title: Home treatment of patients with small to medium sized acute pulmonary embolism.
abstract: 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.
authors.affiliation: Vascular Center, Skåne University Hospital, Ruth Lundskogs Gata 10, 205 02, Malmö, Sweden, johan.elf@skane.se.
authors.forename: J E
authors.initials: JE
authors.lastname: Elf
authors.forename: J
authors.initials: J
authors.lastname: Jögi
authors.forename: M
authors.initials: M
authors.lastname: Bajc
mesh_terms: D000208:Acute Disease; D000328:Adult; D000553:Ambulatory Care / Q000379:methods / Q000706:statistics & numerical data; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D016903:Drug Monitoring; D005260:Female; D006439:Hemodynamics; D006470:Hemorrhage / Q000139:chemically induced*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014692:Ventilation-Perfusion Ratio; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin