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• W2003203854 abstract "Drahomir Aujesky and colleagues1Aujesky D Roy PM Verschuren F et al.Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial.Lancet. 2011; 378: 41-48Summary Full Text Full Text PDF PubMed Scopus (453) Google Scholar conclude that outpatient treatment of pulmonary embolism can be safely used when 30-day mortality is expected to be very low (0–1·6%) or low (1·7–3·5%) on the basis of the pulmonary embolism severity index (PESI).2Aujesky D Obrosky DS Stone RA et al.Derivation and validation of a prognostic model for pulmonary embolism.Am J Respir Crit Care Med. 2005; 172: 1041-1046Crossref PubMed Scopus (807) Google Scholar The PESI was implemented in an attempt to assess whether outpatient management or early hospital discharge of patients with pulmonary embolism identified as at very low risk (class I) or low risk (class II) of early death could reduce costs without added risk. In Aujesky and colleagues' trial, the duration of treatment with low-molecular-weight heparin was longer for patients in the outpatient group than for patients in the inpatient group. Therefore, it would be interesting to know whether cost savings from 3·4 days' reduction in hospital stay could outweigh increased costs from daily home nursing visits and longer use of low-molecular-weight heparin. In Aujesky and colleagues' trial, the mean PESI score was 54 in the outpatient group and 58 in the inpatient group. Given that a score of less than 66 is risk class I and of 66–85 is risk class II, use of outpatient treatment might only be appropriate for class I (very low risk) patients. Recurrent pulmonary emboli can occur despite appropriate anticoagulant treatment, most of which are detected in the first week of follow-up and are fatal.3Nijkeuter M Sohne M Tick LW et al.The natural course of hemodynamically stable pulmonary embolism: clinical outcome and risk factors in a large prospective cohort study.Chest. 2007; 131: 517-523Crossref PubMed Scopus (121) Google Scholar In another trial,4Otero R Uresandi F Jimenez D et al.Home treatment in pulmonary embolism.Thromb Res. 2010; 126: e1-e5Summary Full Text Full Text PDF PubMed Scopus (111) Google Scholar despite strict selection of patients with pulmonary embolism (132 assigned of 1016 screened), two patients (2·8%) died within 10 days of early discharge. I declare that I have no conflicts of interest. Outpatient treatment for pulmonary embolism – Authors' replyAlthough Michael Montalto's concept of the “hospital in the home” is interesting, we are unaware of any data to show that management of pulmonary embolism via this model offers a real safety benefit compared with less costly outpatient care, in particular with respect to bleeding complications. Assuming a mean traditional hospital length of stay of 6 days,1 only one major bleeding episode (an intramuscular haematoma on day 3) occurred in our trial, demonstrating the safety of our outpatient care approach in the acute phase of anticoagulation. Full-Text PDF" @default.
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• W2003203854 date "2011-11-01" @default.
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• W2003203854 title "Outpatient treatment for pulmonary embolism" @default.
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• W2003203854 doi "https://doi.org/10.1016/s0140-6736(11)61732-7" @default.
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