Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study |
| |
Authors: | W. ZONDAG I. C. M. MOS D. CREEMERS‐SCHILD A. D. M. HOOGERBRUGGE O. M. DEKKERS J. DOLSMA M. EIJSVOGEL L. M. FABER H. M. A. HOFSTEE M. M. C. HOVENS G. J. P. M. JONKERS K. W. van KRALINGEN M. J. H. A. KRUIP T. VLASVELD M. J. M. DE VREEDE M. V. HUISMAN ON BEHALF OF THE HESTIA STUDY INVESTIGATORS |
| |
Affiliation: | 1. Section of Vascular Medicine, Department of General Internal Medicine‐Endocrinology, LUMC, Leiden;2. Department of General Internal Medicine, Haga Hospital, The Hague;3. Department of Pulmonology, Spaarne Hospital, Hoofddorp;4. Department of Epidemiology, LUMC;5. Department of Pulmonology, Diaconessenhuis, Leiden;6. Department of Pulmonology, Medical Spectrum Twente, Enschede;7. Department of General Internal Medicine, Rode Kruis Hospital, Beverwijk;8. Department of Internal Medicine, VU University Medical Center, Amsterdam;9. Department of General Internal Medicine, Rijnstate Hospital, Arnhem;10. Department of General Internal Medicine, Rijnland Hospital, Leiderdorp;11. Department of Pulmonology, LUMC, Leiden;12. Department of Hematology, Erasmus Medical Center, Rotterdam;13. Department of General Internal Medicine, Bronovo Hospital, The Hague;14. Department of General Internal Medicine, Haaglanden Medical Center, The Hague, the Netherlands |
| |
Abstract: | Summary. 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: A prospective cohort study of patients with objectively proven acute PE was conducted in 12 hospitals in The Netherlands between 2008 and 2010. Patients with acute PE were triaged with the predefined criteria for eligibility for outpatient treatment, with LMWH (nadroparin) followed by vitamin K antagonists. All patients eligible for outpatient treatment were sent home either immediately or within 24 h after PE was objectively diagnosed. Outpatient treatment was evaluated with respect to recurrent venous thromboembolism (VTE), including PE or deep vein thrombosis (DVT), major hemorrhage and total mortality during 3 months of follow‐up. Results: Of 297 included patients, who all completed the follow‐up, six (2.0%; 95% confidence interval [CI] 0.8–4.3) had recurrent VTE (five PE [1.7%] and one DVT [0.3%]). Three patients (1.0%, 95% CI 0.2–2.9) died during the 3 months of follow‐up, none of fatal PE. Two patients had a major bleeding event, one of which was fatal intracranial bleeding (0.7%, 95% CI 0.08–2.4). Conclusion: Patients with PE selected for outpatient treatment with predefined criteria can be treated with anticoagulants on an outpatient basis. (Dutch Trial Register No 1319; http://www.trialregister.nl/trialreg/index.asp ). |
| |
Keywords: | home treatment outpatient treatment pulmonary embolism venous thromboembolism |
|
|