Abstract Number: PB2480
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » VTE Treatment
Background: Pulmonary Embolism Response Teams (PERT) aim to improve treatment of acute pulmonary embolism (PE). While the original intent of PERT was to focus on the challenging intermediate- and high-risk PE, recent multicenter studies show that low-risk PE patients compose one in five of all PERT cases. Conversely, not all intermediate- and high-risk PE patients trigger a PERT activation. The factors leading to PERT activations remain unknown.
Aims:
1) To describe the patient characteristics associated with a PERT activation for low-risk PE patients and
2) to describe the patient characteristics precluding a PERT activation for intermediate/high-risk PE patients.
Methods: We analysed data from all patients with confirmed PE diagnosed in the Massachusetts General Hospital (MGH) Emergency Department from August 2013 to February 2017 and cross-referred these data with patients who received a PERT activation and patients who did not. Patients were stratified according to the ESC guidelines into low-risk or intermediate/high-risk PE. Data were extracted on demographics, comorbidities, PE risk factors, medication use, presenting symptoms, imaging, and laboratory findings. Univariate analyses were performed within each risk group comparing patients with a PERT activation and patients without.
Results: Fifteen percent (56/374) of low-risk patients triggered a PERT activation. Patient characteristics associated with PERT activation (Table 1) were:
1) vascular disease,
2) pulmonary diseases,
3) thrombophilia,
4) current use of anticoagulants,
5) central PE and
6) concurrent DVT.
Thirty-five percent (110/283) of intermediate/high-risk patients did not trigger a PERT activation. Patient characteristics precluding a PERT activation (Table 2) were:
1) vascular disease,
2) malignancies and
3) asymptomatic at presentation.
Conclusions: In this retrospective analysis, we found that low-risk patients with PERT activations had more extensive clot burden or had failed anticoagulation treatment whereas intermediate/high-risk patients without PERT activations tended to have malignancies and were more often asymptomatic on presentation.
All patients | No activation | PERT activation | P-value | ||||
n | % | n | % | n | % | ||
374 | 100 | 318 | 85 | 56 | 15 | ||
Vascular disease (CAD, AF, CHF, Stroke) | 64 | 17 | 49 | 15 | 15 | 27 | 0.037 |
Pulmonary disease (Asthma, COPD) | 63 | 17 | 45 | 14 | 18 | 32 | <0.001 |
Thrombophilia | 19 | 5 | 13 | 4 | 6 | 10 | 0.049 |
Anticoagulants (currently using) | 40 | 11 | 29 | 9 | 11 | 20 | 0.019 |
Central PE | 152 | 41 | 109 | 37 | 43 | 78 | <0.001 |
Present DVT | 104 | 28 | 78 | 25 | 26 | 50 | <0.001 |
[Table 1. Characteristics of low-risk patients]
All patients | No activation | PERT activation | P-value | ||||
n | % | n | % | n | % | ||
283 | 100 | 110 | 35 | 173 | 65 | ||
Vascular disease (CAD, AF, CHF, Stroke) | 74 | 26 | 40 | 36 | 34 | 20 | 0.002 |
Malignancies (active and in the past) | 108 | 38 | 51 | 46 | 57 | 33 | 0.024 |
Asymptomatic on presentation | 13 | 5 | 11 | 10 | 2 | 1 | <0.001 |
[Table 2. Characteristics of intermediate/high-risk patients]
To cite this abstract in AMA style:
Mortensen CS, Kramer A, Schultz JG, Giordano N, Zheng H, Andersen A, Nielsen-Kudsk JE, Kabrhel C. Predicting Factors for Pulmonary Embolism Response Team (PERT) Activation in a General Pulmonary Embolism Population [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/predicting-factors-for-pulmonary-embolism-response-team-pert-activation-in-a-general-pulmonary-embolism-population/. Accessed March 21, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/predicting-factors-for-pulmonary-embolism-response-team-pert-activation-in-a-general-pulmonary-embolism-population/