Outpatient management of pulmonary embolism

Thrombosis Research
P-M RoyO Sanchez

Abstract

Despite clear potential benefits of outpatient care, most patients suffering from pulmonary embolism (PE) are currently hospitalized due to the fear of possible adverse events. Nevertheless, some teams have increased or envisage to increase outpatient treatment or early discharge. We performed a narrative systematic review of studies published on this topic. We identified three meta-analyses and 23 studies, which involved 3671 patients managed at home (n=3036) or discharged early (n=535). Two main different approaches were applied to select patients eligible for outpatient in recent prospective studies, one based on a list of pragmatic criteria as the HESTIA rule, the other adding severity criteria (i.e. risk of death) as the Pulmonary Embolism Severity Criteria (PESI) or simplified PESI. In all these studies, a specific follow-up was performed for patients managed at home involving a dedicated team. The overall early (i.e. between 1 to 3 months) complication rate was low, <2% for thromboembolic recurrences or major bleedings and <3% for deaths with no evidence in favour of one selection strategy or another. Outpatient management appears to be feasible and safe for many patients with PE. In the coming years, outpatient treatmen...Continue Reading

Citations

Nov 14, 2018·Annals of Internal Medicine·David R VinsonUNKNOWN eSPEED Investigators of the KP CREST Network
Feb 7, 2019·European Heart Journal·Adam Torbicki
Mar 7, 2019·The Cochrane Database of Systematic Reviews·Hugo Hb YooCathryn Broderick
Mar 10, 2019·Journal of Thrombosis and Haemostasis : JTH·W Frank Peacock, Adam J Singer
Jun 20, 2019·The Medical Journal of Australia·Paul C KrugerGraeme J Hankey
Jul 9, 2020·Clinical and Experimental Emergency Medicine·Kajal PatelAnne-Maree Kelly
Nov 16, 2018·The Western Journal of Emergency Medicine·Laura E SimonDavid R Vinson
Jul 16, 2019·European Heart Journal·Olivier Sanchez, Marc Humbert
Dec 2, 2020·Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis·Raein GhazvinianAnders Gottsäter
Feb 6, 2021·The European Respiratory Journal·Kevin SolversonJason Weatherald
Oct 16, 2019·Revue des maladies respiratoires·L BertolettiUNKNOWN Recommandations de bonne pratique pour la prise en charge de la MVTE
Jun 21, 2020·Revista clínica española·J Montes Santiago, A B Argibay Filgueira
Oct 13, 2020·The American Journal of Emergency Medicine·Anne HuylerAndrew D Perron

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