Early discharge and outpatient treatment of patients admitted for acute pulmonary embolism

Moores, Lisa K.; Zamarro, Celia; Gómez, Vicente; Aujesky, Drahomir; García, Leticia; Nieto, Rosa; Yusen, Roger D.; Jimenez, David F.

doi:10.1183/09031936.00124612

Cited by 3 publications

(4 citation statements)

References 7 publications

(6 reference statements)

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“…In France, the mean duration of hospitalization of patients with PE is even longer, around 10 days . Several studies have analyzed the feasibility and safety of outpatient treatment of selected low‐risk patients with PE but, to our knowledge, there were no data available on the benefit/risk ratio of hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Net clinical benefit of hospitalization versus outpatient management of patients with acute pulmonary embolism

Roy

Corsi

Carrier

et al. 2017

Journal of Thrombosis and Haemostasis

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Background The decision to hospitalize or not patients with acute pulmonary embolism (PE) is controversial. Despite the advantages of close monitoring, hospitalization by itself may lead to in-hospital complications and potentially worsen the prognosis of PE patients. Objectives To determine the net clinical benefit of hospitalization vs. outpatient management of normotensive patients with acute pulmonary embolism (PE). Methods Retrospective cohort propensity score analysis (radius marching with replacement). Hemodynamically stable PE patients treated as outpatients or inpatients were matched to balance out differences for 28 patient characteristics and known risk factors for adverse events. The primary outcome was the rate of adverse events at 14 days, including recurrent venous thromboembolism, major bleeding or death. Results Among 1127 eligible patients, 1081 were included in the matched cohort, 576 treated as inpatients and 505 as outpatients. The 14-day rate of adverse events was 13.0% for inpatients and 3.3% for outpatients (adjusted OR, 5.07; 95% CI, 1.68-15.28). The 3-month rate was 21.7% for inpatients and 6.9% for outpatients (OR, 4.90; 95% CI, 2.62-9.17). In the high-risk subgroup (Pulmonary Embolism Severity Index class III-V; n = 597), the 14-day rate of adverse events was 16.5% for hospitalized patients vs. 4.5% for outpatients (OR, 4.16; 95% CI, 1.2-14.35). Conclusion Outpatient treatment of hemodynamically stable PE patients seems to be associated with a lower rate of adverse events than hospitalization and, if confirmed, may be considered as first-line management in patients not requiring specific in-hospital care, regardless of their initial risk stratification, if proper outpatient care can be provided.

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Section: Discussionmentioning

confidence: 99%

Net clinical benefit of hospitalization versus outpatient management of patients with acute pulmonary embolism

Roy

Corsi

Carrier

et al. 2017

Journal of Thrombosis and Haemostasis

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“…The PESI and sPESI consist of objective, easily identifiable clinical parameters that can be quickly obtained immediately on patient presentation. 9 One study even reported that a decrease in PESI scores at the 48-hour interval could significantly identify an additional 8% of patients at low risk of mortality. 9 Finally, low-risk patients as defined by AHA/ESC do not meet the criteria for submassive/intermediate risk.…”

mentioning

confidence: 99%

“…9 One study even reported that a decrease in PESI scores at the 48-hour interval could significantly identify an additional 8% of patients at low risk of mortality. 9 Finally, low-risk patients as defined by AHA/ESC do not meet the criteria for submassive/intermediate risk. 3,6…”

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confidence: 99%

Classification and Stratification of Pulmonary Embolisms

Russell¹,

Keshavamurthy

Saha

2022

Int J Angiol

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Pulmonary embolism remains a leading cause of cardiovascular mortality. Presentation and outcomes are variable among patients and require rapid risk stratification for assessment and prognosis, as well as selection of appropriate treatment. Over the past several decades, several different models and parameters have become available to assess risk and classify pulmonary embolism into different risk categories. Some patients may be candidates for early discharge or complete outpatient treatment, while some may require invasive diagnostics and intensive monitoring. In this review, we summarize contemporary guidelines and methods for classification and risk stratification in an effort to provide tools for physicians to use in their management of patients with acute pulmonary embolisms.

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“…Therefore, cancer-specific PE risk tools have been developed [7,8], but they do not account for UPE. Thus, contemporary clinical data that could fill this evidence gap are much needed to identify patients with cancer-associated PE who can safely be treated as outpatients [17,18].…”

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confidence: 99%

Symptoms, signs, suspicion and setting: a PESI score for cancer-associated pulmonary embolism?

Posch

2017

Eur Respir J

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Early discharge and outpatient treatment of patients admitted for acute pulmonary embolism

Cited by 3 publications

References 7 publications

Net clinical benefit of hospitalization versus outpatient management of patients with acute pulmonary embolism

Net clinical benefit of hospitalization versus outpatient management of patients with acute pulmonary embolism

Classification and Stratification of Pulmonary Embolisms

Symptoms, signs, suspicion and setting: a PESI score for cancer-associated pulmonary embolism?

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