title: Safety of outpatient treatment in acute pulmonary embolism.
abstract: BACKGROUND
  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.
authors.affiliation: Department of General Practice, School for Public Health and Primary Care (CAPHRI) and Laboratory for Clinical Thrombosis and Haemostasis, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
authors.forename: P M G
authors.initials: PM
authors.lastname: Erkens
authors.forename: E
authors.initials: E
authors.lastname: Gandara
authors.forename: P
authors.initials: P
authors.lastname: Wells
authors.forename: A Y-H
authors.initials: AY
authors.lastname: Shen
authors.forename: G
authors.initials: G
authors.lastname: Bose
authors.forename: G
authors.initials: G
authors.lastname: Le Gal
authors.forename: M
authors.initials: M
authors.lastname: Rodger
authors.forename: M H
authors.initials: MH
authors.lastname: Prins
authors.forename: M
authors.initials: M
authors.lastname: Carrier
mesh_terms: D000208:Acute Disease; D000553:Ambulatory Care / Q000379:methods*; D000925:Anticoagulants / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006439:Hemodynamics; D006470:Hemorrhage; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D008297:Male; D010045:Outpatients; D011655:Pulmonary Embolism / Q000628:therapy*; D012189:Retrospective Studies; D012449:Safety
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight