#EMconf: Outpatient treatment for PE

Clinical Question: Is expedited outpatient treatment of low risk pulmonary embolism safe?

Conclusion: Early outpatient treatment of patients with low-risk PEs may be safe in a very select patient population using a well-defined, well-validated method of identifying low-risk patients. Patients must have the ability to comply with therapy, access to reliable and close follow-up, and adequate teaching on outpatient therapy prior to discharge.

Article #1:   
• Purpose: To evaluate safety and efficacy of early discharge vs. standard hospitalization in acute, symptomatic PE
• Design:
       Multicenter, prospective, randomized control trial with 132 pts w/ acute low-risk symptomatic PE
       Treatment = LMWH; bridged to acenocoumarol (Vit K antagonist)
       Early discharge defined as 3rd day after diagnosis (or 5th day if no echo performed)  

• Primary Outcome: Symptomatic, recurrent VTE or death attributable to PE < 3 months
• Results: No statistically significant differences; but study stopped early due to unexpectedly high mortality rate in early discharge group

Article #2:  
• Purpose: Assess safety, efficacy and efficiency of outpatient vs. inpatient management of acute, symptomatic, low-risk PE
• Design:
         Multicenter, open-label, randomized, non-inferiority control trial
         Treatment: enoxaparin (>5 days) followed by oral anticoagulation (Vit K antagonists recommended)
         Early discharged defined as < 24h from randomization
         344 pts w/ low risk PE per PE severity index score 

• Primary Outcome: recurrent, symptomatic VTE w/in 90 days
• Results: no statistically significant difference in recurrent VTE rate at 90 days 

Article #1: Otero, R, Uresandi, F, Jimenez, D et al. Home treatment in pulmonary embolism. Thromb Res. 2010; 126: e1-e5

Article #2: Aujesky D, Roy PM, Verschuren F, et al. Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial. Lancet. 2011;378:41-48