Mounting Evidence for Safe Home Treatment of Selected Patients With Acute Pulmonary Embolism
Authors: Paul D. Stein, Mary J. Hughes
Journal: Annals of Internal Medicine (2018)

Editorials18 December 2018Mounting Evidence for Safe Home Treatment of Selected Patients With Acute Pulmonary EmbolismPaul D. Stein, MD and Mary J. Hughes, DOPaul D. Stein, MDMichigan State University College of Osteopathic Medicine, East Lansing, Michigan (P.D.S., M.J.H.)Search for more papers by this author and Mary J. Hughes, DOMichigan State University College of Osteopathic Medicine, East Lansing, Michigan (P.D.S., M.J.H.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-2869 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Home treatment of pulmonary embolism (PE) is much preferred by patients: Most (88%) who received home treatment would choose it again rather than hospitalization (1). It is also clearly cost-effective: If all eligible patients with PE seen in U.S. emergency departments were treated at home rather than in the hospital, health care costs would decrease by $1 billion per year (2). The evidence for safe home treatment of low-risk patients with acute PE is substantial. Then why are so few—6.0% of stable patients on average throughout the United States—selected for home treatment (3)? The answer may relate to the difficulty ...References1. Bledsoe JR, Woller SC, Stevens SM, Aston V, Patten R, Allen T, et al. Management of low-risk pulmonary embolism patients without hospitalization: the low-risk pulmonary embolism prospective management study. Chest. 2018;154:249-56. [PMID: 29410163] doi:10.1016/j.chest.2018.01.035 CrossrefMedlineGoogle Scholar2. Dalen JE, Dalen JE. Unnecessary hospitalizations for pulmonary embolism: impact on US health care costs [Editorial]. Am J Med. 2016;129:899-900. [PMID: 27143322] doi:10.1016/j.amjmed.2016.03.041 CrossrefMedlineGoogle Scholar3. Stein PD, Matta F, Hughes MJ. National trends in home treatment of acute pulmonary embolism. Clin Appl Thromb Hemost. 2018;24:115-21. [PMID: 27789604] doi:10.1177/1076029616674827 CrossrefMedlineGoogle Scholar4. Vinson DR, Mark DG, Chettipally UK, Huang J, Rauchwerger AS, Reed ME, et al; eSPEED Investigators of the KP CREST Network. Increasing safe outpatient management of emergency department patients with pulmonary embolism. A controlled pragmatic trial. Ann Intern Med. 2018;169:855-65. doi:10.7326/M18-1206 LinkGoogle Scholar5. Aujesky D, Obrosky DS, Stone RA, Auble TE, Perrier A, Cornuz J, et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med. 2005;172:1041-6. [PMID: 16020800] CrossrefMedlineGoogle Scholar6. Zondag W, Mos IC, Creemers-Schild D, Hoogerbrugge AD, Dekkers OM, Dolsma J, et al; Hestia Study Investigators. Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study. J Thromb Haemost. 2011;9:1500-7. [PMID: 21645235] doi:10.1111/j.1538-7836.2011.04388.x CrossrefMedlineGoogle Scholar7. Kovacs MJ, Anderson D, Morrow B, Gray L, Touchie D, Wells PS. Outpatient treatment of pulmonary embolism with dalteparin. Thromb Haemost. 2000;83:209-11. [PMID: 10739374] CrossrefMedlineGoogle Scholar8. Goldhaber SZ. Cautionary notes about outpatient treatment of acute pulmonary embolism [Editorial]. Chest. 2018;154:233-4. [PMID: 30080496] doi:10.1016/j.chest.2018.02.010 CrossrefMedlineGoogle Scholar9. Barco S, Lankeit M, Binder H, Schellong S, Christ M, Beyer-Westendorf J, et al. Home treatment of patients with low-risk pulmonary embolism with the oral factor Xa inhibitor rivaroxaban. Rationale and design of the HoT-PE Trial. Thromb Haemost. 2016;116:191-7. [PMID: 27010343] doi:10.1160/TH16-01-0004 CrossrefMedlineGoogle Scholar10. Singer AJ, Xiang J, Kabrhel C, Merli GJ, Pollack C, Tapson VF, et al. Multicenter trial of rivaroxaban for early discharge of pulmonary embolism from the emergency department (MERCURY PE): rationale and design. Acad Emerg Med. 2016;23:1280-6. [PMID: 27537530] doi:10.1111/acem.13072 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Michigan State University College of Osteopathic Medicine, East Lansing, Michigan (P.D.S., M.J.H.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2869.Corresponding Author: Paul D. Stein, MD, Michigan State University College of Osteopathic Medicine, Department of Osteopathic Medical Specialties, 909 Wilson Road, B 305 West Fee, East Lansing, MI 48824; e-mail, [email protected]edu.Current Author Addresses: Drs. Stein and Hughes: Michigan State University College of Osteopathic Medicine, Department of Osteopathic Medical Specialties, 909 Wilson Road, East Lansing, MI 48824.This article was published at Annals.org on 13 November 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIncreasing Safe Outpatient Management of Emergency Department Patients With Pulmonary Embolism David R. Vinson , Dustin G. Mark , Uli K. Chettipally , Jie Huang , Adina S. Rauchwerger , Mary E. Reed , James S. Lin , Mamata V. Kene , David H. Wang , Dana R. Sax , Tamara S. Pleshakov , Ian D. McLachlan , Cyrus K. Yamin , Andrew R. Elms , Hilary R. Iskin , Ridhima Vemula , Donald M. Yealy , Dustin W. Ballard , and Metrics Cited byDecision-Making in the Management of Venous ThromboembolismTratamiento domiciliario de la enfermedad tromboembólica venosaStop the Clot: Should Emergency Clinicians Champion Stroke Prevention and Prescribe Anticoagulation for Patients With Atrial Fibrillation?Clinical decision support tool in ED increases outpatient PE management 18 December 2018Volume 169, Issue 12Page: 881-882KeywordsComputersEmergency departmentHealth careOutpatientsPatientsPulmonary embolismSafetySafety studiesUltrasound imaging ePublished: 13 November 2018 Issue Published: 18 December 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...