Outpatient treatment proves safe, effective for low-risk patients with pulmonary embolism

Outpatient care for certain low-risk patients with pulmonary embolism (PE) can be safely and effectively used in place of inpatient care, according to a randomized, multi-center study in 19 emergency departments. The findings, published June 23 online in the Lancet, support current practice guidelines that are rarely followed by physicians.

"This is the most rigorous study to date to compare inpatient and for a selected group of stable with ," said Donald M. Yealy, M.D., senior author of the study and chairman of the Department of at the University of Pittsburgh School of Medicine. "Our findings support a shift in of PE for a substantial portion of low-risk patients, which may reduce hospitalizations and costs."

Pulmonary embolism is a blockage of the main artery of the lung or one of its branches. Most are due to pelvic and upper leg blood clots that grow in the vein before detaching and traveling to the lungs. The most common symptoms include unexplained shortness of breath or chest pain while breathing. On average, 650,000 PEs occur annually, and it is the third-leading cause of hospital death.

In the Outpatient Treatment of Pulmonary Embolism (OPTE) trial, researchers looked at more than 300 patients at 19 emergency departments in Switzerland, Belgium, France and the U.S. who had been randomly assigned to inpatient or outpatient care between February 2007 and June 2010. These patients were judged to have a low risk of death, based on a validated clinical prognostic model. Of those screened, 30 percent met the eligibility criteria, suggesting that a shift in the clinical management of such patients may have a broad effect.

Patients assigned to outpatient treatment received standardized teaching from a study nurse about self-injection with enoxaparin, an anti-coagulant, and were to be discharged from the within 24 hours. Patients assigned to inpatient treatment were admitted to the hospital and received the same enoxaparin regimen. In both groups, the study protocol recommended early initiation of oral anticoagulation medications and continuation for a minimum of 90 days.

Patient outcomes for outpatient care showed that it was as safe and effective as inpatient care. For instance, researchers found that one of 171 outpatients developed recurrent venous thromboembolism, or blood clots forming within the veins, within 90 days compared with none of 168 inpatients. One patient in each group died within 90 days. Two of the outpatients and no inpatients had major bleeding within 14 days.

Patient satisfaction regarding care exceeded 90 percent for both groups, and both had essentially the same numbers of hospital readmissions, visits and outpatient visits to a doctor's office within 90 days. But researchers found that cost savings from reductions in hospital stays might be partially offset by an increased frequency in home-nursing visits.

"Our findings are consistent with previous non-randomized studies and systematic reviews that outpatient care of PE is associated with low rates of recurrent venous thromboembolism, major bleeding and death," said Dr. Yealy. "Patients with PE prefer outpatient treatment, and these reassuring trial results should prompt physicians to consider such care more often for low-risk patients."

Provided by University of Pittsburgh

not rated yet
add to favorites email to friend print save as pdf

Related Stories

Recommended for you

What are the chances that your dad isn't your dad?

Apr 16, 2014

How confident are you that the man you call dad is really your biological father? If you believe some of the most commonly-quoted figures, you could be forgiven for not being very confident at all. But how ...

New technology that is revealing the science of chewing

Apr 15, 2014

CSIRO's 3D mastication modelling, demonstrated for the first time in Melbourne today, is starting to provide researchers with new understanding of how to reduce salt, sugar and fat in food products, as well ...

After skin cancer, removable model replaces real ear

Apr 11, 2014

(HealthDay)—During his 10-year struggle with basal cell carcinoma, Henry Fiorentini emerged minus his right ear, and minus the hearing that goes with it. The good news: Today, the 56-year-old IT programmer ...

Italy scraps ban on donor-assisted reproduction

Apr 09, 2014

Italy's Constitutional Court on Wednesday struck down a Catholic Church-backed ban against assisted reproduction with sperm or egg donors that has forced thousands of sterile couples to seek help abroad.

User comments