Home therapy for deep vein thrombosis and pulmonary embolism in cancer patients

Siragusa, Sergio; Arcara, Carlo; Malato, Alessandra; Anastasio, Raffaela; Valerio, Maria Rosaria; Fulfaro, Fabio; Coco, Lucio Lo; Grimaudo, Stefania; Bajardi, G; Abbadessa, Vincenzo; Gebbia, Nicola

doi:10.1093/annonc/mdi923

Cited by 93 publications

(79 citation statements)

References 13 publications

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“…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].…”

Section: Resultsmentioning

confidence: 99%

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

Piran

Gal

Wells

et al. 2013

Thrombosis Research

136

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Background: Patients with acute deep vein thrombus (DVT) can safely be treated as outpatients. However the role of outpatient treatment in patients diagnosed with a pulmonary embolism (PE) is controversial. We sought to determine the safety of outpatient management of patients with acute symptomatic PE. Materials and Methods: A systematic literature search strategy was conducted using MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and all EBM Reviews. Pooled proportions for the different outcomes were calculated. Results: A total of 1258 patients were included in the systematic review. The rate of recurrent venous thromboembolism (VTE) in patients with PE managed as outpatients was 1.47% (95% CI: 0.47 to 3.0%; I 2 : 65.4%) during the 3 month follow-up period. The rate of fatal PE was 0.47% (95% CI: 0.16 to 1.0%; I 2 : 0%). The rates of major bleeding and fatal intracranial hemorrhage were 0.81% (95% CI: 0.37 to 1.42%; I 2 : 0%) and 0.29% (95% CI: 0.06 to 0.68%; I 2 : 0%), respectively. The overall 3 month mortality rate was 1.58% (95% CI: 0.71 to 2.80%; I 2 : 45%). The event rates were similar if employing risk stratification models versus using clinical gestalt to select appropriate patients for outpatient management. Conclusions: Independent of the risk stratification methods used, the rate of adverse events associated with outpatient PE treatment seems low. Based on our systematic review and pooled meta-analysis, low-risk patients with acute PE can safely be treated as outpatients if home circumstances are adequate.

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Section: Resultsmentioning

confidence: 99%

“…Several studies have reported that outpatient management or early discharge of patients with acute PE is safe and effective [8][9][10][11][12][13]. Two systematic reviews suggested that patients with acute PE treated as outpatients had low incidences of major bleeding, recurrent venous thromboembolism (VTE), and mortality [14,15].…”

Section: Introductionmentioning

confidence: 99%

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

Piran

Gal

Wells

et al. 2013

Thrombosis Research

136

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“…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).…”

Section: Resultsmentioning

confidence: 99%

“…No study fulfilled the criteria required for high quality (table 1). A single study, which only enrolled patients with cancer, was of medium quality [35].…”

Section: Resultsmentioning

confidence: 99%

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

Squizzato¹,

Galli²,

Dentali³

et al. 2009

European Respiratory Journal

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The published literature regarding the safety of outpatient treatment of symptomatic pulmonary embolism (PE) was systematically summarised.A literature search was performed using the PubMed and EMBASE databases. Studies in which patients had symptomatic PE and the antithrombotic treatment was administered completely at home or the patients were discharged early were selected. A scoring system was used to divide studies into three quality categories. Short-and long-term outcomes were extracted: all-cause mortality, death from PE or from major haemorrhage, recurrent venous thromboembolism, and major bleeding.Eleven observational studies were included. No randomised controlled studies were identified. No study fulfilled the criteria for high quality. A total of 928 patients with symptomatic PE were treated completely as outpatients or discharged early; haemodynamic instability and hypoxia were the main exclusion criteria. No patient died during the first 7 days of antithrombotic treatment.Outpatient treatment of symptomatic PE is not based on high-quality evidence. Although the published data suggest that certain subgroups of haemodynamically and respiratorily stable patients may be safely treated at home when a well-defined management programme is applied, further studies are warranted for a short-term prognostic risk stratification of this PE subgroup.

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Anticoagulation for the initial treatment of venous thromboembolism in patients with cancer

Akl¹,

Rohilla²,

Barba³

et al. 2008

Cochrane Database of Systematic Reviews

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Home therapy for deep vein thrombosis and pulmonary embolism in cancer patients

Cited by 93 publications

References 13 publications

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

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

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

Anticoagulation for the initial treatment of venous thromboembolism in patients with cancer

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