Prognostic assessment

Prognostic assessment in patients with acute venous thromboembolism is essential to drive clinical management in terms of hospitalization or home treatment, and revascularization strategies or anticoagulation alone. In these patients, single predictors, combinations of predictors, or prognostic models can be used for prognostic assessment. Overall, the risk for short-term death is about tenfold higher after acute pulmonary embolism than after acute deep vein thrombosis. Localization of thrombosis (proximal or distal) and some clinical features are the main predictors of prognosis in patients with deep vein thrombosis. In patients with pulmonary embolism, prognostic assessment includes the evaluation of clinical features, findings at imaging (computed tomography angiography, echocardiography, and/or ultrasonography of the lower limbs), or biomarkers of right ventricular dysfunction or injury. The presence of shock or sustained hypotension is the main criterion for the identification of high-risk patients. Clinical models with high negative predictive value have been validated to identify patients at low risk for short-term death. Whether the assessment of right ventricular dysfunction in these patients can further improve the negative predictive value of clinical models remains to be defined. Right ventricular dysfunction as assessed by echocardiography or computed tomography angiography as well as right ventricular damage by troponin levels are associated with an about twofold increase in the risk for short-term death in intermediate risk patients. However, prognostic assessment in these patients requires further improvement before it can be used to drive decisions on treatment.