To examine the association between individualized anticoagulation management guided by dynamic Caprini scoring and in-hospital clinical outcomes in patients with pulmonary embolism (PE).

This was a retrospective cohort study. A total of 179 hospitalized patients with PE (Caprini score ≥5 on admission) admitted to our hospital between May 2022 and May 2024 were analyzed, including 102 men and 77 women. According to the anticoagulation management strategy used during hospitalization, patients were divided into an observation group (n=87, dynamic Caprini monitoring combined with individualized anticoagulation) and a control group (n=92, routine anticoagulation management). The study endpoint was restricted to the in-hospital period. The incidence of new-onset PE and deep venous thrombosis (DVT), coagulation indices, D-dimer, arterial blood gas parameters, echocardiographically estimated pulmonary arterial systolic pressure, bleeding events and all-cause mortality were compared between the two groups. Multivariable logistic regression and inverse probability of treatment weighting (IPTW) were used to control for confounding.

Baseline characteristics were comparable between the two groups (all P>0.05). The incidence of new-onset PE was lower in the observation group than in the control group [3.45%(3/87) vs. 13.04% (12/92); χ²=4.185, P=0.041], as were the incidences of new-onset DVT (6.90% vs. 17.39%, P=0.040) and the repeat CTPA positivity rate (3.45% vs. 14.13%, P=0.017). After treatment, D-dimer and fibrinogen were lower, PaO₂ and the oxygenation index were higher, and pulmonary arterial systolic pressure was lower in the observation group (all P<0.001). PT, APTT and INR also differed significantly between groups, with lower values in the observation group that remained within or close to the normal reference range. No significant differences were found in bleeding events (4.60% vs. 3.26%, P=0.715), in-hospital all-cause mortality (1.15% vs. 5.43%, P=0.212) or the overall response rate (87.37% vs. 81.52%, P=0.05). Multivariable logistic regression and IPTW-weighted analyses were consistent in direction with the primary analysis.

This retrospective study suggests that individualized anticoagulation management guided by dynamic Caprini monitoring is associated with a lower incidence of in-hospital thromboembolic events and with improvement in multiple clinical indicators, without an increase in bleeding risk. Given the retrospective design, these findings are associative rather than causal and require confirmation in prospective studies.