Outpatient Management of Stable Acute Pulmonary Embolism: Proposed Accelerated Pathway for Risk Stratification

• Published in: The American journal of medicine Vol. 120; no. 10; pp. S18 - S25
• Main Authors: AlMahameed, Amjad, MD, MPH, Carman, Teresa L., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2007; Elsevier Sequoia S.A
• Subjects: Algorithms; Ambulatory Care; Anticoagulants - administration & dosage; Anticoagulants - therapeutic use; Anticoagulation; Blood clots; Coagulation; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - therapeutic use; Humans; Internal Medicine; Medical treatment; Outpatients; Patient Selection; Pharmacotherapy; Practice Guidelines as Topic; Pulmonary arteries; Pulmonary embolism; Pulmonary Embolism - drug therapy; Reproducibility of Results; Risk Assessment; Risk stratification; Treatment; Treatment Outcome; Venous thromboembolism; Pulmonary embolism; Pharmacotherapy; Anticoagulation; Treatment; Venous thromboembolism; Risk stratification
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2007.08.010

Abstract Pulmonary embolism (PE) is a major health problem and a cause of worldwide morbidity and mortality. The current standard therapy for acute PE encourages admitting patients to the hospital for administration of parenteral anticoagulation therapy as a bridge to oral vitamin K antagonists. Prognostic models that identify patients with stable (nonmassive) acute PE (SPE) who are at low risk for adverse outcome have recently been reported. Based on these risk stratification models, hospital-based therapy is warranted for patients with PE who meet the criteria associated with a high risk for adverse outcome. However, a growing body of evidence suggests the feasibility of partial outpatient management and accelerated hospital discharge (AHD) in a subset of patients with SPE. Prospective validation of these risk stratification models for predicting patient suitability for AHD is needed.