title: Is it time for home treatment of pulmonary embolism?
abstract: Acute pulmonary embolism (PE) is a frequent cause of death, but not all patients are at high risk of an adverse early outcome. It has been proposed that selected patients may be considered for early discharge and home treatment, but it was only recently that improved risk assessment strategies permitted advances in the identification of low-risk PE. Clinical prediction rules, such as the Pulmonary Embolism Severity Index (PESI), and laboratory biomarkers, particularly natriuretic peptides and cardiac troponins, appeared capable of excluding severe PE and serious comorbidity. Recently, two randomised trials and two prospective cohort studies investigated the feasibility and safety of outpatient treatment. All excluded patients with haemodynamic instability and serious comorbidity, but only one trial used a validated clinical score (PESI) for patient inclusion, and only one cohort study employed a biomarker test. Overall, 90-day outcome was favourable and the results appear promising. To optimise patient selection, future trials will need to test simplified clinical scores combined with high-sensitivity biomarker assays, and it will have to be determined whether echocardiography and/or compression ultrasonography are also required before discharge. Furthermore, ongoing trials will show whether new oral anticoagulants are a safe and cost-effective option for managing patients out of hospital.
authors.affiliation: Department of Cardiology, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
authors.forename: Mareike
authors.initials: M
authors.lastname: Lankeit
authors.forename: Stavros
authors.initials: S
authors.lastname: Konstantinides
mesh_terms: D000208:Acute Disease; D000925:Anticoagulants / Q000627:therapeutic use; D015415:Biomarkers / Q000032:analysis; D005260:Female; D006699:Home Care Services / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D008297:Male; D045265:Natriuretic Peptides / Q000032:analysis; D010351:Patient Discharge; D018579:Patient Selection; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D014336:Troponin / Q000032:analysis
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D045265:Natriuretic Peptides; D014336:Troponin