Home treatment in pulmonary embolism

Otero, Remedios; Uresandi, Fernando; Jiménez, David; Cabezudo, Miguel Ángel; Oribe, Mikel; Nauffal, Dolores; Conget, F.; Rodríguez, C.; Cayuela, Aurelio

doi:10.1016/j.thromres.2009.09.026

Cited by 118 publications

(98 citation statements)

References 25 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%

“…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].…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…Ideally, these rates should be compared to low-risk patients that were hospitalized for the initial management of their acute PE. Unfortunately, only two RCTs compared these risks in patients with acute PE managed as in or out-patients [16,17]. Both RCTs used a risk stratification model (PESI and Uresandi) to identify low risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…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]. However the quality of the included studies was low and subsequent and recent larger observational studies and randomized control trials were not included [8,11,16,17]. More recently, two additional systematic reviews of the outpatient management of acute symptomatic PE were published [18,19].…”

Section: Introductionmentioning

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%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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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Treatment of Venous Thromboembolism

Wells

Forgie

Rodger

2014

JAMA

190

134

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The mainstay of VTE treatment is anticoagulation, while interventions such as thrombolysis and inferior vena cava filters are reserved for limited circumstances. Multiple therapeutic modes and options exist for VTE treatment with small but nonetheless important differential effects to consider. Anticoagulants will probably always increase bleeding risk, necessitating tailored treatment strategies that must incorporate etiology, risk, benefit, cost, and patient preference. Although great progress has been made, further study to understand individual patient risks is needed to make ideal treatment decisions.

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Early discharge hospital at home

Gonçalves‐Bradley

Iliffe

Doll³

et al. 2017

Cochrane Database of Systematic Reviews

169

248

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Analysis 2.1. Comparison 2 Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 1 Mortality at 3-6 months-older people with a mix of conditions.. .. .. .. .. .. Analysis 2.2. Comparison 2 Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 2 Mortality-chronic obstructive pulmonary disease.. .. .. .. .. .. .. .. .. Analysis 2.3. Comparison 2 Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 3 Hospital readmission at 3 months-older people with a mix of conditions.. .. .. .. .. Analysis 2.4. Comparison 2 Early discharge hospital at home versus inpatient care for older people with a mix of conditions,

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Home treatment in pulmonary embolism

Cited by 118 publications

References 25 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

Treatment of Venous Thromboembolism

Early discharge hospital at home

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