment in the overall population and predefined patient subgroups.

Methods: We performed a systematic review and individual patient-data meta-analysis (IPDMA) with 9 prospective studies including 2,640 acute PE patients treated at home (discharged within 24 hours). The 30-day incidence of all-cause mortality and the combined endpoint of recurrent venous thromboembolism (VTE), major bleeding and/or all-cause mortality were evaluated. For the current abstract, we performed a complete case analysis calculating incidences and relative risks (RR) using a fixed-effects approach to pool across studies.

Results: Patients’ mean age was 54 years (±16) and 1,246 were woman (47%). The overall pooled incidence of the 30-day combined endpoint was 1.4% (95% confidence interval [CI] 1.2-1.7; Table 1). For the combined endpoint, the point estimate of the RR exceeded 2.0 for patients with cancer, preexisting pulmonary disease, an abnormal troponin and signs of right ventricular (RV) overload (RR 2.4, 2.3, 3.3 and 2.9 respectively), but not across age categories nor in patients with previous VTE or renal insufficiency. Cancer and pulmonary comorbidities were the only determinants of 30-day all-cause mortality (RR 8.6, 95%CI 2.1-34.9 and 4.7, 95%CI 1.3-17.2 respectively).

Conclusion(s): The absolute incidence of death and PE-specific complications was low in patients selected for home treatment. We identified several patient subgroups at higher risk of short-term complications and death, in particular patients with active cancer and pulmonary comorbidities. At the ISTH meeting, full results will be presented after the inclusion of one more study (totaling ~3000 patients) and full data imputation of missing variables.

Learning Objectives:

Describe overall safety of home-treatment for acute pulmonary embolism patients
Recognize acute pulmonary embolism subgroups at higher risk for adverse events when receiving home-treatment
Gain knowledge on how to decide on eligibility for home-treatment in acute pulmonary embolism patients