Pulmonary embolism discharge care and long term treatment
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [2]
Overview
Pulmonary embolism patient are at increased risk of second attack of PE (If un-treated almost 1/3 patient die, usually from recurrent PE) and therefore a patient should be discharged only after proper diagnosis and discharge medication. Information pertaining the safety of outpatient treatment of pulmonary embolism is still inadequate due to the lack of a randomized control trial comparing in-patient and outpatient management.
Discharge criteria
High-risk PE patients have a 30-day mortality of greater than 15%, and thus hospital admission is necessary[1].
Hemodynamically stability is not the criteria for discharge, patients who are hemodynamically stable but with right ventricular dysfunction should be admitted.
Patients having a low-risk score and do not require supplemental oxygen are potential candidates for early discharge and outpatient treatment. Patients with absent Right ventricular dysfunction and a normal troponin level can be discharged and put on out-patient treatment[2].
Discharge medications
- Outpatient administration of LMWH is as safe as unfractionated heparin administered in hospital for the treatment of DVT.
- An ongoing trial is discussing whether or not to withhold anticoagulation among patient with subsegmental PE. (ClinicalTrials.gov number, NCT01455818). The result of this trial will further enlighten physicians about discharge care in PE patients.
References
- ↑ Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, Bengel F, Brady AJ, Ferreira D, Janssens U, Klepetko W, Mayer E, Remy-Jardin M, Bassand JP (2008). "Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)". Eur. Heart J. 29 (18): 2276–315. doi:10.1093/eurheartj/ehn310. PMID 18757870. Retrieved 2011-12-07. Unknown parameter
|month=ignored (help) - ↑ Agnelli G, Becattini C (2010). "Acute pulmonary embolism". N Engl J Med. 363 (3): 266–74. doi:10.1056/NEJMra0907731. PMID 20592294.