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Early discharge of patients with pulmonary embolism: a two-phase observational study

¹ Royal Berkshire Hospital, Royal Berkshire Hospital NHS Foundation Trust, Reading, ² Norfolk and Norwich University Hospital, Norfolk and Norwich University Hospital NHS Trust, Norwich, ³ Great Western Hospital, Swindon and Marlborough NHS Trust, Swindon, ⁴ Royal Albert Edward Infirmary, Wigan and Leigh NHS Trust, Wigan, ⁵ Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, Gateshead, ⁶ Milton Keynes Hospital, Milton Keynes General NHS Trust, Milton Keynes, ⁷ North Tyneside General Hospital, Northumbria Healthcare NHS Trust, North Shields, ⁸ Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, ⁹ Walsgrave Hospital, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, and ¹⁰ St Mary’s Hospital, St Mary’s NHS Trust, London, UK.

CORRESPONDENCE: C. W. H. Davies, Royal Berkshire Hospital NHS Trust, London Road, Reading, RG1 5AN, UK. Fax: 44 1183228525. E-mail: chris.davies{at}royalberkshire.nhs.uk

Keywords: Early discharge, home supervision, low molecular weight heparin, pulmonary embolism, warfarin

Received: October 30, 2006
Accepted June 4, 2007

The aim of the present study was to assess whether patients with pulmonary embolism (PE) could be managed as outpatients after early discharge from hospital using low molecular weight heparin instead of remaining as in-patients until effective oral anticoagulation was achieved.

Phase 1 of the study identified criteria for the safe discharge of selected patients; phase 2 treated a cohort of low-risk patients with PE as outpatients with tinzaparin using existing deep venous thrombosis services.

In phase 1, 127 (56.4%) of 225 patients were considered unsuitable for outpatient management. Reasons included: admission for another medical reason; additional monitoring or requirement for oxygen; bleeding disorders; previous PE/further PE while on warfarin; co-existing major deep venous thrombosis; likelihood of poor compliance; significant immobility; and pregnancy. In phase 2, 157 patients with PE received outpatient anticoagulation therapy. There were no deaths, bleeding or recurrent thromboembolic events during acute treatment with low molecular weight heparin. The median (range) length of hospital stay was 1.0 (1–4) day, with a median saving of 5.0 (1–42) bed-days per patient.

Patients were highly satisfied with outpatient management; 144 (96.6%) indicated that they would prefer treatment as outpatients for a subsequent pulmonary embolism. Early discharge and outpatient management of pulmonary embolism appears safe and acceptable in selected low-risk patients, and can be implemented using existing outpatient deep venous thrombosis services.

This article has been cited by other articles:

				R. Otero, D. Jimenez, and on behalf of the Cooperative Study for the Ambulat Pulmonary embolism at home Eur. Respir. J., March 1, 2008; 31(3): 686 - 687. [Full Text] [PDF]

				C. W. H. Davies From the authors Eur. Respir. J., March 1, 2008; 31(3): 687 - 687. [Full Text] [PDF]