Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2023 Jun;123(6):613-626.
doi: 10.1055/a-2031-3859. Epub 2023 Feb 9.

Contemporary Management and Clinical Course of Acute Pulmonary Embolism: The COPE Study

Cecilia Becattini  1 , Giancarlo Agnelli  1 , Aldo P Maggioni  2 , Francesco Dentali  3 , Andrea Fabbri  4 , Iolanda Enea  5 , Fulvio Pomero  6 , Maria Pia Ruggieri  7 , Andrea di Lenarda  8 , Ludovica Anna Cimini  1 , Giuseppe Pepe  9 , Susanna Cozzio  10 , Donata Lucci  2 , Michele M Gulizia  2   11 ; COPE Investigators
Affiliations
Multicenter Study

Contemporary Management and Clinical Course of Acute Pulmonary Embolism: The COPE Study

Cecilia Becattini et al. Thromb Haemost. 2023 Jun.

Abstract

Background: New diagnosis, risk stratification, and treatment strategies became recently available for patients with acute pulmonary embolism (PE) leading to changes in clinical practice and potentially influencing short-term patients' outcomes.

Research question: The COntemporary management of PE (COPE) study is aimed at assessing the contemporary clinical management and outcomes in patients with acute symptomatic PE.

Study design and methods: Prospective, noninterventional, multicenter study. The co-primary study outcomes, in-hospital and 30-day death, were reported overall and by risk categories according to the European Society of Cardiology (ESC) and American Heart Association guidelines.

Results: Among 5,213 study patients, PE was confirmed by computed tomography in 96.3%. In-hospital, 289 patients underwent reperfusion (5.5%), 92.1% received parenteral anticoagulants; at discharge, 75.6% received direct oral anticoagulants and 6.7% vitamin K antagonists. In-hospital and 30-day mortalities were 3.4 and 4.8%, respectively. In-hospital death occurred in 20.3% high-risk patients (n = 177), in 4.0% intermediate-risk patients (n = 3,281), and in 0.5% low-risk patients (n = 1,702) according to ESC guidelines. Further stratification in intermediate-high and intermediate-low risk patients did not reach statistical significance, but intermediate-risk patients with sPESI > 0 alone had lower mortality compared to those with one or both among right ventricular dilation at echocardiography or increased troponin. Death or clinical deterioration occurred in 1.5, 5.0, and 9.4% of patients at low, intermediate-low, and intermediate-high risk for death according to ESC guidelines.

Conclusion: For the majority of patients with PE, contemporary initial management includes risk stratification and treatment with direct oral anticoagulants. In-hospital mortality remains high in intermediate and high-risk patients calling for and informing research focused on its reduction.

Trial registration number: NCT03631810.

PubMed Disclaimer

Conflict of interest statement

C.B. reports lecture fees and consultancies from Bayer, Bristol Myers Squibb, Pfizer, and Daiichi Sankyo; G.A. reports lecture fees and consultancies from Bayer, Bristol Myers Squibb, and Pfizer; A.P.M., D.L., and M.M.G. declare payments made to their institution from Daiichi Sankyo; F.D. reports lecture fees from Bayer, Bristol Myers Squibb, Pfizer, and Daiichi Sankyo; A.F., I.E., F.P., M.P.R., A.D.L., L.A.C., G.P., and S.C. reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Figures

Fig. 1
Fig. 1
Cause of death during the hospital stay and at 30 days
Fig. 2
Fig. 2
Kaplan–Meier curve for time to all-cause death: in the overall study population ( A ); by category of risk according to ESC guidelines 2014 ( B ); and with further categorization of intermediate-risk patients ( C ).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Barco S, Mahmoudpour S H, Valerio L. Trends in mortality related to pulmonary embolism in the European Region, 2000-15: analysis of vital registration data from the WHO Mortality Database. Lancet Respir Med. 2020;8(03):277–287. - PubMed
    1. Bikdeli B, Wang Y, Jimenez D. Pulmonary embolism hospitalization, readmission, and mortality rates in US older adults, 1999-2015. JAMA. 2019;322(06):574–576. - PMC - PubMed
    1. RIETE Investigators . Jiménez D, de Miguel-Díez J, Guijarro R. Trends in the management and outcomes of acute pulmonary embolism: analysis from the RIETE registry. J Am Coll Cardiol. 2016;67(02):162–170. - PubMed
    1. Dentali F, Di Micco G, Giorgi Pierfranceschi M. Rate and duration of hospitalization for deep vein thrombosis and pulmonary embolism in real-world clinical practice. Ann Med. 2015;47(07):546–554. - PubMed
    1. Konstantinides S V, Barco S, Lankeit M, Meyer G. Management of pulmonary embolism: an update. J Am Coll Cardiol. 2016;67(08):976–990. - PubMed

Publication types

Associated data

Grants and funding

Funding The study was supported by an unrestricted grant from Daiichi Sankyo Europe and Daiichi Sankyo Italy.