Is it time for home treatment of pulmonary embolism?

Lankeit, Mareike; Konstantinides, Stavros

doi:10.1183/09031936.00216811

Cited by 36 publications

(23 citation statements)

References 67 publications

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“…Outpatient treatment and early discharge of patients with PE should be restricted to patients with a low risk for adverse clinical outcome [32]. In the included studies, different methods for the selection of low-risk patients were used.…”

Section: Discussionmentioning

confidence: 99%

Outpatientversusinpatient treatment in patients with pulmonary embolism: a meta-analysis

Zondag¹,

Kooiman²,

Klok³

et al. 2012

Eur Respir J

156

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Our aim was to study the safety of outpatient treatment in low risk patients with acute pulmonary embolism compared with inpatient treatment, the current clinical standard.We searched Medline, Web of Science, Cochrane and EMBASE databases and included studies on outpatient treatment of pulmonary embolism. The outcomes were 3-month recurrent venous thromboembolism, major bleeding and all-cause mortality. We identified 13 studies (1657 patients) with outpatients (discharge ,24 h), three studies (256 patients) with early discharge patients (discharged within 72 h) and five studies (383 patients) with inpatients. The pooled incidence of recurrent venous thromboembolism was 1.7% (95% CI 0.92-3.1%) in outpatients, 1.1% (0.22-5.4%) in patients discharged early and 1.2% (0.16-8.1%) in inpatients. The pooled incidence of major bleeding was 0.97% (0.58-1.6%) in outpatients, 0.78% (0.16-3.7%) in early discharge patients and 1.0% (0.39-2.8%) in inpatients. The pooled incidence of mortality was 1.9% (0.79-4.6%) in outpatients, 2.3% (1.1-5.1%) in early discharge patients and 0.74% (0.04-11%) in inpatients.Incidences of recurrent venous thromboembolism, major bleeding and, after correction for malignancies, mortality were comparable between outpatients, patients discharged early and inpatients. We conclude that home treatment or early discharge of selected low-risk patients with pulmonary embolism is as safe as inpatient treatment. @ERSpublications Home treatment or early discharge of selected low-risk patients with pulmonary embolism is as safe as inpatient treatment

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Section: Discussionmentioning

confidence: 99%

Outpatientversusinpatient treatment in patients with pulmonary embolism: a meta-analysis

Zondag¹,

Kooiman²,

Klok³

et al. 2012

Eur Respir J

156

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“…Therapeutic implications according to the patients' risk strata were demonstrated by recent randomised trials. While patients with a low risk of an early adverse outcome or death may be candidates for early discharge and continuation of treatment at home, if proper outpatient care and anticoagulant treatment can be provided [1][2][3][4], early reperfusion treatment (e.g. systemic thrombolysis) should be considered for patients with intermediate-high-risk PE and clinical signs of haemodynamic decompensation [1,5,6].…”

Section: Introductionmentioning

confidence: 99%

Comparison of risk assessment strategies for not-high-risk pulmonary embolism

et al. 2016

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We compared the prognostic performance of the 2014 European Society of Cardiology (ESC) risk stratification algorithm with the previous 2008 ESC algorithm, the Bova score and the modified FAST score (based on a positive heart-type fatty acid-binding protein (H-FABP) test, syncope and tachycardia, modified using high-sensitivity troponin T instead of H-FABP) in 388 normotensive pulmonary embolism patients included in a single-centre cohort study.Overall, 25 patients (6.4%) had an adverse 30-day outcome. Regardless of the score or algorithm used, the rate of an adverse outcome was highest in the intermediate-high-risk classes, while all patients classified as low-risk had a favourable outcome (no pulmonary embolism-related deaths, 0-1.

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“…The Pulmonary Embolism Severity Index (PESI) and its simplified version (sPESI) [4] are the most extensively validated clinical scores to date. Its major strength lies in the identification of low-risk patients who might be candidates for home treatment [5,6]. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a frequently cited biomarker for risk stratification of acute normotensive pulmonary embolism.…”

Section: Introductionmentioning

confidence: 99%

Validation of N-terminal pro-brain natriuretic peptide cut-off values for risk stratification of pulmonary embolism

et al. 2014

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The optimal N-terminal pro-brain natriuretic peptide (NT-proBNP) cut-off value for risk stratification of pulmonary embolism remains controversial.In this study we validated and compared different proposed NT-proBNP cut-off values in 688 normotensive patients with pulmonary embolism.During the first 30 days, 28 (4.1%) patients reached the primary outcome (pulmonary embolism-related death or complications) and 29 (4.2%) patients died. Receiver operating characteristic analysis yielded an area under the curve of 0.70 (0.60-0.80) for NT-proBNP. A cut-off value of 600 pg?mL -1 was associated with the best prognostic performance (sensitivity 86% and specificity 50%) and the highest odds ratio (6.04 (95% CI 2.07-17.59), p50.001) compared to the cut-off values of 1000, 500 or 300 pg?mL -1 . Using multivariable logistic regression analysis, NT-proBNP o600 pg?mL -1 had a prognostic impact on top of that of the simplified Pulmonary Embolism Severity Index and right ventricular dysfunction on echocardiography (OR 4.27 (95% CI 1.22-15.01); p50.024, c-index 0.741). The use of a stepwise approach based on the simplified Pulmonary Embolism Severity Index, NT-proBNP o600 pg?mL -1 and echocardiography helped optimise risk assessment.Our findings confirm the prognostic value of NT-proBNP and suggest that a cut-off value of 600 pg?mL -1 is most appropriate for risk stratification of normotensive patients with pulmonary embolism. NT-proBNP should be used in combination with a clinical score and an imaging procedure for detecting right ventricular dysfunction. @ERSpublicationsStepwise approach based on sPESI, NT-proBNP and echocardiography for pulmonary embolism risk stratification

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Is it time for home treatment of pulmonary embolism?

Cited by 36 publications

References 67 publications

Outpatientversusinpatient treatment in patients with pulmonary embolism: a meta-analysis

Outpatientversusinpatient treatment in patients with pulmonary embolism: a meta-analysis

Comparison of risk assessment strategies for not-high-risk pulmonary embolism

Validation of N-terminal pro-brain natriuretic peptide cut-off values for risk stratification of pulmonary embolism

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