Out of Hospital Treatment of Acute Pulmonary Embolism in Patients with a Low NT-ProBNP Level.

Agterof, Mariette J; Schutgens, Roger E.G.; Snijder, Repke J.; Epping, G.; Peltenburg, H. G.; Posthuma, Ward; Hardeman, J. A.; Griend, René van der; Koster, Ted; Prins, Martin H.; Biesma, Douwe H.

doi:10.1182/blood.v114.22.3996.3996

Cited by 31 publications

(58 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Subsequent studies found no significant difference between in-patient and out-patient mortality or recurrent VTE when appropriately selected as 'low risk'. 53,54,56,101 The largest issue remains a lack of standardised criteria for determining low risk patients. A sPESI ≥1 and/or markers of right heart dysfunction should indicate at least intermediate-low risk and encourage admission.…”

Section: Anti-coagulation Guidelinesmentioning

confidence: 99%

Acute pulmonary embolism: a concise review of diagnosis and management

Hepburn-Brown

Darvall

Hammerschlag

2019

Internal Medicine Journal

View full text Add to dashboard Cite

An acute pulmonary embolism (aPE) is characterised by occlusion of one or more pulmonary arteries. Physiological disturbance may be minimal, but often cardiac output decreases as the right ventricle attempts to overcome increased afterload. Additionally, ventilation‐perfusion mismatches can develop in affected vascular beds, reducing systemic oxygenation. Incidence is reported at 50–75 per 100 000 in Australia and New Zealand, with 30‐day mortality rates ranging from 0.5% to over 20%. Incidence is likely to increase with the ageing population, increased survival of patients with comorbidities that are considered risk factors and improving sensitivity of imaging techniques. Use of clinical prediction scores, such as the Wells score, has assisted in clinical decision‐making and decreased unnecessary radiological investigations. However, imaging (i.e. computed tomography pulmonary angiography or ventilation‐perfusion scans) is still necessary for objective diagnosis. Anti‐coagulation remains the foundation of PE management. Haemodynamically unstable patients require thrombolysis unless absolutely contraindicated, while stable patients with right ventricular dysfunction or ischaemia should be aggressively anti‐coagulated. Stable patients with no right ventricular dysfunction can be discharged home early with anti‐coagulation and review. However, treatment should be case dependent with full consideration of the patient’s clinical state. Direct oral anti‐coagulants have become an alternative to vitamin K antagonists and are facilitating shorter hospital admissions. Additionally, duration of anti‐coagulation must be decided by considering any provoking factors, bleeding risk and comorbid state. Patients with truly unprovoked or idiopathic PE often require indefinite treatment, while in provoked cases it is typically 3 months with some patients requiring longer periods of 6–12 months.

show abstract

Section: Anti-coagulation Guidelinesmentioning

confidence: 99%

Acute pulmonary embolism: a concise review of diagnosis and management

Hepburn-Brown

Darvall

Hammerschlag

2019

Internal Medicine Journal

View full text Add to dashboard Cite

show abstract

“…The 3 months overall mortality in these studies ranged from 0% to 43.5%. The percentage of recurrent VTE and major bleeding ranged from 0% to 9.3% and 0% to 3.7%, respectively [8,[10][11][12][13][14][15][16][17][18][19][20].…”

Section: Safety Of Outpatient Treatment 2415mentioning

confidence: 99%

Safety of outpatient treatment in acute pulmonary embolism

Erkens

Gándara

Wells

et al. 2010

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

See also Baglin T. Fifty per cent of patients with pulmonary embolism can be treated as outpatients. This issue, pp 2404–5; Kovacs MJ, Hawel JD, Rekman JF, Lazo‐Langner A. Ambulatory management of pulmonary embolism: a pragmatic evaluation. This issue, pp 2406–11. Summary. Introduction: Data regarding outpatient treatment of pulmonary embolism (PE) is scarce. This study evaluates the safety of outpatient management of acute PE. Methods: This is a retrospective cohort study of consecutive patients presenting at the Ottawa Hospital with acute PE diagnosed between 1 January 2007 and 31 December 2008. PE was defined as an arterial filling defect on CTPA or a high probability V/Q scan. Patients were managed as outpatients if they were hemodynamically stable, did not require supplemental oxygenation and did not have contraindications to low‐molecular‐weight heparin therapy. Results: In this cohort of 473 patients with acute PE, 260 (55.0%) were treated as outpatients and 213 (45.0%) were admitted to the hospital. The majority of the patients were admitted because of severe comorbidities (45.5%) or hypoxia (22.1%). No outpatient died of fatal PE during the 3‐month follow‐up period. At the end of follow‐up, the overall mortality was 5.0% (95% CI, 2.7–8.4%). The rates of recurrent venous thromboembolism (VTE) in outpatients were 0.4% (95% CI, 0.0–2.1%) and 3.8% (95% CI, 1.9–7.0%) within 14 days and 3 months, respectively. The rates of major bleeding episodes were 0% (95% CI, 0–1.4%) and 1.5% (95% CI, 0.4–3.9%) within 14 days and 3 months, respectively. Four (1.5%) outpatients were admitted to the hospital within 14 days. Conclusions: A majority of patients with acute PE can be managed as outpatients with a low risk of mortality, recurrent VTE and major bleeding episodes.

show abstract

“…Several studies have reported that outpatient management or early discharge of patients with acute PE is safe and effective [8][9][10][11][12][13]. Two systematic reviews suggested that patients with acute PE treated as outpatients had low incidences of major bleeding, recurrent venous thromboembolism (VTE), and mortality [14,15].…”

Section: Introductionmentioning

confidence: 99%

Outpatient Treatment of Symptomatic Pulmonary Embolism: A Systematic Review and Meta-Analysis

Piran

Gal

Wells

et al. 2012

Blood

View full text Add to dashboard Cite

Background: Patients with acute deep vein thrombus (DVT) can safely be treated as outpatients. However the role of outpatient treatment in patients diagnosed with a pulmonary embolism (PE) is controversial. We sought to determine the safety of outpatient management of patients with acute symptomatic PE. Materials and Methods: A systematic literature search strategy was conducted using MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and all EBM Reviews. Pooled proportions for the different outcomes were calculated. Results: A total of 1258 patients were included in the systematic review. The rate of recurrent venous thromboembolism (VTE) in patients with PE managed as outpatients was 1.47% (95% CI: 0.47 to 3.0%; I 2 : 65.4%) during the 3 month follow-up period. The rate of fatal PE was 0.47% (95% CI: 0.16 to 1.0%; I 2 : 0%). The rates of major bleeding and fatal intracranial hemorrhage were 0.81% (95% CI: 0.37 to 1.42%; I 2 : 0%) and 0.29% (95% CI: 0.06 to 0.68%; I 2 : 0%), respectively. The overall 3 month mortality rate was 1.58% (95% CI: 0.71 to 2.80%; I 2 : 45%). The event rates were similar if employing risk stratification models versus using clinical gestalt to select appropriate patients for outpatient management. Conclusions: Independent of the risk stratification methods used, the rate of adverse events associated with outpatient PE treatment seems low. Based on our systematic review and pooled meta-analysis, low-risk patients with acute PE can safely be treated as outpatients if home circumstances are adequate.

show abstract

Out of Hospital Treatment of Acute Pulmonary Embolism in Patients with a Low NT-ProBNP Level.

Cited by 31 publications

References 0 publications

Acute pulmonary embolism: a concise review of diagnosis and management

Acute pulmonary embolism: a concise review of diagnosis and management

Safety of outpatient treatment in acute pulmonary embolism

Outpatient Treatment of Symptomatic Pulmonary Embolism: A Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About