RT Journal Article
SR Electronic
T1 Outpatient treatment and early discharge of symptomatic pulmonary embolism: a systematic review
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1148
OP 1155
DO 10.1183/09031936.00133608
VO 33
IS 5
A1 A. Squizzato
A1 M. Galli
A1 F. Dentali
A1 W. Ageno
YR 2009
UL http://erj.ersjournals.com/content/33/5/1148.abstract
AB The published literature regarding the safety of outpatient treatment of symptomatic pulmonary embolism (PE) was systematically summarised. A literature search was performed using the PubMed and EMBASE databases. Studies in which patients had symptomatic PE and the antithrombotic treatment was administered completely at home or the patients were discharged early were selected. A scoring system was used to divide studies into three quality categories. Short- and long-term outcomes were extracted: all-cause mortality, death from PE or from major haemorrhage, recurrent venous thromboembolism, and major bleeding. Eleven observational studies were included. No randomised controlled studies were identified. No study fulfilled the criteria for high quality. A total of 928 patients with symptomatic PE were treated completely as outpatients or discharged early; haemodynamic instability and hypoxia were the main exclusion criteria. No patient died during the first 7 days of antithrombotic treatment. Outpatient treatment of symptomatic PE is not based on high-quality evidence. Although the published data suggest that certain subgroups of haemodynamically and respiratorily stable patients may be safely treated at home when a well-defined management programme is applied, further studies are warranted for a short-term prognostic risk stratification of this PE subgroup.