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Editorial - October 2021

ESC Working Group on Pulmonary Circulation & Right Ventricular Function



Dear Members,

Early hospital discharge after the diagnosis of acute pulmonary embolism (PE) new data.

Current guidelines suggest home treatment in patients with low risk acute pulmonary embolism (PE), when home circumstances are adequate. However, current evidence is mainly based on cohort studies using different sets of eligibility criteria.  The Hospitalization or Out-treatment ManagEment of Patients With Pulmonary Embolism (HOME-PE) randomized trial authored by Dr. Roy and colleagues compared the utilisation of the Hestia criteria to that of the simplified Pulmonary Embolism Severity Index criteria to identify low-risk PE patients. The main take-home message: both strategies, if applied to a suitable environment, can be safely used to support early discharge after acute PE diagnosis.

The second study, an individual patient level meta-analysis authored by Dr. Becattini and colleagues, showed that the risk of complications among patients with right ventricular dysfunction may still be remarkable, even if those are classified at a low-risk of complications according to clinical scores. Considering right ventricular function on top of clinical scores would, therefore, reduce the number of candidates to early discharge to some extent, but maximise safety.    

This data integrates evidence from prior trials and management studies investigating the safety of different strategies to identify low-risk patients who could be considered for early hospital discharge. These included, among others, the OTPE, HoT-PE, Hestia, and eSPEED studies.

Without forgetting to translate the available individual-level risk estimates to a population-level context, we own now enough information to optimise early PE management and adapt available scientific evidence to patient values, as well as to specific settings, logistics, geographies, and institutions.

Home PE treatment role of RVD in PE risk stratification home and other hot topic in venous thromboembolism were deeply and intensively discussed during the 5th Euro Spring School on Venous Thromboembolism endorsed by our Woring Group. This major bi-annual international event on the science and practice of venous thromboembolism (VTE) due to COVID 19 pandemic was postponed and took place in late September on Crete, Greece. VTE School was very sucesssfull and included the most relevant and contemporary scientific topics related to thrombosis and VTE, and promoted active interactions and scientific networking Europe. We were happy to participate in this high quality scientific event. Congratulatuons.   

 

On behalf of the Working Group nucleus,

Piotr Pruszczyk  Chairperson 2020-2022

George Giannakoulas Chairperson-Elect 2020-2022

And Stefano Barco Communication Coordinator 2020-2022

 

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