Home Treatment of Pulmonary Embolism in the Era of Novel Oral Anticoagulants

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• 作者：Paul D. Stein ; MD^a ; ^{steinp@msu.edu" class="auth_mail" title="E-mail the corresponding author} ; Fadi Matta ; MD^a ; Patrick G. Hughes ; DO^a ; ^b ; ^c ; Zak N. Hourmouzis ; MD^b ; Nina P. Hourmouzis ; MD^b ; Rachel M. White ; DO^a ; ^d ; Martina M. Ghiardi ; DO^c ; Matthew A. Schwartz ; MD^e ; Hillary L. Moore ; MD^e ; Jennifer A. Bach ; DO^f ; Robert E. Schweiss ; DO^f ; Viviane M. Kazan ; MD^e ; Edward J. Kakish ; DO^e ; Daniel C. Keyes ; MD^a ; ^f ; Mary J. Hughes ; DO^a ; ^d
• 关键词：Home treatment ; Oral anticoagulants ; Pulmonary embolism ; Venous thromboembolism
• 刊名：The American Journal of Medicine
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：129
• 期：9
• 页码：974-977
• 全文大小：234 K

文摘

Outpatient therapy of patients with acute pulmonary embolism has been shown to be safe in carefully selected patients. Problems related to the injection of low-molecular-weight heparin at home can be overcome by use of novel oral anticoagulants. The purpose of this investigation is to assess the prevalence of home treatment in the era of novel oral anticoagulants.

Methods

This was a retrospective cohort study of patients aged ≥18 years with acute pulmonary embolism seen in 5 emergency departments from January 2013 to December 2014.

Results

Pulmonary embolism was diagnosed in 983 patients. Among these, 237 were considered ineligible for home treatment because of instability or hypoxia. Home treatment was selected for 13 of 746 (1.7%) patients who were potentially eligible. Anticoagulant treatment for those treated at home was low-molecular-weight heparin or warfarin in 9 (69.2%) and novel oral anticoagulants in 4 (30.8%). Hospitalization was chosen for 733 of 746 (98.3%). Discharge in ≤2 days was in 119 patients (16.2%). Treatment of these patients was low-molecular-weight heparin or warfarin in 76 (63.9%), novel oral anticoagulants in 34 (28.6%), and in 9 (7.6%), anticoagulants were not given because of metastatic cancer or treatment was not known.

Conclusion

Even in the era of novel oral anticoagulants, the vast majority of patients with acute pulmonary embolism were hospitalized, and only a small proportion were discharged in ≤2 days. Although home treatment has been found to be safe in carefully selected patients, and scoring systems have been derived to identify those at low risk of adverse events, home treatment was infrequently selected.