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

¹ Consultant Physician, Royal Berkshire Hospital NHS Trust, London Road, Reading, RG1 5AN: Fax: 0044 (0)118 322 8525 E-mail: Chris.Davies@royalberkshire.nhs.uk
² Consultant Haematologist, Norfolk and Norwich Healthcare NHS Trust
³ Consultant Haematologist, Swindon and Marlborough NHS Trust
⁴ Consultant Haematologist, Wrightington, Wigan and Leigh NHS Trust
⁵ Consultant Physician, Gateshead Health NHS Trust
⁶ Consultant Physician, Milton Keynes General NHS Trust
⁷ Consultant Haematologist, Northumbria Healthcare NHS Trust
⁸ Consultant Haematologist, Newcastle upon Tyne Hospitals NHS Trust
⁹ Consultant Haematologist, University Hospitals Coventry and Warwickshire NHS Trust
¹⁰ Consultant Physician, St Mary's NHS Trust

	Abstract

This study assessed whether patients with pulmonary embolism (PE) could be managed as outpatients (OP) after early discharge from hospital using low molecular weight heparin (LMWH) instead of remaining as inpatients until achieving effective oral anticoagulation.

Phase 1 identified criteria for safe discharge of selected patients and phase 2 treated a cohort of low-risk patients with PE as OP with tinzaparin using existing deep vein thrombosis (DVT) services. In phase 1, 127/225 (56.4%) patients were considered unsuitable for OP management. Reasons included: admission for another medical reason; additional monitoring or requirement for oxygen; bleeding disorders; previous PE/further PE whilst on warfarin; co-existing major DVT; likelihood of poor compliance; significant immobility; pregnancy.

In phase 2, 157 patients with PE received OP anticoagulation. There were no deaths, bleeding or recurrent thromboembolic events during acute treatment with LMWH. Median length of hospital stay was 1.0 (range 1 to 4) day. Median of 5.0 (range 1 to 42) bed days were saved per patient.

Patients were highly satisfied with OP management. 144 (96.6%) indicated they would prefer treatment as OP for a subsequent PE. Early discharge and OP management of PE appears safe and acceptable in selected low-risk patients and can be implemented using existing outpatient DVT services.

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