Stable Patients with Pulmonary Embolism Can Be Treated as Outpatients

Typically, diagnosis of pulmonary embolism (PE) means certain admission. Researchers performed an open-label, randomized, noninferiority study to compare outcomes of outpatient and inpatient treatment in consecutive adult patients who presented to 19 emergency departments in Europe and the U.S. with symptomatic PE and risk for death less than 4% (based on the PE Severity Index; see table). Patients were excluded if they had oxygen saturation <90% on room air, systolic blood pressure <100 mm Hg, chest pain requiring opioids, active bleeding, or were at high risk for hemorrhage (recent stroke or gastrointestinal bleeding or platelet count <75,000/mm³). All patients initially received subcutaneous enoxaparin (1 mg/kg twice daily) followed by anticoagulation with vitamin K antagonists for at least 90 days.

Overall, the study included 171 outpatients (mean age, 47) and 168 inpatients (mean age, 49). Cancer prevalence was 1% and 2%, respectively. Within 90 days, one patient in each group died, neither from PE. Recurrent venous thromboembolism occurred in only one patient (outpatient group). Major bleeding occurred within 90 days in three outpatients (intramuscular hematoma on day 3 and day 13 and menometrorrhagia on day 50) and no inpatients. At 14 days, more than 90% of patients in both groups were satisfied or very satisfied with treatment.