Coagulation

Paradigm of care in acute PE changed by rapid response teams


Multidisciplinary pulmonary embolism response teams that include haematologists have the potential to make a positive impact on the care of acute pulmonary embolism, US clinicians say. 

Dr Mateo Porres-Aguilar from Texas and colleagues said in some parts of the world, including Australia, pulmonary embolism response teams (PERTs) are changing how complex acute PE cases are approached by medical teams. 

Since their inception almost a decade ago PERTs had evolved to provide rapid multimodality assessment and risk stratification, streamline the care in challenging clinical cases and facilitate recommended therapeutic strategies on time.

Setting up a PERT was not just reserved for larger health facilities as teams came in “all shapes and sizes” with no defined or specific number of team members. 

“However, a PERT leader must orchestrate and moderate discussion of challenging case scenarios among participants, and ideally, a skilled interventionist on the team. PERT team members may include specialists from cardiology, interventional cardiology, pulmonary/critical care medicine, haematology, vascular surgery, vascular medicine and interventional radiology,” they advised in their review paper published in the Journal of Thrombosis and Haemostasis. 

Emerging data showed the value of PERTs in improving time to PE diagnosis, shorter time to initiation of anticoagulation, reducing hospital length of stay, increasing use of advanced therapies and a decrease in mortality.  

Nevertheless, they said more data was needed in the form of registries and randomised controlled trials to demonstrate a true net clinical benefit of PERTs. More education and awareness was also essential for rapid acceptance and adoption world-wide. 

“Despite being challenging to design and perform a prospective randomised clinical trial evaluating the benefits and risks of interventions executed by PERTs, we believe PERTs will continue to change the paradigm in the care of acute PE, achieving excellence in such care, with full adoption by clinical-practice guidelines globally,” they said. 

Australia’s first PE response team was set up at Westmead Hospital in Sydney in 2018 and has improved PE risk stratification, assessment for RV dysfunction and increased catheter-directed thrombolysis (CDT) use in intermediate/high risk patients, according to haematologist Dr Jennifer Curnow.

In her review of 28 consecutive PERT-managed patients managed by the team in its first year of operation, the findings showed that compared to pre-PERT patients, more PERT patients had saddle/main pulmonary artery PE (82% vs 29%; p< 0.01), intermediate-high risk PE (64% vs 14%, p,0.01) and underwent CDT (74% vs 4%, p< 0.01).

Also, risk stratification was incomplete in pre-PERT patients, with fewer echocardiographic assessment for RV dysfunction (64% vs 100%; p < 0.01).

“Our PERT model of care 12 month data is consistent with international published patient outcomes for mortality, complications and successful reperfusion,” Dr Curnow and colleagues said in a presentation to the ISTH 2020 Congress.

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