Pulmonary Embolism With Low Mortality Risk Treated in Outpatient Setting

Certain patients with acute pulmonary embolism (PE) who were considered to have low mortality risk were treated successfully as outpatients, according to study results published in Chest.¹

Acute PE is the third leading cause of cardiovascular death in the United States, with 90-day mortality as high as 17%. As a result, PE treatment usually includes hospitalization for all patients. However, a previously reported retrospective analysis suggested that treatment on an outpatient basis is feasible in select patients with PE.²

Joseph Bledsoe, MD, of Stanford University Department of Emergency Medicine, Salt Lake City, Utah, and colleagues performed a prospective cohort, single-arm management trial (ClinicalTrials.gov Identifier: NCT02355548), between January 2013 and October 2016 in 5 emergency departments. 

They enrolled 200 consecutive adults diagnosed with objectively confirmed acute PE who were assessed to have a low risk for mortality using PE Severity Index <86, echocardiography, and whole-leg compression ultrasound.

The primary intervention was observation in the emergency department or the hospital for more than 12 but fewer than 24 hours, followed by outpatient management with therapeutic anticoagulation approved by the US Food and Drug Administration. The primary outcome was the 90-day composite rate of all-cause mortality, recurrent symptomatic venous thromboembolism, and major bleeding.

One out of 200 patients met the composite outcome, for a 90-day composite rate of 0.5%. None of the patients had recurrent venous thromboembolisms or died during the 90-day follow-up period, but a major bleeding episode occurred in 1 patient. Patients reported a high level of satisfaction with their care, and 91% indicated that they would choose outpatient management again if given the choice.

The authors advised that the study results should be viewed with caution because of the small sample size relative to the end point and generalizability regarding availability of emergent echocardiography. 

References

1. Bledsoe J, Woller S, Stevens S, et al. Management of low-risk pulmonary embolism (LoPE) patients without hospitalization: the LoPE prospective management study [published online February 1, 2018]. Chest. doi:10.1016/j.chest.2018.01.035

2. Stein PD, Matta F, Hughes PG, et al. Home treatment of pulmonary embolism in the era of novel oral anticoagulants. Am J Med. 2016;129(9):974-977.

This article originally appeared on Pulmonology Advisor