From the Guidelines
Yes, a pulmonary embolism (PE) resulting from an acute illness is considered a provoked event. Provoked PEs are those that occur in the presence of temporary or reversible risk factors, which include acute medical illnesses such as pneumonia, heart failure exacerbation, or severe infections 1. This classification is important because it affects treatment decisions, particularly the duration of anticoagulation therapy.
Key Points to Consider
- For provoked PEs, anticoagulation is typically recommended for 3-6 months with medications such as apixaban, rivaroxaban, or warfarin 1.
- After this period, anticoagulation can often be discontinued if the provoking factor has resolved.
- The classification as provoked is based on the understanding that the acute illness creates a temporary hypercoagulable state through mechanisms such as inflammation, immobility, and endothelial damage, which increases the risk of clot formation.
- Once the acute illness resolves, the risk of recurrent PE decreases substantially compared to unprovoked events, which justifies the limited duration of anticoagulation therapy.
Treatment Approach
According to the 2019 ESC guidelines, anticoagulation with a NOAC is preferred over the traditional LMWH-VKA regimen unless the patient has contraindications to this type of drug 1.
Follow-Up
After acute PE, patients should not be lost to follow-up, and regular follow-up examinations are recommended to check for possible signs of VTE recurrence, cancer, or bleeding complications of anticoagulation 1.
From the Research
Definition of Provoked Pulmonary Embolism
A pulmonary embolism (PE) is considered provoked if it is triggered by a specific event or condition, such as surgery, trauma, or acute illness.
Acute Illness as a Provoking Factor
- Acute illness can be a provoking factor for PE, as it can increase the risk of blood clots forming in the veins 2.
- The risk of PE is higher in patients with acute illnesses, such as cancer, due to the increased risk of blood clots 3.
- However, the definition of a provoked PE is not strictly limited to acute illness, and other factors such as surgery, trauma, or immobilization can also be considered provoking factors 4.
Clinical Considerations
- The treatment of PE, regardless of whether it is provoked or unprovoked, typically involves anticoagulation therapy [(5,6)].
- The choice of anticoagulant and the duration of treatment may depend on the underlying cause of the PE, as well as the patient's individual risk factors [(2,6)].
- In patients with acute illness, the risk of recurrent PE and anticoagulant-related bleeding must be carefully balanced 3.