RT Journal Article
SR Electronic
T1 Early discharge of patients with pulmonary embolism: a two-phase observational study
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 708
OP 714
DO 10.1183/09031936.00140506
VO 30
IS 4
A1 C. W. H. Davies
A1 J. Wimperis
A1 E. S. Green
A1 K. Pendry
A1 J. Killen
A1 I. Mehdi
A1 C. Tiplady
A1 P. Kesteven
A1 P. Rose
A1 W. Oldfield
YR 2007
UL http://erj.ersjournals.com/content/30/4/708.abstract
AB 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.