Pulmonary embolism discharge care and long term treatment
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Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Pulmonary embolism patients are at increased risk of a second attack of PE. If un-treated, almost 1/3 of the patients die, usually from recurrent PE. Therefore, a patient should be discharged only after proper diagnosis and discharge medication. Information pertaining to the safety of outpatient treatment of a 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]
Hemodynamic stability is not the criteria for discharge. Patients who are hemodynamically stable, but have 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) [3]. 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.