Long-term follow-up of patients with highand intermediate-risk pulmonary embolism

Aim. To study the results of long-term follow-up of patients with pulmonary embolism (PE) of intermediate and high 30-day mortality risk.

Material and methods. This retrospective study included 53 patients (45,3% men) with intermediateand high-risk PE, hospitalized at the Almazov National Medical Research Center from 2019 to 2020. The mean follow-up period was 20,9 [4,0; 33,5] months. The data were obtained from the health information system, as well as through phone calls.

Results. Seven patients (13,2%) were classified as high, 29 (54,7%) as intermediate-high, and 17 (32,1%) as intermediate-low risk for 30-day mortality. Systemic thrombolytic therapy was performed in 11,3%, and selective transcatheter thrombolysis was performed in 24,5%. Of the 33 patients with available data, 23 (69,7%) attended in-person outpatient appointments. Another 10 (30,3%) patients were interviewed by telephone. Cancer screening was recommended to 36 (73,5%) patients, but the recommendation was followed only in a quarter of cases and papillary thyroid cancer was detected in one patient. Examination for thrombophilia was recommended for 20 (40,8%) patients, while 12 (60,0%) patients underwent it, 5 (41,6%) of whom were found to have hereditary thrombophilia. After discharge, 15 (30,6%) patients underwent control echocardiography, and 8 (16,3%) patients underwent repeat computed tomography pulmonary angiography. Chronic thromboembolic pulmonary disease was diagnosed in two cases, and chronic thromboembolic pulmonary hypertension was confirmed in one patient. Upon discharge, 30 (61,2%) patients were prescribed direct oral anticoagulants, 15 (30,5%) — vitamin K antagonists, 4 (8,2%) — low molecular weight heparin. The median duration of anticoagulant therapy was 22 [7,5; 31,5] months, with 20 (69,0%) patients receiving anticoagulants for >12 months. Outpatient bleeding was observed in 4 (13,8%) patients, all of which were recognized minor according to the International Society on Thrombosis and Haemostasis (ISTH) classification. No recurrence of deep vein thrombosis and/or PE was observed. After discharge, 3 (6,1%) deaths were recorded, the causes of which were unknown. One-year survival rate was 88%.

Conclusion. There is insufficient patient compliance with discharge recommendations and low continuity of inpatient and outpatient treatment of patients with PE. Further implementation of the algorithm for outpatient management of patients after PE is required, which will allow making decisions on anticoagulant therapy and effectively and timely identifying PE consequences.

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