Early prescription of direct oral anticoagulants for acute intermediate-high risk pulmonary embolism

Abstract

The use of direct oral anticoagulants (DOACs) for the early treatment of intermediate-high risk pulmonary embolism (PE) is poorly described. The aims of the present study were to describe clinical patterns and associated risk of adverse events between early and late DOAC prescription after admission for intermediate-high risk PE. We used a prospective regional multicenter registry including all consecutive hemodynamically stable PE patients stratified as intermediate-high risk with right heart strain on cardiac imaging and elevation of cardiac biomarkers. Early DOAC group was defined as a prescription < 72 h after admission, and late DOAC group was defined as a prescription between 72 h and 7 days. Efficacy and safety outcomes were evaluated at 30 days and 6 months. Among 477 patients admitted with an intermediate-high risk PE between 10/2012 and 12/2017, 209 patients were treated with DOACs within the acute phase: early DOAC group was composed of 68 patients (32.5%) and late DOAC group of 141 patients (67.8%). There was no significant difference in baseline characteristics between groups. The rates of efficacy and safety outcomes were similar between patients who were treated early with a DOAC and those who received a late strategy with a prolonged heparin lead-in. Hospital length of stay was shorter in the early DOAC group (6.0 ± 3.6 days vs. 8.2 ± 6.8 days, P = 0.01). Our results might suggest that, if a DOAC is selected for intermediate-high risk PE treatment, it could be prescribed early after admission.