Early discharge of patients with pulmonary embolism: a two-phase observational study

Abstract

The aim of the present study was to assess whether patients with pulmonary embolism (PE) could be managed as outpatients after early discharge from hospital using low molecular weight heparin instead of remaining as in-patients until effective oral anticoagulation was achieved.Phase 1 of the study identified criteria for the safe discharge of selected patients; phase 2 treated a cohort of low-risk patients with PE as outpatients with tinzaparin using existing deep venous thrombosis services.In phase 1, 127 (56.4%) of 225 patients were considered unsuitable for outpatient management. Reasons included: admission for another medical reason; additional monitoring or requirement for oxygen; bleeding disorders; previous PE/further PE while on warfarin; co-existing major deep venous thrombosis; likelihood of poor compliance; significant immobility; and pregnancy. In phase 2, 157 patients with PE received outpatient anticoagulation therapy. There were no deaths, bleeding or recurrent thromboembolic events during acute treatment with low molecular weight heparin. The median (range) length of hospital stay was 1.0 (1-4) day, with a median saving of 5.0 (1-42) bed-days per patient.Patients were highly satisfied with outpatient management; 144 (96.6%) indicated that they would prefer treatment as outpatients for a subsequent pulmonary embolism. Early discharge and outpatient management of pulmonary embolism appears safe and acceptable in selected low-risk patients, and can be implemented using existing outpatient deep venous thrombosis services.

Outpatient treatment of symptomatic pulmonary embolism: A systematic review and meta-analysis

“…The remaining 11 studies were included in our systematic review. Eight were prospective cohort studies [8,[11][12][13][31][32][33][34]] and 3 were randomized controlled trials (RCT's) [16,17,35]. Furthermore, 2 studies did not report outcomes at 3 months and could not be used in our pooled meta-analysis [12,13].…”

“…Eight of the studies exclusively included patients that were treated entirely as outpatients. Two studies included patients that were discharged early [16,32] and 1 study reported early discharge and outpatient groups separately [34]. Early discharge was generally defined as inpatient stay of 1-3 days [16,32].…”

“…Two studies included patients that were discharged early [16,32] and 1 study reported early discharge and outpatient groups separately [34]. Early discharge was generally defined as inpatient stay of 1-3 days [16,32]. Most studies treated patients with intravenous unfractionated heparin or subcutaneous LMWH in combination with a vitamin K antagonist.…”

Outpatient treatment and early discharge of symptomatic pulmonary embolism: a systematic review

“…Short-term outcomes were available for only six studies: no patient died in the first 7-10 days, seven patients had recurrent VTE and two experienced major bleeding [20,22,[29][30][31][32]. Data on the long-term outcome were available for nine out of the 11 studies [9,19,22,27,29,31,32,35,37].…”

“…No RCTs were identified. Seven observational studies had a prospective cohort design [19,20,22,27,31,35,37]. No study fulfilled the criteria required for high quality (table 1).…”