Impact of different anticoagulation strategies on outcomes in patients hospitalized with acute pulmonary embolism

SESSION TITLE: Pulmonary Vascular Disease Posters 1 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Pulmonary embolism (PE) is the third most common acute cardiovascular disease with mortality rate of approximately 6.5%. Hospitalizations for PE represent a substantial cost burden with the mean cost per admission for acute PE approximating $37,000. We hypothesized that different anticoagulation (AC) strategies in acute PE may be associated with differences in overall patient outcomes. Our aim was to assess the impact of different AC strategies on length of stay (LOS), bleeding complications, and mortality. METHODS: A retrospective chart review was performed of 209 patients with acute PE evaluated by the Pulmonary Embolism Response Team, admitted to one of three hospitals in the Mount Sinai Health System from 1/2020 to 9/2022. Demographic, clinical, laboratory, radiographic data, and AC therapies were collected. Linear and logistic regression models were applied to assess the impact of different variables on quantitative (LOS) and qualitative (mortality, bleeding and readmission) endpoints respectively. RESULTS: 105 women and 104 men with a mean age of 62.9 (standard deviation [SD]: 16.8) years were included. The mean PESI score was 88.7 (SD: 30.2). Median LOS was 6 (interquartile range: 3-10) days. Bleeding complications occurred in 17 (8.1%) patients, while the all-cause mortality rate was 11.5%. Most patients (n=158, 75.6%) were initially treated with intravenous unfractionated heparin (UFH). Of these, 70 were transitioned to low molecular weight heparin (LMWH), while another 69 were transitioned to a direct oral anticoagulant (DOAC). Among the 70 patients transitioned to LMWH from UFH, 42 were subsequently transitioned to a DOAC, 15 were transitioned to warfarin, while the remaining 13 patients were discharged on LMWH. Among patients treated with LMWH from the start (n=47), 37 were subsequently transitioned to a DOAC, while 2 were switched to warfarin. Another 5 patients were discharged on LMWH. In multivariate regression analysis, a strategy of UFH with transition to LMWH followed by warfarin was associated with a longer LOS (regression coefficient: 11.92; p=0.02). With respect to overall mortality, patients who were initially on UFH and subsequently discharged on LMWH (without being switched to oral anticoagulants) had increased 30-day mortality (odds ratio: 1.27, p=0.01). Risk of bleeding and readmission rates did not differ significantly among the various AC strategies. CONCLUSIONS: Patients initially treated with UFH who were switched to LMWH followed by warfarin therapy had significantly longer LOS. The risk of bleeding complications or readmission rates were similar among the various AC strategies. However, patients who were started on UFH and discharged on LMWH had higher mortality. CLINICAL IMPLICATIONS: The study result should be considered by clinicians when choosing an AC strategy in order to minimize PE-related cost burden and risks of mortality. DISCLOSURES: No relevant relationships by Jeeyune Bahk No relevant relationships by Hafiza Noor Ul Ain Baloch No relevant relationships by Abdul Rehman No relevant relationships by Sidra Salman No relevant relationships by Venus Sharma No relevant relationships by Avinash Singh No relevant relationships by David Steiger