The concept of pulmonary embolism is evolving. Recent and emerging evidence on the treatment of specific patient populations, its secondary prevention, long-term complications, and the unmet need for rehabilitation has the potential to change clinical practice for the benefit of the patients. This review discusses the recent evidence from clinical trials, observational studies, and guidelines focusing on anticoagulation treatment, rehabilitation, emotional stress, quality of life, and the associated outcomes for patients with pulmonary embolism. Guidelines suggest that the type and duration of treatment with anticoagulation should be based on prevalent risk factors. Recent studies demonstrate that an anticoagulant treatment that is longer than two years may be effective and safe for some patients. The evidence for extended treatment in cancer patients is limited. Careful consideration is particularly necessary for pulmonary embolisms in pregnancy, cancer, and at the end of life. The rehabilitation and prevention of unnecessary deconditioning, emotional distress, and a reduced quality of life is an important, but currently they are unmet priorities for many patients with a pulmonary embolism. Future research could demonstrate optimal anticoagulant therapy durations, follow-ups, and rehabilitation, and effective patient-centered decision making at the end of life. A patient preferences and shared decision making should be incorporated in their routine care when weighing the benefits and risks with primary treatment and secondary prevention.

/pdf/long-term-management-of-pulmonary-embolism-a-review-of-279xlruw.pdf

Long-Term Management of Pulmonary Embolism: A Review of Consequences, Treatment, and Rehabilitation

Given high recurrence risk after venous thromboembolism (VTE), guidelines recommend extended dose rivaroxaban (10 mg OD) or apixaban (2.5 mg BID) to be considered after 6 months of initial treatment. This study aimed to provide insight into clinical practice regarding the use of extended preventive treatment and to describe duration of the initial treatment. Linkage of nationwide health registers identified all in- and outpatients with VTE from April 2017 through 2018. Hazard ratios (HR) with 95% confidence intervals (CIs) were calculated adjusting for other VTE-related factors. The study included 6030 patients with VTE. Among rivaroxaban users, 2.2% (n = 113) received the extended 10-mg dose after mean 9.4 (SD 3.1) months of standard treatment. For apixaban, 4.7% (n = 40) received extended 2.5-mg dose after mean 8.0 months (SD 3.9). After adjustments, incident pulmonary embolism (HR 1.81 95% CI 1.12;2.91) and trauma/fracture (HR 1.42 95% CI 0.46;4.43) were associated with switching to extended dose, whereas patients with unprovoked VTE were less likely to receive the extended dose (HR 0.68 95% CI 0.30;1.55). Less than 3% of patients with incident VTE received extended treatment after initial standard treatment. Even though international guidelines suggest that the risk-benefit balance is in favour of extended VTE treatment, this was yet to be translated into clinical practice as of 2018. Studies using contemporary data are warranted to investigate routine clinical practice of extended treatment for VTE recurrence.

Characteristics of patients receiving extended treatment after incident venous thromboembolism.

Utility of a recurrence prediction tool (DASH score) at a single centre after unprovoked venous thromboembolism: patient uptake of the tool and short term risks of stopping anticoagulation

articipation in clinical research results in improved outcomes, not only for participants but also for other patients treated at centers with research engagement. malignant hematology is a hotbed of nonmalignant hematology is underserved aside from a

https://doi.org/10.1097/hs9.0000000000000766

HaemSTAR—Growing Experience From a National, Trainee-led Research Network

After an initial treatment period for venous thromboembolism (VTE), indefinite anticoagulation may be considered, depending upon individual risks The aim of the study was to determine if there is consensus amongst clinicians that manage VTE regarding which patients require 3–6 months versus indefinite anticoagulation The importance of VTE site and severity in decision making was also evaluated An international survey of clinicians involved in VTE management was undertaken Respondents were asked about long-term treatment of six patients that had completed 3–6 months initial anticoagulation These included four cases of VTE not associated with a major reversible risk factor and two control cases; one unprovoked VTE and one VTE associated with a major reversible risk factor For consensus, there was a pre-defined equivalence boundary whereby at least 70% of clinicians had to decide either to stop or consider indefinite anticoagulation for each case 351 responses were collected In the control cases, there was a ≥ 95% consensus on long-term management (stop versus indefinite anticoagulation) In three of the four test cases, there was no consensus about duration of anticoagulation In case 3, 78% (99% confidence interval 73–84%) would stop anticoagulation after 3–6 months When analysed by grade or specialty of doctor, a lack of consensus remained Opinion on whether site or severity of VTE influenced decision making was variable For patients with unprovoked VTE or VTE associated with a major transient risk factor there is treatment consensus For the remainder, there is a lack consensus regarding the need for indefinite anticoagulation

An international survey of clinicians regarding their management of venous thromboembolism following the initial 3-6 months of anticoagulation

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An international survey of clinicians regarding their management of venous thromboembolism following the initial 3-6 months of anticoagulation