title: Pulmonary embolism: whom to discharge and whom to thrombolyze?
abstract: Patients with pulmonary embolism can be divided in two groups according to their risk of death or major complication: a small group of high-risk patients defined by the presence of systemic hypotension or cardiogenic shock and a large group of normotensive patients. Among normotensive patients, further risk stratification, based on clinical grounds alone or on the combination of clinical data, biomarkers, and imaging tests, allows selection of low-risk patients and intermediate-risk patients. The safety of outpatient treatment for low-risk patients has been established mainly on the basis of retrospective and prospective cohorts using different selection tools. In most studies, about 50% of the patients have been safely treated at home. Although thrombolytic therapy has a favorable benefit to risk profile in patients with high-risk pulmonary embolism, the risk of major and especially intracranial bleeding outweighs the benefits in terms of hemodynamic decompensation in patients with intermediate-risk pulmonary embolism.
authors.affiliation: Service de Pneumologie, Hôpital Européen Georges Pompidou, APHP, Paris, France.|Sorbonne Paris Cité, INSERM UMRS 970, CIC 1418, Université Paris Descartes, Paris, France.|GIRC Thrombose, Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Meyer
authors.affiliation: Service de Pneumologie, Hôpital Européen Georges Pompidou, APHP, Paris, France.|Sorbonne Paris Cité, INSERM UMRS 970, CIC 1418, Université Paris Descartes, Paris, France.|GIRC Thrombose, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Planquette
authors.affiliation: Service de Pneumologie, Hôpital Européen Georges Pompidou, APHP, Paris, France.|Sorbonne Paris Cité, INSERM UMRS 970, CIC 1418, Université Paris Descartes, Paris, France.|GIRC Thrombose, Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Sanchez
mesh_terms: D003661:Decision Support Techniques; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced; D010351:Patient Discharge; D018579:Patient Selection; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: anticoagulants; outpatient; prognosis; pulmonary embolism; thrombolytic therapy