Outpatient treatment in patients with acute pulmonary embolism: The Hestia Study.
J Thromb Haemost. 2011 Jun 4;
Authors: Zondag W, Mos IC, Creemers-Schild D, Hoogerbrugge AD, Dekkers OM, Dolsma J, Eijsvogel M, Faber LM, Hofstee HM, Hovens MM, Jonkers GJ, van Kralingen KW, Kruip MJ, Vlasveld T, de Vreede MJ, Huisman MV,
Background: Traditionally, patients with pulmonary embolism (PE) are initially treated in the hospital with low molecular weight heparin (LMWH). The results of a few small non-randomized studies suggest that in selected patients with proven PE outpatient treatment is potentially feasible and safe.Objective: To evaluate the efficacy and safety of outpatient treatment according to predefined criteria in patients with acute PE. Patients and Methods: Prospective cohort study of patients with objectively proven acute pulmonary embolism, conducted in twelve hospitals in the Netherlands between 2008 and 2010. Patients with acute PE were triaged with the predefined criteria for eligibility for outpatient treatment starting with LMWH (Nadroparin), followed by vitamin K antagonists. All patients eligible for outpatient treatment were sent home either immediately or within 24 hours after PE was objectively diagnosed. Outpatient treatment was evaluated with respect to recurrent venous thromboembolism (VTE), including PE or deep venous thrombosis (DVT), major haemorrhage and total mortality during 3 months follow up. Results: Of 297 included patients, who all completed follow-up, 6 patients (2.0%; 95% confidence interval [CI], 0.8-4.3) had recurrent VTE (5 PE (1.7%), 1 DVT (0.3%)). Three patients (1.0%, 95% CI 0.2-2.9) died during three months follow-up, none of fatal PE. Two patients had a major bleeding event, of which one fatal intracranial bleeding (0.7%, 95% CI 0.08%-2.4%). Conclusion: Patients with pulmonary embolism selected for outpatient treatment with predefined criteria can be treated with anticoagulants on outpatient basis. (Dutch Trial Register http://www.trialregister.nl/trialreg/index.asp NTR1319).
PMID: 21645235 [PubMed - as supplied by publisher]