BACKGROUND: Currently, guidelines do not recommend any standard approach for treatment of pulmonary thromboembolism (PTE) at outpatient setting. We investigated the efficacy and safety of a 90-day anticoagulant treatment of outpatients diagnosed with PTE who had negative troponin levels and low-risk simplified pulmonary embolism severity index (sPESI) at presentation. METHODS: This prospective cohort study included a total of 206 patients with objectively confirmed acute symptomatic PTE. Any troponin negative (cTn-) and low sPESI patients (as classified Group-1) were treated in outpatient setting. The primary endpoint was all-cause mortality during the first 90 days, and the secondary endpoint included non-fatal symptomatic recurrent PTE or non-fatal major bleeding. Presence of cancer was excluded from sPESI score. RESULTS: Fifty-two of 206 patients were eligible for had Group-1, and 31 were treated at outpatients settings. The 90-day all-cause mortality rate was 3.2 % among patients who received outpatient treatment. Otherwise cTn+ and high-risk sPESI 90-day mortality rate was 43.7 %. No difference was found in terms of secondary endpoints between the patients who received outpatient treatment and those who received inpatient treatment in Group-1 (p = NS). In our study, cancer was present in 16 (51.6 %) of the 31 outpatients. CONCLUSION: We observed that patients with acute PTE, low-risk sPESI, and negative troponin levels can be safely treated in the outpatient settings. Also the presence of cancer alone does not necessitate hospitalization.
BACKGROUND: Currently, guidelines do not recommend any standard approach for treatment of pulmonary thromboembolism (PTE) at outpatient setting. We investigated the efficacy and safety of a 90-day anticoagulant treatment of outpatients diagnosed with PTE who had negative troponin levels and low-risk simplified pulmonary embolism severity index (sPESI) at presentation. METHODS: This prospective cohort study included a total of 206 patients with objectively confirmed acute symptomatic PTE. Any troponin negative (cTn-) and low sPESI patients (as classified Group-1) were treated in outpatient setting. The primary endpoint was all-cause mortality during the first 90 days, and the secondary endpoint included non-fatal symptomatic recurrent PTE or non-fatal major bleeding. Presence of cancer was excluded from sPESI score. RESULTS: Fifty-two of 206 patients were eligible for had Group-1, and 31 were treated at outpatients settings. The 90-day all-cause mortality rate was 3.2 % among patients who received outpatient treatment. Otherwise cTn+ and high-risk sPESI 90-day mortality rate was 43.7 %. No difference was found in terms of secondary endpoints between the patients who received outpatient treatment and those who received inpatient treatment in Group-1 (p = NS). In our study, cancer was present in 16 (51.6 %) of the 31 outpatients. CONCLUSION: We observed that patients with acute PTE, low-risk sPESI, and negative troponin levels can be safely treated in the outpatient settings. Also the presence of cancer alone does not necessitate hospitalization.
Authors: Stavros V Konstantinides; Adam Torbicki; Giancarlo Agnelli; Nicolas Danchin; David Fitzmaurice; Nazzareno Galiè; J Simon R Gibbs; Menno V Huisman; Marc Humbert; Nils Kucher; Irene Lang; Mareike Lankeit; John Lekakis; Christoph Maack; Eckhard Mayer; Nicolas Meneveau; Arnaud Perrier; Piotr Pruszczyk; Lars H Rasmussen; Thomas H Schindler; Pavel Svitil; Anton Vonk Noordegraaf; Jose Luis Zamorano; Maurizio Zompatori Journal: Eur Heart J Date: 2014-08-29 Impact factor: 29.983
Authors: Drahomir Aujesky; Pierre-Marie Roy; Franck Verschuren; Marc Righini; Joseph Osterwalder; Michael Egloff; Bertrand Renaud; Peter Verhamme; Roslyn A Stone; Catherine Legall; Olivier Sanchez; Nathan A Pugh; Alfred N'gako; Jacques Cornuz; Olivier Hugli; Hans-Jürg Beer; Arnaud Perrier; Michael J Fine; Donald M Yealy Journal: Lancet Date: 2011-06-22 Impact factor: 79.321
Authors: W Zondag; I C M Mos; D Creemers-Schild; A D M Hoogerbrugge; O M Dekkers; J Dolsma; M Eijsvogel; L M Faber; H M A Hofstee; M M C Hovens; G J P M Jonkers; K W van Kralingen; M J H A Kruip; T Vlasveld; M J M de Vreede; M V Huisman Journal: J Thromb Haemost Date: 2011-08 Impact factor: 5.824
Authors: S Konstantinides; A Geibel; M Olschewski; F Heinrich; K Grosser; K Rauber; S Iversen; M Redecker; J Kienast; H Just; W Kasper Journal: Circulation Date: 1997-08-05 Impact factor: 29.690