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Home treatment of patients with small to medium sized acute pulmonary embolism

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Abstract

Most patients with acute pulmonary embolism (PE) are still treated as inpatients. This is a retrospective cohort study of patients with acute PE, diagnosed using V/P SPECT between 2007 and 2011. Patients were treated at home if they were hemodynamically stable, did not require oxygen or parenteral analgetics, had no contraindications to anticoagulant treatment and V/P SPECT showed an extension of the PE of less than 40 %. The aim of the study was to evaluate the efficacy and safety of home treatment with our algorithm. During the study period 416 outpatients were diagnosed with acute symptomatic PE of whom in total 260 (62.5 %) were discharged home from the emergency unit and another 47 (11 %) within 24 h from admission. During 3 months follow-up one (0.3 %) patient had a recurrent thrombotic event. Eleven (3.6 %) patients had a major or clinically relevant bleed and the overall mortality was 2 % (n = 6). There were no PE-related mortality. Home treatment should be considered and is safe in the majority of hemodynamically stable outpatients with small to medium size PE, quantified using V/P SPECT.

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Abbreviations

INR:

International normalised ratio

LMHW:

Low molecular weight heparin

PE:

Pulmonary embolism

V/P SPECT:

Ventilation/perfusion single photon emission tomography

sPESI:

Simplified pulmonary embolism severity index

VTE:

Venous thromboembolism

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Acknowledgments

The authors would like to thank Berit Olsson and Alaa al Hadad for helping in the collection of data. Carl-Gustav Olsson for taking care of patients and implementing the algorithm. This study was supported by grants from the Research Funds at Skåne University Hospital and the Swedish state under the LUA/ALF agreement.

Conflict of interest

The authors state that they have no conflict of interest.

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Authors and Affiliations

  1. Vascular Center, Skåne University Hospital, Ruth Lundskogs Gata 10, 205 02, Malmö, Sweden

    J. E. Elf

  2. Lund University, Lund, Sweden

    J. E. Elf, J. Jögi & M. Bajc

  3. Center for Medical Imaging and Clinical Physiology, Lund University Hospital, Lund, Sweden

    J. Jögi & M. Bajc

Authors
  1. J. E. Elf
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  2. J. Jögi
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  3. M. Bajc
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Correspondence to J. E. Elf.

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Elf, J.E., Jögi, J. & Bajc, M. Home treatment of patients with small to medium sized acute pulmonary embolism. J Thromb Thrombolysis 39, 166–172 (2015). https://doi.org/10.1007/s11239-014-1097-y

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  • DOI: https://doi.org/10.1007/s11239-014-1097-y

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