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Outpatient Treatment of Pulmonary Embolism Reduces Rates of Adverse Events

December 30, 2021

The decision to hospitalize patients with acute pulmonary embolism (PE) or treat them as outpatients remains controversial, but according to a study published in the Journal of Thrombosis and Haemostasis, outpatient management of hemodynamically stable PE is associated with a lower rate of adverse events (AEs) compared with hospitalization.

"If confirmed [in further studies], [outpatient treatment] may be considered as firstline management in patients not requiring specific in-hospital care, regardless of their initial risk stratification, if proper outpatient care can be provided," the authors, led by Pierre-Marie Roy, MD, PhD, from the Emergency Department at CHU Angers in France, said.

Dr. Roy and colleagues conducted a retrospective, propensity score-matched, cohort analysis of 1,081 patients with acute PE (576 were treated as inpatients and 505 were outpatients) to determine if there was a net clinical benefit of hospitalization versus outpatient management.

The 14-day rate of AEs (the study's primary endpoint) was 13.0 percent for inpatients versus 3.3 percent for outpatients (adjusted odds ratio [OR] = 5.07; 95% CI 1.68-15.28; p value not reported). This trend persisted at three-month follow-up, with an AE rate of 21.7 percent for inpatients and 6.9 percent for outpatients (OR=4.90; 95% CI 2.62-9.17; p value not reported).

The authors also found that outpatient treatment was safer than hospitalization for a subgroup of 597 high-risk patients (defined as Pulmonary Embolism Severity Index class 3-5). The 14-day rate of AEs was 16.5 percent for inpatients and 4.5 percent for outpatients (OR=4.16; 95% CI 1.2-14.35; p value not reported).

The variation in types of inpatient and outpatient management in the study centers could limit the generalizability of the study's results, the authors noted.

Source: Roy PM, Corsi DJ, Carrier M, et al. Net clinical benefit of hospitalization versus outpatient management of patients with acute pulmonary embolism. J Thromb Haemost. 2017 January 20. [Epub ahead of print]

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