Can We Manage Low-Risk Pulmonary Embolism in the Outpatient Setting?

Although most patients with acute pulmonary embolism (PE) are hospitalized, clinical trials have suggested that outpatient treatment for low-risk PE patients is safe (NEJM JW Gen Med Aug 15 2011 and Lancet 2011; 378:41). Investigators prospectively assigned 200 adults with low-risk acute PE (i.e., pulmonary embolism severity index [PESI], <86; no evidence of right ventricular dysfunction on echocardiogram; and no residual clot proximal to the popliteal vein on lower-extremity ultrasound) to outpatient anticoagulant therapy at five U.S. hospitals.

No deaths or recurrent venous thromboembolic events and only one major bleed had occurred at 90-day follow up. Very few patients had active cancer (1%). Most patients (87%) received anticoagulation …