title: Value of Cardiac Troponin and sPESI in Treatment of Pulmonary Thromboembolism at Outpatient Setting.
abstract: BACKGROUND
  Currently, guidelines do not recommend any standard approach for treatment of pulmonary thromboembolism (PTE) at outpatient setting. We investigated the efficacy and safety of a 90-day anticoagulant treatment of outpatients diagnosed with PTE who had negative troponin levels and low-risk simplified pulmonary embolism severity index (sPESI) at presentation.
  
  
  METHODS
  This prospective cohort study included a total of 206 patients with objectively confirmed acute symptomatic PTE. Any troponin negative (cTn-) and low sPESI patients (as classified Group-1) were treated in outpatient setting. The primary endpoint was all-cause mortality during the first 90 days, and the secondary endpoint included non-fatal symptomatic recurrent PTE or non-fatal major bleeding. Presence of cancer was excluded from sPESI score.
  
  
  RESULTS
  Fifty-two of 206 patients were eligible for had Group-1, and 31 were treated at outpatients settings. The 90-day all-cause mortality rate was 3.2 % among patients who received outpatient treatment. Otherwise cTn+ and high-risk sPESI 90-day mortality rate was 43.7 %. No difference was found in terms of secondary endpoints between the patients who received outpatient treatment and those who received inpatient treatment in Group-1 (p = NS). In our study, cancer was present in 16 (51.6 %) of the 31 outpatients.
  
  
  CONCLUSIONS
  We observed that patients with acute PTE, low-risk sPESI, and negative troponin levels can be safely treated in the outpatient settings. Also the presence of cancer alone does not necessitate hospitalization.
authors.affiliation: Department of Pulmonary Medicine, School of Medicine, Karadeniz Technical University, Trabzon, Turkey, savasozsu@gmail.com.
authors.forename: Savas
authors.initials: S
authors.lastname: Ozsu
authors.forename: Hayriye
authors.initials: H
authors.lastname: Bektas
authors.forename: Yasin
authors.initials: Y
authors.lastname: Abul
authors.forename: Tevfik
authors.initials: T
authors.lastname: Ozlu
authors.forename: Asım
authors.initials: A
authors.lastname: Örem
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000925:Anticoagulants / Q000627:therapeutic use; D002423:Cause of Death; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood / Q000188:drug therapy* / Q000401:mortality*; D012008:Recurrence; D012720:Severity of Illness Index; D014336:Troponin / Q000097:blood*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014336:Troponin
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