[Clinical-instrumental management and anticoagulant therapy in the follow-up of patients with pulmonary embolism: the results of the "FOLLOW-EP" survey promoted by the ANMCO Working Group on Pulmonary Vascular Diseases].

Abstract

Background: Follow-up management of patients with pulmonary embolism (PE) is crucial to reduce the risk of recurrence and the early identification of those who develop pulmonary hypertension. However, this pathway is poorly defined.

Methods: The ANMCO Working Group on Pulmonary Vascular Diseases together with the ANMCO Study Center addressed a web-based set of 16 questions to ANMCO members to investigate their experience in PE follow-up settings and adherence to guidelines.

Results: Out of 4488 submissions, 294 (6.5%) answered, of which 69% were cardiologists. An outpatient clinic for PE follow-up is not present in 43% of the centers, in 28% it is present in a structured form and in 27% only as an outpatient clinic for anticoagulant therapy (AC). The referring doctor is a cardiologist in 68% of cases. The first visit after PE is usually at 3 months (60%). The bleeding and recurrence risk profiles are assessed in 63% and 36% of cases, respectively. Thrombophilia screening guides AC discontinuation after idiopathic PE (47%), especially in women and young people (55%). Risk factors associated with the index event are decisive for AC extended duration in estrogen-progestin-induced PE (69%) as well as in incidental PE (80%). In the extended phase, direct oral anticoagulants (DOACs) at low dose are used in 45% in accordance with current literature, in 40% due to the risk of bleeding. In patients with active cancer, 47% continue DOACs at full dose indefinitely, 36% at reduced dose. In 93% of cases, exertional dyspnea in the follow-up leads to the request for additional tests: a ventilation-perfusion scan in 44%, a pulmonary computed tomography angiography in 34%.

Conclusions: The data collected show wide heterogeneity in the follow-up management of PE. Dedicated clinics and local pathways are needed in caring for the patient after an episode of PE.