Outpatient treatment of pulmonary embolism.

Abstract:

:Pulmonary embolism (PE) is traditionally treated in hospital. Growing evidence from non randomized prospective studies suggests that a substantial proportion of patients with non-massive PE might be safely treated in the outpatient setting using low molecular weight heparins. Based on this evidence, professional societies started to recommend outpatient care for selected patients with non-massive PE. Despite these recommendations, outpatient treatment of non-massive PE appears to be uncommon in clinical practice. The major barriers to PE outpatient care are, firstly, the uncertainty as how to identify low risk patients with PE who are candidates for outpatient care and secondly the lack of high quality evidence from randomized trials demonstrating the safety of PE outpatient care compared to traditional inpatient management. Also, although clinical prognostic models, echocardiography and cardiac biomarkers accurately identify low risk patients with PE in prospective studies, the benefit of risk stratification strategies based on these instruments should be demonstrated in prospective management studies and clinical trials before they can be implemented as decision aids to guide PE outpatient treatment. Before high quality evidence documenting the safety of an outpatient treatment approach is published, outpatient management of non-massive PE cannot be generally recommended.

journal_name

Swiss Med Wkly

journal_title

Swiss medical weekly

authors

Aujesky D,Mazzolai L,Hugli O,Perrier A

doi

smw-12661

subject

Has Abstract

pub_date

2009-11-28 00:00:00

pages

685-90

issue

47-48

eissn

1424-7860

issn

1424-3997

pii

smw-12661

journal_volume

139

pub_type

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