Date of Award

5-2020

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

Daryl Sieg

Keywords

anticoagulation, unprovoked pulmonary embolism, warfarin, direct oral anticoagulants, aspirin, anticoagulation duration

Abstract

The purpose of this research was to identify the best course of action in response to a diagnosis of unprovoked pulmonary embolism. This meta-review was compiled through a systematic query of four databases: Pubmed, Embase, CINAHL Complete, and Cochrane Review. The search was limited to peer-reviewed systematic reviews published between October 1, 2014, and October 1, 2019. 17 reviews were included in this research which evaluated relevant trials of FDA-approved anticoagulation therapies. Key search terms that were used included anticoagulation, unprovoked, and duration. MeSH terms applied on PubMed included anticoagulation, therapy, and duration. The evidence demonstrates non-inferiority status of new direct oral anticoagulants (DOAC) when indirectly compared to conventional warfarin therapy. Aspirin was also found effective in mitigating the risk of recurrence, but to a lesser extent than both DOAC agents and warfarin. Current research demonstrates all DOAC agents as potential alternatives to conventional therapy, but attention to the comorbidities of each individual patient may direct providers to find advantage with one therapy over another. The research, thus far, has not been able to identify a universally safe and an effective agent for all patients experiencing a first-time unprovoked pulmonary embolism. Additional research is needed to evaluate the duration of therapy and generate more robust data to recommend a specific therapeutic agent for all patients.

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