Emergency Department Discharge of Pulmonary Embolus Patients

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
W Frank PeacockAdam J Singer

Abstract

Hospitalization for low-risk pulmonary embolism (PE) is common, expensive, and of questionable benefit. The objective was to determine if low-risk PE patients discharged from the emergency department (ED) on rivaroxaban require fewer hospital days compared to standard of care (SOC). Multicenter, open-label randomized trial in low-risk PE defined by Hestia criteria. Adult subjects were randomized to early ED discharge on rivaroxaban or SOC. Primary outcome was total number of initial hospital hours, plus hours of hospitalization for bleeding or venous thromboembolism (VTE), 30 days after randomization. A 90-day composite safety endpoint was defined as major bleeding, clinically relevant nonmajor bleeding, and mortality. Of 114 randomized subjects, 51 were early discharge and 63 were SOC. Of 112 (98.2%) receiving at least one dose of study drug, 99 (86.8%) completed the study. Initial hospital LOS was 4.8 hours versus 33.6 hours, with a mean difference of -28.8 hours (95% confidence interval [CI] = -42.55 to -15.12 hours) for early discharge versus SOC, respectively. At 90 days, mean total hospital days (for any reason) were less for early discharge than SOC, 19.2 hours versus 43.2 hours, with a mean difference of 26.4 hours (95%...Continue Reading

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Nov 1, 2016·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Adam J SingerW Frank Peacock

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Citations

Mar 10, 2019·Journal of Thrombosis and Haemostasis : JTH·W Frank Peacock, Adam J Singer
Mar 29, 2019·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Alexander T Cohen, Rupert Bauersachs
Mar 7, 2019·The Cochrane Database of Systematic Reviews·Hugo Hb YooCathryn Broderick
Apr 28, 2020·American Journal of Respiratory and Critical Care Medicine·Gregory Piazza
Aug 12, 2020·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Brandon C MaughanJeffrey A Kline
May 21, 2020·BMJ : British Medical Journal·Terry McCormackUNKNOWN Guideline Committee
Aug 8, 2020·BMJ : British Medical Journal·Lisa DuffettMelissa A Forgie
Dec 2, 2020·Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis·Raein GhazvinianAnders Gottsäter
Nov 29, 2020·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Lauren M WestaferPeter K Lindenauer
Jan 29, 2021·Cardiovascular Therapeutics·Muhammad AjmalTom Lassar
Jun 21, 2020·Revista clínica española·J Montes Santiago, A B Argibay Filgueira
Apr 13, 2021·Postgraduate Medicine·William B Stubblefield, Jeffrey A Kline
Oct 13, 2020·The American Journal of Emergency Medicine·Anne HuylerAndrew D Perron
Oct 31, 2020·Journal of the American College of Cardiology·Elizabeth Renner, Geoffrey D Barnes

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Clinical Trials Mentioned

NCT02584660

Software Mentioned

PE
MERCURY

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