NEW YORK (Reuters Health) – Selected low-risk patients with pulmonary embolism (PE) may be safely treated as outpatients or with early discharge (within 72 hours), a meta-analysis shows.
Although PE is traditionally treated in the hospital, in recent years several large studies and reviews have suggested that outpatient treatment in selected cases is as safe as standard inpatient care.
For the new meta-analysis, Dr. Wendy Zondag and colleagues from Leiden University Medical Center in The Netherlands pooled data from 15 published studies involving 2,296 low-risk patients.
Different methods were used to define PE patients as low risk – but the researchers say most of the studies used comparable clinical criteria to select patients for outpatient or early discharge treatment.
The pooled risks of recurrent venous thromboembolism (VTE) were comparable at 1.7% for outpatients, 1.1% for early discharge patients, and 1.2% for inpatients, according to a report online October 25 in the European Respiratory Journal.
The pooled risk of major bleeding was 0.97% among outpatients, 0.78% among those discharged early, and 1.0% among inpatients.
The pooled mortality risk was also similar for outpatients (1.9%), those discharged early (2.3%), and inpatients (0.74%), and there were no deaths from PE.
“The strength of this study is that it is the first meta-analysis on outpatient treatment in PE patients with pooled incidences of adverse clinical outcome,” the researchers note. “Although the results presented here indicate that outpatient treatment and early discharge may be as safe as treatment in the hospital, the level of evidence of the included studies remains limited.”
With regard to the heterogeneous criteria used to select patients in the studies they included, the authors add, “it is of utmost importance to define ‘low risk patients’ in a uniform manner in future studies.”
Dr. Zondag did not respond to a request for comments.
Eur Respir J 2012.