The decision to hospitalize patients with acute pulmonary embolism (PE) or treat them as outpatients remains controversial, but according to a study published in the Journal of Thrombosis and Haemostasis, outpatient management of hemodynamically stable PE is associated with a lower rate of adverse events (AEs) compared with hospitalization.
“If confirmed [in further studies], [outpatient treatment] may be considered as firstline management in patients not requiring specific in-hospital care, regardless of their initial risk stratification, if proper outpatient care can be provided,” the authors, led by Pierre-Marie Roy, MD, PhD, from the Emergency Department at CHU Angers in France, said.
Dr. Roy and colleagues conducted a retrospective, propensity score-matched, cohort analysis of 1,081 patients with acute PE (576 were treated as inpatients and 505 were outpatients) to determine if there was a net clinical benefit of hospitalization versus outpatient management.
The 14-day rate of AEs (the study’s primary endpoint) was 13.0 percent for inpatients versus 3.3 percent for outpatients (adjusted odds ratio [OR] = 5.07; 95% CI 1.68-15.28; p value not reported). This trend persisted at three-month follow-up, with an AE rate of 21.7 percent for inpatients and 6.9 percent for outpatients (OR=4.90; 95% CI 2.62-9.17; p value not reported).
The authors also found that outpatient treatment was safer than hospitalization for a subgroup of 597 high-risk patients (defined as Pulmonary Embolism Severity Index class 3-5). The 14-day rate of AEs was 16.5 percent for inpatients and 4.5 percent for outpatients (OR=4.16; 95% CI 1.2-14.35; p value not reported).
The variation in types of inpatient and outpatient management in the study centers could limit the generalizability of the study’s results, the authors noted.
Source: Roy PM, Corsi DJ, Carrier M, et al. Net clinical benefit of hospitalization versus outpatient management of patients with acute pulmonary embolism. J Thromb Haemost. 2017 January 20. [Epub ahead of print]