Evidence map›Paper›PMID 38888528›Full record

ArticleAnnals of emergency medicine2024

Trends in Initial Anticoagulation Among US Patients Hospitalized With Acute Pulmonary Embolism 2011-2020.

Lauren M Westafer, Thomas Presti, Meng-Shiou Shieh, Penelope S Pekow, Geoffrey D Barnes, Alok Kapoor, Peter K Lindenauer

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of emergency medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Review
  2. Initial management of intermediate- and high-risk pulmonary embolism.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026
    Review
  3. Article
  4. Article
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Lauren M WestaferDepartment of Emergency Medicine, University of Massachusetts Chan Medical School - Baystate, Springfield, MA; Department of Healthcare Delivery and Population Science University of Massachusetts Chan Medical School - Baystate, Springfield, MA. Electronic address: lauren.westafer@baystatehealth.org.
Thomas PrestiDivision of Pulmonary and Critical Care, Baystate Medical Center, Springfield, MA.
Meng-Shiou ShiehDepartment of Healthcare Delivery and Population Science University of Massachusetts Chan Medical School - Baystate, Springfield, MA.
Penelope S PekowDepartment of Healthcare Delivery and Population Science University of Massachusetts Chan Medical School - Baystate, Springfield, MA; School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA.
Geoffrey D BarnesFrankel Cardiovascular Center, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
Alok KapoorDepartment of Population and Quantitative Health Science, University of Massachusetts Medical School, Worcester, MA; Department of Medicine, Division of Hospital Medicine, University of Massachusetts Chan Medical School, Worcester, MA.
Peter K LindenauerDepartment of Healthcare Delivery and Population Science University of Massachusetts Chan Medical School - Baystate, Springfield, MA; Department of Population and Quantitative Health Science, University of Massachusetts Medical School, Worcester, MA; Division of Hospital Medicine, Baystate Medical Center, Springfield, MA.

Funding

De-Implementation of Low Value Imaging in Pulmonary Embolism (DELVE PE)K23HL155895 · NHLBI · BAYSTATE MEDICAL CENTER, INC. · PI WESTAFER, LAUREN · 2021 to 2025
$872k
Research and Mentoring in Comparative Effectiveness and Implementation ScienceK24HL132008 · NHLBI · BAYSTATE MEDICAL CENTER, INC. · PI LINDENAUER, PETER KYLE · 2016 to 2020
$574k
NHLBI NIH HHS K23 HL155895NHLBI NIH HHS K24 HL132008
6 · The paper itself

Abstract

STUDY

objectiveGuidelines recommend low-molecular-weight heparin (LMWH) and direct oral anticoagulants (DOACs) rather than unfractionated heparin (UFH) for treatment of acute pulmonary embolism (PE) given their efficacy and reduced risk of bleeding. Using data from a large consortium of US hospitals, we examined trends in initial anticoagulation among hospitalized patients diagnosed with acute PE.

methodsWe conducted a retrospective study of inpatient and observation cases between January 1, 2011, and December 31, 2020, among individuals aged more than or equal to 18 years treated at acute care hospitals contributing data to the Premier Healthcare Database. Included cases received a diagnosis of acute PE, underwent imaging for PE, and received anticoagulation at the time of admission. The primary outcome was the initial anticoagulant selected for treatment.

resultsAmong 299,016 cases at 1,045 hospitals, similar proportions received initial treatment with UFH (47.4%) and LMWH (47.9%). Between 2011 and 2020, the proportion of patients initially treated with UFH increased from 41.9% to 56.3%. Over this period, use of LMWH as the initial anticoagulant was reduced from 58.1% in 2011 to 37.3% in 2020. The proportion of cases admitted to the ICU, treated with mechanical ventilation or vasopressors, and inpatient mortality were stable. Factors most strongly associated with receipt of UFH were admission to the ICU (odds ratio [OR] 6.90; 95% confidence interval [CI] 6.31 to 7.54) or step-down unit (OR 2.30; 95% CI 2.16 to 2.45), receipt of thrombolysis (OR 4.25; 95% CI 3.09 to 5.84) or vasopressors (OR 1.83; 95% CI 1.32 to 2.54), and chronic renal disease (OR 1.67; 95% CI 1.54 to 1.81).

conclusionsDespite recommendations that LMWH and DOACs be considered first-line for most patients with acute PE, use of UFH is common and increasing. Further research is needed to elucidate factors associated with persistent use of UFH and opportunities for deimplementation of low-value care.

Indexed as

AnticoagulantsHeparin, Low-Molecular-WeightPulmonary EmbolismAcute DiseaseAgedAged, 80 and overFemaleHeparinHospitalizationHumansMaleMiddle AgedRetrospective StudiesUnited StatesAnticoagulantsHeparinHeparin, Low-Molecular-Weight

Identifiers

PMID38888528
PMCPMC11493503

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.