タカダ　タクマ   TAKADA Takuma   髙田　卓磨    所属   医学研究科 医学研究科 (医学部医学科をご参照ください)    職種   非常勤講師
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Selection of Home Treatment and Identification of Low-Risk Patients With Pulmonary Embolism Based on Simplified Pulmonary Embolism Severity Index Score in the Era of Direct Oral Anticoagulants.
掲載誌名	正式名：Journal of the American Heart Association 略　 称：J Am Heart Assoc ISSNコード：20479980/20479980
掲載区分	国外
巻・号・頁	13(19),pp.e034953
著者・共著者	Nishikawa Ryusuke, Yamashita Yugo, Morimoto Takeshi, Kaneda Kazuhisa, Chatani Ryuki, Nishimoto Yuji, Ikeda Nobutaka, Kobayashi Yohei, Ikeda Satoshi, Kim Kitae, Inoko Moriaki, Takase Toru, Tsuji Shuhei, Oi Maki, Takada Takuma, Otsui Kazunori, Sakamoto Jiro, Ogihara Yoshito, Inoue Takeshi, Usami Shunsuke, Chen Po-Min, Togi Kiyonori, Koitabashi Norimichi, Hiramori Seiichi, Doi Kosuke, Mabuchi Hiroshi, Tsuyuki Yoshiaki, Murata Koichiro, Takabayashi Kensuke, Nakai Hisato, Sueta Daisuke, Shioyama Wataru, Dohke Tomohiro, Ono Koh, Kimura Takeshi,
発行年月	2024/10
概要	BACKGROUND:The simplified Pulmonary Embolism Severity Index (sPESI) score could help identify low-risk patients with pulmonary embolism for home treatment. However, the application of the sPESI score and selection for home treatment have not been fully evaluated in the direct oral anticoagulants era.METHODS AND RESULTS:The COMMAND VTE (Contemporary Management and Outcomes in Patients With Venous Thromboembolism) Registry-2 is a multicenter registry enrolling consecutive patients with acute symptomatic venous thromboembolism. The current study population consists of 2496 patients with hemodynamically stable pulmonary embolism (2100 patients [84%] treated with direct oral anticoagulants), who were divided into 2 groups: sPESI scores of 0 and ≥1. We investigated the 30-day mortality, home treatment prevalence, and factors predisposing to home treatment using the Kaplan-Meier method and logistic regression model. Patients with an sPESI score of 0 accounted for 612 (25%) patients, and only 17% among 532 patients with out-of-hospital pulmonary embolism were treated at home. The cumulative 30-day mortality was lower in patients with an sPESI score of 0 than the score of ≥1 (0% and 4.8%, log-rank P<0.001). There was no patient with 30-day mortality with an sPESI score of 0. Independent factors for home treatment among out-of-hospital pulmonary embolism patients with an sPESI score of 0 were no transient risk factors for venous thromboembolism, no cardiac biomarker elevation, and direct oral anticoagulants use in the acute phase.CONCLUSIONS:The 30-day mortality rate was notably low in an sPESI score of 0. Nevertheless, only a minority of patients with an sPESI score of 0 were treated at home between 2015 and 2020 after the introduction of direct oral anticoagulants for venous thromboembolismin Japan.
DOI	10.1161/JAHA.124.034953
PMID	39344589