Emergency Department Discharge of Pulmonary Embolus Patients.
Acad Emerg Med. 2018 May 14;:
Authors: Frank Peacock W, Coleman CI, Diercks D, Francis S, Kabrhel C, Keay C, Kline J, Manteuffel J, Wildgoose P, Xiang J, Singer AJ
BACKGROUND: Hospitalization for low risk pulmonary embolism (PE) is common, expensive, and of questionable benefit.
OBJECTIVE: Determine if low-risk PE patients discharged from the emergency department (ED) on rivaroxaban require fewer hospital days compared to standard of care (SOC).
METHODS: Multicenter, open label randomized trial in low risk PE defined by Hestia criteria. Adult subjects were randomized to early ED discharge on rivaroxaban, or SOC. Primary outcome was total number of initial hospital hours, plus hours of hospitalization for bleeding or venous thromboembolism, 30 days after randomization. A 90-day composite safety endpoint was defined as major bleeding, clinically relevant non-major bleeding, and mortality.
RESULTS: Of 114 randomized subjects; 51 were early discharge and 63 SOC. Of 112 (98.2%) receiving at least 1 dose of study drug, 99 (86.8%) completed the study. Initial hospital LOS was 4.8 vs 33.6 hours; mean difference -28.8 hours (95% CI -42.55, -15.12) for early discharge vs SOC, respectively. At 90 days, mean total hospital days (for any reason) were less for early discharge than SOC; 19.2 vs. 43.2 hours; mean difference 26.4 hours (95% CI -46.97, -3.34). At 90 days, there were no bleeding events, recurrent VTE, or deaths. The composite safety endpoint was similar in both groups; difference in proportions 0.005 (95% CI: -0.18 to 0.19). Total costs were $1496 for early discharge and $4234 for SOC, median difference $2496 (95% CI: -$2999, -$2151).
CONCLUSIONS: Low risk ED PE patients receiving early discharge on rivaroxaban have similar outcomes to SOC, but fewer total hospital days, and lower costs over 30 days. This article is protected by copyright. All rights reserved.
PMID: 29757489 [PubMed - as supplied by publisher]