Outpatient care can be used in low-risk patients with PE

January 01, 0001

Outpatient care can be used in low-risk patients with PE

Although practice guidelines recommend outpatient care for selected, haemodynamically stable patients with pulmonary embolism, most treatment is presently inpatient based. The international researchers aimed to assess non-inferiority of outpatient care compared with inpatient care. They undertook an open-label, randomised non-inferiority trial at 19 emergency departments in Switzerland, France, Belgium, and the USA. They randomly assigned patients with acute, symptomatic pulmonary embolism and a low risk of death (pulmonary embolism severity index risk classes I or II) with a computer- generated randomisation sequence (blocks of 2—4) in a 1:1 ratio to initial outpatient (ie, discharged from hospital less than or equal to 24 h after randomisation) or inpatient treatment with subcutaneous enoxaparin (greater than or equal to 5 days) followed by oral anticoagulation (greater than or equal to 90 days). Between February, 2007, and June, 2010, they enrolled 344 eligible patients.

In the primary analysis, 0.6% of outpatients developed recurrent venous thromboembolism within 90 days compared with none of inpatients. 0.6% of patients in each treatment group died within 90 days and 1.2% of outpatients and no inpatients had major bleeding within 14 days. By 90 days, 1.8% outpatients but no inpatients had developed major bleeding. Mean length of stay was 0.5 days for outpatients and 3.9 days for inpatients.

The researchers concluded: "In selected low-risk patients with pulmonary embolism, outpatient care can safely and effectively be used in place of inpatient care."

We have known this for DVT, but now PE. This can be very cost-effective, as well as convenient.

For the full abstract, click here.

The Lancet 378(9785):41-48, 2 July 2011 © 2011 Elsevier Limited
Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial. Drahomir Aujesky, Pierre-Marie Roy, Franck Verschuren et al. Correspondence to Drahomir Aujesky: [email protected]

Category: R. Respiratory. Keywords: outpatient, inpatient, treatment, acute pulmonary embolism, international open-label randomised non-inferiority trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 22 July 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.