title: Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study.
abstract: BACKGROUND
  Traditionally, patients with pulmonary embolism (PE) are initially treated in the hospital with low molecular weight heparin (LMWH). The results of a few small non-randomized studies suggest that, in selected patients with proven PE, outpatient treatment is potentially feasible and safe.
  
  
  OBJECTIVE
  To evaluate the efficacy and safety of outpatient treatment according to predefined criteria in patients with acute PE.
  
  
  METHODS
  A prospective cohort study of patients with objectively proven acute PE was conducted in 12 hospitals in The Netherlands between 2008 and 2010. Patients with acute PE were triaged with the predefined criteria for eligibility for outpatient treatment, with LMWH (nadroparin) followed by vitamin K antagonists. All patients eligible for outpatient treatment were sent home either immediately or within 24 h after PE was objectively diagnosed. Outpatient treatment was evaluated with respect to recurrent venous thromboembolism (VTE), including PE or deep vein thrombosis (DVT), major hemorrhage and total mortality during 3 months of follow-up.
  
  
  RESULTS
  Of 297 included patients, who all completed the follow-up, six (2.0%; 95% confidence interval [CI] 0.8-4.3) had recurrent VTE (five PE [1.7%] and one DVT [0.3%]). Three patients (1.0%, 95% CI 0.2-2.9) died during the 3 months of follow-up, none of fatal PE. Two patients had a major bleeding event, one of which was fatal intracranial bleeding (0.7%, 95% CI 0.08-2.4).
  
  
  CONCLUSIONS
  Patients with PE selected for outpatient treatment with predefined criteria can be treated with anticoagulants on an outpatient basis. (Dutch Trial Register No 1319; http://www.trialregister.nl/trialreg/index.asp).
authors.affiliation: Section of Vascular Medicine, Department of General Internal Medicine-Endocrinology, LUMC, Leiden, The Netherlands. W.Zondag@LUMC.nl
authors.forename: W
authors.initials: W
authors.lastname: Zondag
authors.forename: I C M
authors.initials: IC
authors.lastname: Mos
authors.forename: D
authors.initials: D
authors.lastname: Creemers-Schild
authors.forename: A D M
authors.initials: AD
authors.lastname: Hoogerbrugge
authors.forename: O M
authors.initials: OM
authors.lastname: Dekkers
authors.forename: J
authors.initials: J
authors.lastname: Dolsma
authors.forename: M
authors.initials: M
authors.lastname: Eijsvogel
authors.forename: L M
authors.initials: LM
authors.lastname: Faber
authors.forename: H M A
authors.initials: HM
authors.lastname: Hofstee
authors.forename: M M C
authors.initials: MM
authors.lastname: Hovens
authors.forename: G J P M
authors.initials: GJ
authors.lastname: Jonkers
authors.forename: K W
authors.initials: KW
authors.lastname: van Kralingen
authors.forename: M J H A
authors.initials: MJ
authors.lastname: Kruip
authors.forename: T
authors.initials: T
authors.lastname: Vlasveld
authors.forename: M J M
authors.initials: MJ
authors.lastname: de Vreede
authors.forename: M V
authors.initials: MV
authors.lastname: Huisman
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D017762:Nadroparin / Q000009:adverse effects / Q000627:therapeutic use*; D009426:Netherlands; D018579:Patient Selection; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D017762:Nadroparin; D014812:Vitamin K