Outpatient management of pulmonary embolism feasible
MedWire News: Study findings suggest that outpatient management of uncomplicated pulmonary embolism, in the absence of other indications for hospital admission, is effective and does not increase the risk for complications.
"Patients diagnosed with pulmonary embolism should be considered for treatment on an outpatient basis, however this practice is not accepted in many centers," say Michael Kovacs (Victoria Hospital, Ontario, Canada) and co-authors.
Previous study findings by the research team support the outpatient management of pulmonary embolism and a large proportion of pulmonary embolism patients are managed entirely as outpatients in Canada.
Kovacs et al performed a retrospective single center cohort study of 639 patients diagnosed with idiopathic or secondary pulmonary embolism between 2003 and 2008. Patients were eligible for outpatient management if they were hemodynamically stable, did not require oxygen therapy or parenteral pain medication, and were not classed as being at high risk for a major hemorrhage.
"These criteria obviously require clinical judgment and we believe that they may be assessed by any practicing clinician familiar with treatment of venous thromboembolism," say the researchers.
In total, 314 (49.1%) of the patients were managed on an outpatient basis and all were followed-up for 3 months. Inpatients were on average 9.5 years older than outpatients.
After 3 months of follow-up, there were three pulmonary embolism thrombosis recurrences and three major hemorrhage events on days 39, 40, and 53 among the patients treated as outpatients. No deaths occurred due to major hemorrhage or pulmonary embolism in this cohort, while nine deaths occurred due to underlying cancer, all after the first 7 days of treatment.
Inpatients were not routinely followed-up by the Thrombosis Unit to determine their major outcome rates, the authors explain. However, they add, given the unexpectedly low rate of thrombotic recurrences and major hemorrhage found among the outpatient cohort, and that it is unlikely that hospital admission would lead to a lower proportion of recurrences or hemorrhagic events, any comparison would be statistically underpowered to show clinically meaningful differences.
The researchers caution that not all patients received the same therapy and that inpatients were significantly older than outpatients. In addition, they note that their center has a dedicated infrastructure for the care of thrombosis patients and that the findings may therefore not be entirely applicable to other centers.
"The cost saving of such a strategy would be at least comparable to that of managing deep vein thrombosis as an outpatient," suggest Kovacs and team in the Journal of Thrombosis and Haemostasis.
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By Ingrid Grasmo