R.E.B.E.L.EM - August 31, 2017
"Clinical Question:
What is the safety and efficacy of rivaroxaban in patients with a range of sPESI scores in comparison to standard treatment with enoxaparin/VKA?...
Authors’ Conclusions:
“The findings support using risk stratification with the simplified PESI score to identify low risk patients with PE.”
Our Conclusions:
In this post hoc analysis, a higher sPESI correlated with a higher rate of adverse events, thereby corroborating previous validation studies. Furthermore, when stratified by sPESI, the safety and efficacy outcomes for patients treated with rivaroxaban versus standard therapy were similar.
Potential impact to Current Practice:
DOACs are a simple, effective, safe, and cost-effective treatment for acute PE. The sPESI is a validated tool for identifying low-risk acute PEs for possible outpatient treatment. However, is it possible to combine these two concepts? Can low-risk PE patients be safely treated by initiating a DOAC in the ED and then discharging the patient to outpatient follow-up? This study provides further support towards the momentum that is already headed in that direction..."