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

Abstract

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.

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

“…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].…”

Hestia criteria can discriminate high- from low-risk patients with pulmonary embolism

“…Two systematic reviews summarised the results of a few small observational studies on outpatient treatment in patients with PE [2,3]. These reviews concluded that although the evidence is not of high quality, it indicates that certain subgroups of patients with PE could be eligible for outpatient treatment.…”

Comparison and combination of a hemodynamics/biomarkers-based model with simplified PESI score for prognostic stratification of acute pulmonary embolism: findings from a real world study

“…10 Both version of PESI score, original and simplified, have been used as prognostic model for identifying low risk patients candidate for home treatment. [11][12][13] Despite this background, literature evidence reporting on which is the best prognosticator for adverse outcome in patients suffering for acute PE in real world lacks. Therefore, the aim of the present study was to compare and combine the predictive values of 2008 European Society of Cardiology prognostic model (ESC) and simplified PESI score (sPESI) as prognosticator for inhospital mortality and fatal and/or major bleedings.…”