Some Pulmonary Embolisms Can Be Treated at Home

Pulmonary embolism is a block in the main lung artery or one of its branches; this is due to a blood clot or clots in the pelvic or upper leg veins that detach and travel to the lungs.  Symptoms include chest pain or unexplained shortage of breath, or chest pain on breathing.  Pulmonary embolism is the 3^rd leading cause of hospital death.  Not surprisingly, most people are diagnosed in the Emergency Room and treated as inpatients, with an anticoagulant (e.g. heparin).  This is in spite of practice guidelines recommending outpatient care for selected stable patients.  To assess if there are drawbacks to outpatient care of pulmonary embolism, 19 emergency departments in Europe took part in a so-called ‘non-inferiority’ study.  The results are published in the Lancet.

Patients with acute pulmonary embolism, who were at a low risk of death, were randomly assigned to initial outpatient treatment (i.e. discharged from hospital within 24 hours) or inpatient treatment.  In both cases, treatment consisted of subcutaneous injections of enoxaparin – a heparin product – for at least 5 days, followed by oral anticoagulation (e.g. warfarin) for at least 3 months.  (The ‘low risk of death’ was determined using a validated clinical index.)

Of the 344 eligible patients enrolled, one of 171 outpatients developed a recurrent venous thromboembolism, compared with none of the 168 inpatients.  One patient in each group died within 90 days.  Three of the outpatients but none of the inpatients had major bleeding within 14 days.  These findings showed that safety and effectiveness of outpatient treatment was not statistically inferior to inpatient treatment.  Patients were reported to prefer the outpatient treatment compared to an average 4 days of hospitalization.  And it is clearly a cheaper option.  A win-win situation, if you’re in the low-risk group . . .