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Outpatient treatment of pulmonary embolism

Aujesky, Drahomir
Mazzolai, Lucia
Hugli, Olivier
Published in Schweizerische medizinische Wochenschrift. 2009, vol. 139, no. 47-48, p. 685-690
Abstract Pulmonary embolism (PE) is traditionally treated in hospital. Growing evidence from non randomized prospective studies suggests that a substantial proportion of patients with non-massive PE might be safely treated in the outpatient setting using low molecular weight heparins. Based on this evidence, professional societies started to recommend outpatient care for selected patients with non-massive PE. Despite these recommendations, outpatient treatment of non-massive PE appears to be uncommon in clinical practice. The major barriers to PE outpatient care are, firstly, the uncertainty as how to identify low risk patients with PE who are candidates for outpatient care and secondly the lack of high quality evidence from randomized trials demonstrating the safety of PE outpatient care compared to traditional inpatient management. Also, although clinical prognostic models, echocardiography and cardiac biomarkers accurately identify low risk patients with PE in prospective studies, the benefit of risk stratification strategies based on these instruments should be demonstrated in prospective management studies and clinical trials before they can be implemented as decision aids to guide PE outpatient treatment. Before high quality evidence documenting the safety of an outpatient treatment approach is published, outpatient management of non-massive PE cannot be generally recommended.
Keywords *Ambulatory CareAnticoagulants/*therapeutic useHeparin, Low-Molecular-Weight/*therapeutic useHumansOutpatientsPatient SelectionPractice Guidelines as TopicPulmonary Embolism/diagnosis/*drug therapyRisk AssessmentTreatment Outcome
PMID: 20047130
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Research groups Groupe Perrier Arnaud (Médecine interne générale, de réhabilitation et de gériatrie) (585)
La maladie thromboembolique veineuse (808)
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AUJESKY, Drahomir et al. Outpatient treatment of pulmonary embolism. In: Schweizerische medizinische Wochenschrift, 2009, vol. 139, n° 47-48, p. 685-690. doi: 10.4414/smw.2009.12661 https://archive-ouverte.unige.ch/unige:19489

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Deposited on : 2012-04-23

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