Practice patterns of pulmonologists regarding extended anticoagulation therapy after pulmonary embolism

BACKGROUND/OBJECTIVES: Determining the optimal duration of anticoagulation after pulmonary embolism remains a clinical challenge. Although guidelines recommend individualized decisions based on recurrence and bleeding risk, no universally accepted algorithm exists. This study aimed to evaluate pulmonologists' practice patterns regarding extended anticoagulation in Türkiye. METHODS: A 14 item questionnaire based on current international guidelines on pulmonary embolism management was distributed to pulmonology specialists. The survey collected information on physicians' demographics, preferred duration of extended anticoagulation therapy, anticoagulant choice, use of imaging or laboratory tests when determining treatment duration, and reliance on clinical guidelines. Associations between professional characteristics and clinical decision-making patterns were analyzed using chi-square tests and Fisher's exact tests. RESULTS: A total of 159 pulmonologists participated in the study. Most physicians (76.1%) preferred extending anticoagulation therapy for an additional three months, and 88.1% reported using bleeding risk assessment tools when determining treatment duration. The most common reasons for extended therapy were high thrombus burden (51.6%), transient or reversible venous thromboembolism risk factors (50.3%), prior thrombolytic therapy (47.2%), and persistent deep vein thrombosis (45.3%). Direct oral anticoagulants were the most frequently preferred agents, with rivaroxaban selected by 74.8% of respondents. More than half of respondents routinely requested imaging or laboratory tests at the third month, most commonly lower extremity venous doppler ultrasonography (61.6%), echocardiography (56.0%), and computed tomography pulmonary angiography (52.2%). Additionally, 67.9% of participants reported that current clinical guidelines were partially sufficient for guiding treatment decisions. CONCLUSIONS: Considerable variability exists in self-reported practice patterns regarding extended anticoagulation after pulmonary embolism among the participating pulmonologists. These findings suggest a perceived need for clearer clinical guidance and more practical integrated risk assessment tools to support treatment decisions.