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, E. F. M.; Hardeman, J. A.; Griend, René van der; Koster, Ted; Prins, Martin H.; Biesma, Douwe H.

doi:10.1111/j.1538-7836.2010.03831.x

Cited by 128 publications

(84 citation statements)

References 38 publications

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“…The remaining 11 studies were included in our systematic review. Eight were prospective cohort studies [8,[11][12][13][31][32][33][34]] and 3 were randomized controlled trials (RCT's) [16,17,35]. Furthermore, 2 studies did not report outcomes at 3 months and could not be used in our pooled meta-analysis [12,13].…”

Section: Resultsmentioning

confidence: 99%

“…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%

“…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]. However the quality of the included studies was low and subsequent and recent larger observational studies and randomized control trials were not included [8,11,16,17]. More recently, two additional systematic reviews of the outpatient management of acute symptomatic PE were published [18,19].…”

Section: Introductionmentioning

confidence: 99%

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Outpatient treatment of symptomatic pulmonary embolism: A systematic review and meta-analysis

Piran

Gal

Wells

et al. 2013

Thrombosis Research

139

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outpatient treatment of symptomatic pulmonary embolism: A systematic review and meta-analysis

Piran

Gal

Wells

et al. 2013

Thrombosis Research

139

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“…The cut-off levels for D-dimer were based on previous studies in which D-dimer with a cut-off level >3,000 lg/l FEU was a strong predictor for short-term [28,29]. The chosen cut-off level for NT-proBNP of >500 pg/ml was based on our previous study in which outpatient treatment of PE-patients was based on NT-proBNP levels <500 pg/ml [30]. The addition of age, gender, or cardiopulmonary disease did not improve the model.…”

Section: Prognostic Model For Adverse Clinical Eventsmentioning

confidence: 99%

A prognostic model for short term adverse events in normotensive patients with pulmonary embolism

et al. 2011

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Risk stratification of patients with PE has gained interest in terms of the identification of patients in whom treatment on an outpatient base can be considered. Previous studies are of limited value due to their focus on adverse clinical events within several months after diagnosis of PE. We developed a prognostic model, based on easily accessible, clinical, and laboratory parameters, to predict adverse events during the first 10 days after the diagnosis of acute PE. We have analyzed the data of 210 outpatients with confirmed PE. Collected data included medical history, pulse rate, blood pressure, NT-proBNP, and D-dimer concentrations. The primary outcome was the occurrence of adverse clinical events in a 10 day follow-up period. Our final prognostic model to predict short-term adverse events consists of NT-proBNP levels, D-dimer concentrations, pulse rate, and the occurrence of active malignancy; the total score ranges from 0 to 37 points. Patients with a low score (no active malignancy, pulse rate <90 bpm, NT-proBNP <500 pg/ml, and D-dimer <3,000 lg/l FEU) have a 10-day adverse event risk <1.5%. This risk increases to over 30% in patients with a maximum score, based on high pulse rate, D-dimer concentrations, and NT-proBNP levels. Our prognostic model, once prospectively validated in an independent sample of patients, can be used in the early risk stratification of PE to estimate the risk of adverse events and to differentiate between candidates for in-or out-hospital treatment. Am. J. Hematol. 86:646-649, 2011. V

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“…Some clinical severity classifications have been made as prognostic indicators in APE (4,5). There are also publications which indicate that biochemical indicators such as troponins, heart-type fatty acid-binding protein, brain natriuretic peptide or N-terminalproBNP and right ventricular dysfunction may be prognostic factors (6)(7)(8)(9)(10). Neutrophil-Lymphocyte Ratio (NLR) is a readily measurable laboratory marker used to evaluate systemic inflammation.…”

Section: Introductionmentioning

confidence: 99%

Correlation Between Clot Load Burden with Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios in Patients with Acute Pulmonary Embolism

Çildağ¹,

Çildağ²

2017

Ulutas Med J

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Background: The correlation between neutrophil-lymphocyte ratio (NLR) and acute pulmonary embolism (APE) related mortality, platelet-lymphocyte ratio (PLR) and clinical severity classification of APE were demostrated. Also clot load burden one of the prognostic criteria of pulmonary embolism.Method: The pulmonary arterial computed tomographic obstruction index ratio (PACTOIR) was calculated in 62 patients diagnosed with APE, retrospectively. Patients were divided into two groups according to their PACTOIR values. NLR and PLR were calculated from the blood samples collected on the day of diagnosis.Results: Mean PACTOIR, NLR and PLR of all patients with APE were calculated as 23.58%, 4.4 and 186.5, respectively. A positive correlation was observed between PACTOIR and NLR and PLR (p<0.001). A statistically significant difference was found between the NLR and PLR levels of low and high PACTOIR groups (p<0.05).Conclusion: A statistically significant correlation was found between PACTOIR and NLR and PLR in patients with APE. According to the findings of our study, NLR and PLR ratios may give an idea about the thrombus load in patients with clinically suspected APE.

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Out of hospital treatment of acute pulmonary embolism in patients with a low NT‐proBNP level

Abstract: http://clinicaltrials.gov/ct2/show/NCT00455819.

Cited by 128 publications

References 38 publications

Outpatient treatment of symptomatic pulmonary embolism: A systematic review and meta-analysis

Outpatient treatment of symptomatic pulmonary embolism: A systematic review and meta-analysis

A prognostic model for short term adverse events in normotensive patients with pulmonary embolism

Correlation Between Clot Load Burden with Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios in Patients with Acute Pulmonary Embolism

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