Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study

Abstract

Summary. Background: Traditionally, patients with pulmonary embolism (PE) are initially treated in the hospital with low molecular weight heparin (LMWH). The results of a few small non-randomized studies suggest that, in selected patients with proven PE, outpatient treatment is potentially feasible and safe. Objective: To evaluate the efficacy and safety of outpatient treatment according to predefined criteria in patients with acute PE. Patients and Methods: A prospective cohort study of patients with objectively proven acute PE was conducted in 12 hospitals in The Netherlands between 2008 and 2010. Patients with acute PE were triaged with the predefined criteria for eligibility for outpatient treatment, with LMWH (nadroparin) followed by vitamin K antagonists. All patients eligible for outpatient treatment were sent home either immediately or within 24 h after PE was objectively diagnosed. Outpatient treatment was evaluated with respect to recurrent venous thromboembolism (VTE), including PE or deep vein thrombosis (DVT), major hemorrhage and total mortality during 3 months of follow-up. Results: Of 297 included patients, who all completed the follow-up, six (2.0%; 95% confidence interval

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].…”

“…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].…”

“…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].…”

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

“…We have recently published the results of a large prospective study in which clinical signs and symptoms were used to select patients with PE for outpatient treatment [6]. The Hestia criteria consist of 11 clinical criteria that can be used as a bedside test.…”

Cost of Treating Venous Thromboembolism With Heparin and Warfarin Versus Home Treatment With Rivaroxaban

“…While DVT has been treated as an outpatient for many years, recently developed risk stratification tools have been validated to select patients with PE who have a low risk of shortterm complications. [1][2][3][4][5][6][7] In particular, the Hestia criteria identifies a subgroup of PE patients who have a 1.0% mortality rate as outpatients over 3 months and a low rate of short-term complications requiring rehospitalization. 8 In this article, we assumed that many patients with DVT have undiagnosed PE and therefore must undergo the same risk stratification as patients with documented PE.…”