Home treatment of patients with small to medium sized acute pulmonary embolism
- 304 Downloads
Most patients with acute pulmonary embolism (PE) are still treated as inpatients. This is a retrospective cohort study of patients with acute PE, diagnosed using V/P SPECT between 2007 and 2011. Patients were treated at home if they were hemodynamically stable, did not require oxygen or parenteral analgetics, had no contraindications to anticoagulant treatment and V/P SPECT showed an extension of the PE of less than 40 %. The aim of the study was to evaluate the efficacy and safety of home treatment with our algorithm. During the study period 416 outpatients were diagnosed with acute symptomatic PE of whom in total 260 (62.5 %) were discharged home from the emergency unit and another 47 (11 %) within 24 h from admission. During 3 months follow-up one (0.3 %) patient had a recurrent thrombotic event. Eleven (3.6 %) patients had a major or clinically relevant bleed and the overall mortality was 2 % (n = 6). There were no PE-related mortality. Home treatment should be considered and is safe in the majority of hemodynamically stable outpatients with small to medium size PE, quantified using V/P SPECT.
KeywordsPulmonary embolism Home treatment Prognosis V/P SPECT
International normalised ratio
Low molecular weight heparin
- V/P SPECT
Ventilation/perfusion single photon emission tomography
Simplified pulmonary embolism severity index
The authors would like to thank Berit Olsson and Alaa al Hadad for helping in the collection of data. Carl-Gustav Olsson for taking care of patients and implementing the algorithm. This study was supported by grants from the Research Funds at Skåne University Hospital and the Swedish state under the LUA/ALF agreement.
Conflict of interest
The authors state that they have no conflict of interest.
- 2.Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galie N, Pruszczyk P, Bengel F, Brady AJ, Ferreira D, Janssens U, Kleptetko W, Mayer E, Remy-Jardin M, Bassande JP, Vahanian A, Camm J, de Caterina R, Dean V, Dickstein K, Filippatos G et al (2008) Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 29:2276–2315PubMedCrossRefGoogle Scholar
- 5.Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther M, Kahn SR (2012) Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 141:e419S–e494SPubMedCentralPubMedCrossRefGoogle Scholar
- 7.Zondag W, Mos IC, Creemers-Schild D, Hoogerbrugge AD, Dekkers OM, Dolsma J, Eijsvogel M, Faber LM, Hofstee HM, Hovens MM, Jonkers GJ, van Kralingen KW, Kruip MJ, Vlasfeld T, de Vreede MJ, Huismann MV (2011) Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study. J Thromb Haemost 9:1500–1507PubMedCrossRefGoogle Scholar
- 8.Aujesky D, Roy PM, Verschuren F, Righini M, Osterwalder J, Egloff M, Renaud B, Verhamme P, Stone RA, Legell C, Sanchez O, Pugh NA, N`gako A, Cornuz J, Hugli O, Beer HJ, Perrier A, Fine MJ, Yealy DM (2011) Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial. Lancet 378:41–48PubMedCrossRefGoogle Scholar
- 15.Soares TH, de Bastos M, de Carvalho BV, Moreira W, Cabral CP, de Paula LF, Caram C, Rezende SM (2012) Prognostic value of computed tomographic pulmonary angiography and pulmonary embolism severity index in patients with acute pulmonary embolism. Blood Coagul Fibrinolysis 24:64–70CrossRefGoogle Scholar
- 17.Bajc M, Neilly JB, Miniati M, Schuemichen C, Meignan M, Jonson B (2009) EANM guidelines for ventilation/perfusion scintigraphy: part 2. Algorithms and clinical considerations for diagnosis of pulmonary emboli with V/P(SPECT) and MDCT. Eur J Nucl Med Mol Imaging 36:1528–1538PubMedCrossRefGoogle Scholar
- 18.Olsson CG, Bitzen U, Olsson B, Magnusson P, Carlsson, Jonson B, Bajc M (2006) Outpatient tinzaparin therapy in pulmonary embolism quantified with ventilation/perfusion scintigraphy. Med Sci Monit 12:9–13Google Scholar
- 22.Bajc M, Olsson C-G, Palmer J, Jonson B (2004) Quantitative ventilation/perfusion SPECT (QV/PSPECT): a primary method for diagnosis of pulmonary embolism. In: Freeman LM (ed) Nuclear medicine annual. Lippincott Williams&Wilkins, Philadelphia, pp 173–186Google Scholar
- 25.Begic A, Jogi J, Hadziredzepovic A, Kucukalic-Selimovic E, Begovic-Hadzimuratovic S, Bajc M (2011) Tomographic ventilation/perfusion lung scintigraphy in the monitoring of the effect of treatment in pulmonary embolism: serial follow-up over a 6-month period. Nucl Med Commun 32:508–514PubMedCrossRefGoogle Scholar
- 30.Zwierzina D, Limacher A, Mean M, Righini M, Jaeger K, Beer HJ, Frauchiger B, Ostenwalder J, Kucher N, Matter CM, Banyai M, Angelillo-Scherrer A, Lämmle B, Egloff M, Aschwanden M, Mazzolai L, Hugli O, Huismann M, Bounameaux H, Cornuz J, Rodondi N, Aujesky D (2012) Prospective comparison of clinical prognostic scores in elderly patients with pulmonary embolism. J Thromb Haemost 10:2270–2276PubMedCrossRefGoogle Scholar