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

• Published in: The American journal of medicine Vol. 129; no. 9; pp. 974 - 977
• Main Authors: Stein, Paul D., MD, Matta, Fadi, MD, Hughes, Patrick G., DO, Hourmouzis, Zak N., MD, Hourmouzis, Nina P., MD, White, Rachel M., DO, Ghiardi, Martina M., DO, Schwartz, Matthew A., MD, Moore, Hillary L., MD, Bach, Jennifer A., DO, Schweiss, Robert E., DO, Kazan, Viviane M., MD, Kakish, Edward J., DO, Keyes, Daniel C., MD, Hughes, Mary J., DO
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2016; Elsevier Sequoia S.A
• Subjects: Administration, Oral; Ambulatory Care - methods; Ambulatory Care - statistics & numerical data; Anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - therapeutic use; Drug therapy; Embolisms; Emergency Service, Hospital - statistics & numerical data; Female; Heparin, Low-Molecular-Weight - therapeutic use; Home treatment; Hospitalization; Hospitalization - statistics & numerical data; Humans; Internal Medicine; Male; Middle Aged; Oral anticoagulants; Pulmonary embolism; Pulmonary Embolism - drug therapy; Retrospective Studies; Venous thromboembolism; Warfarin - therapeutic use; home treatment; oral anticoagulants; pulmonary embolism; venous thromboembolism; Pulmonary embolism; Home treatment; Venous thromboembolism; Oral anticoagulants
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2016.03.035

Background Outpatient therapy of patients with acute pulmonary embolism has been shown to be is 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 – 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 and/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 and/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. Even though 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.