Home Treatment of Pulmonary Embolism in the Era of Novel Oral Anticoagulants.
Outpatient therapy of patients with acute pulmonary embolism has been shown to be safe in carefully selected patients. Problems related to the injection of low-molecular-weight heparin at home can be overcome by use of novel oral anticoagulants. The purpose of this investigation is to assess the prevalence of home treatment in the era of novel oral anticoagulants.



This was a retrospective cohort study of patients aged ≥18 years with acute pulmonary embolism seen in 5 emergency departments from January 2013 to December 2014.



Pulmonary embolism was diagnosed in 983 patients. Among these, 237 were considered ineligible for home treatment because of instability or hypoxia. Home treatment was selected for 13 of 746 (1.7%) patients who were potentially eligible. Anticoagulant treatment for those treated at home was low-molecular-weight heparin or warfarin in 9 (69.2%) and novel oral anticoagulants in 4 (30.8%). Hospitalization was chosen for 733 of 746 (98.3%). Discharge in ≤2 days was in 119 patients (16.2%). Treatment of these patients was low-molecular-weight heparin or warfarin in 76 (63.9%), novel oral anticoagulants in 34 (28.6%), and in 9 (7.6%), anticoagulants were not given because of metastatic cancer or treatment was not known.



Even in the era of novel oral anticoagulants, the vast majority of patients with acute pulmonary embolism were hospitalized, and only a small proportion were discharged in ≤2 days. Although home treatment has been found to be safe in carefully selected patients, and scoring systems have been derived to identify those at low risk of adverse events, home treatment was infrequently selected.
Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing. Electronic address: steinp@msu.edu.
Paul D
PD
Stein
Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing.
Fadi
F
Matta
Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing; Department of Medical Education, Summa Akron City Hospital, Ohio; Department of Emergency Medicine, McLaren Oakland Hospital, Pontiac, Mich.
Patrick G
PG
Hughes
Department of Medical Education, Summa Akron City Hospital, Ohio.
Zak N
ZN
Hourmouzis
Department of Medical Education, Summa Akron City Hospital, Ohio.
Nina P
NP
Hourmouzis
Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing; Department of Emergency Medicine, Sparrow Health System, Lansing, Mich.
Rachel M
RM
White
Department of Emergency Medicine, McLaren Oakland Hospital, Pontiac, Mich.
Martina M
MM
Ghiardi
Department of Emergency Medicine, University of Toledo Medical Center, Ohio.
Matthew A
MA
Schwartz
Department of Emergency Medicine, University of Toledo Medical Center, Ohio.
Hillary L
HL
Moore
Department of Emergency Medicine, St. Mary Mercy Hospital, Livonia, Mich.
Jennifer A
JA
Bach
Department of Emergency Medicine, St. Mary Mercy Hospital, Livonia, Mich.
Robert E
RE
Schweiss
Department of Emergency Medicine, University of Toledo Medical Center, Ohio.
Viviane M
VM
Kazan
Department of Emergency Medicine, University of Toledo Medical Center, Ohio.
Edward J
EJ
Kakish
Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing; Department of Emergency Medicine, St. Mary Mercy Hospital, Livonia, Mich.
Daniel C
DC
Keyes
Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing; Department of Emergency Medicine, Sparrow Health System, Lansing, Mich.
Mary J
MJ
Hughes
D000284:Administration, Oral; D000553:Ambulatory Care / Q000379:methods / Q000706:statistics & numerical data*; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000188:drug therapy*; D012189:Retrospective Studies; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin
Home treatment; Oral anticoagulants; Pulmonary embolism; Venous thromboembolism