Efficacy and safety of outpatient treatment with direct oral anticoagulation in pulmonary embolism

Abstract

Anticoagulant treatment of acute pulmonary embolism (PE) has traditionally been hospital-based. The lesser need for monitoring with the increasingly used direct acting oral anticoagulants (DOAC) in comparison to warfarin potentially facilitates outpatient treatment of PE with these drugs. This study aimed to evaluate efficacy and safety of outpatient treatment of PE with DOAC. We extracted data from the Swedish quality registry for patients on oral anticoagulation (AuriculA) for all 245 patients in the southernmost hospital region in Sweden (1.3 million inhabitants) selected for outpatient treatment with of PE with DOAC during 2013–2015. Comorbidites, risk factors, and simplified pulmonary embolism severity index were evaluated at baseline, and death, recurrent venous thromboembolism (VTE), and bleeding was recorded during 6 months of follow-up. Outpatient treatment was defined as discharge from the emergency department within 24 h. During 6 months of follow-up, one patient died during DOAC therapy, the cause of death was unrelated to VTE. No VTE recurrences occured, whereas, one patient experienced major bleeding, and five patients experienced minor bleedings. Outpatient treatment of PE with DOAC is efficient and safe in selected patients.

Outpatient treatment in low-risk pulmonary embolism patients receiving direct acting oral anticoagulants is associated with cost savings.

“…Furthermore, as both the in-or outpatient treatment variable and the sPESI group variable were associated with total cost in multivariate analysis, it was of special interest to evaluate sPESI groups 0 and 1 separately documenting cost savings with outpatient treatment both in patients with sPESI 0 and sPESI 1 [23]. Our study therefore corroborates the results of Dasta et al [25], showing that LOS is a major cost driver in PE and that any reduction in LOS may translate into relatively important cost savings.…”

“…2). A previous study has documented that outpatient treatment based on the CGO-algorithm is safe and effective, although 48% of the patients were high risk PE patients according to the most validated risk stratification tool (Simplified Pulmonary Embolism Severity Index, sPESI ≥ 1) [23].…”

“…2), i.e. The treatment had been started already during an ED visit not exceeding 24 hours [23], whereas the remaining 287 (52%) patients had been treated on a hospital basis.…”

“…Symptoms and signs at presentation were retrospectively retreived from files and imaging databases, and the sPESI risk stratification score [31,23] was calculated. Furthermore, we retrospectively assessed all other hospitalizations and scheduled and unscheduled appointments with nurses and doctors from six months before to six months after the acute PE episode, together with mortality, recurrent VTE episodes, and bleeding complications.…”

“…As the need for monintoring of DOAC treatment is less than for warfarin [21,22], outpatient treatment of VTE is potentially facilitated by DOAC use. We have recently demonstrated that selected low-risk PE patients in our institution could be safely treated with DOAC on an outpatient basis [23].…”