It may be unnecessary to exclude these patients in future treatment protocols. All-cause death occurred in 1.7% of patients in both groups (odds ratio, 1.0; 95% CI, 0.11-8.7).26  These observations suggest that the hemodynamic profile of a patient (ie, the severity of RV overload and the resulting hemodynamic response) rather than just an abnormal RV/LV ratio or NT-proBNP is intrinsically taken into account in the decision to treat patients at hospital or at home when applying the Hestia criteria. Five (22%) of the 23 patients were discharged the same day from the intensive care unit (ICU) following thrombolysis completion. Echocardiography and biochemical predictive tests were not performed routinely as part of the present study since neither was routinely available in the study centres at the time the study commenced. Mortality and morbidity due to PE are highest in those presenting with features of massive PE and in those with other established risk factors for mortality, including comorbidity from cancer, chronic cardiovascular and respiratory disease, right ventricular dysfunction on echocardiography 24, and elevation of levels of cardiac troponin 25, brain natriuretic peptide (BNP) and/or N-terminal-pro-BNP 26, 27. Outpatient treatment after early discharge was highly acceptable to patients, and use of once-daily tinzaparin required no significant laboratory monitoring. Early discharge and outpatient management of pulmonary embolism appears safe and acceptable in selected low-risk patients, and can be implemented using existing outpatient deep venous thrombosis services. The results from phase 1 suggested that early discharge and outpatient anticoagulation therapy may be suitable for nearly half of all patients with confirmed PE. Heart medicine: These medicines may be given to make your heartbeat stronger or more regular, or to lower your blood pressure. A deep vein thrombosis (DVT) is a blood clot in a large vein deep in a leg, arm, or elsewhere in the body. Such patients may even prefer being at home surrounded by relatives over hospital admission. In absence of an alternative explanation, 1 YEARS item was awarded (PE most likely diagnosis), and a d-dimer test was ordered.12  Because the d-dimer level was above the threshold (782 ng/mL; threshold, 500 ng/mL), a computed tomography pulmonary angiography was ordered showing a segmental PE in the left lower lobe. research staff and clinical nurse specialists) and if all patients are reviewed for potential early discharge. 13 highlighted this difficulty. This is a major limitation and should be considered in future studies attempting to stratify the risk associated with outpatient treatment of PE. Patients were highly satisfied with outpatient management; 144 (96.6%) indicated that they would prefer treatment as outpatients for a subsequent pulmonary embolism. This is a very reasonable approach in practice-based conditions as well. Frederikus A. Klok, Menno V. Huisman; When I treat a patient with acute pulmonary embolism at home. The patient is a 40-year-old COVID-19 positive male that presented to the emergency department eight days after his discharge with shortness of breath and diaphoresis. Home treatment is feasible and safe in selected patients with acute pulmonary embolism (PE) and is associated with a considerable reduction in health care costs. A similar level of support should be possible in centres wishing to implement outpatient anticoagulation therapy for PE using existing DVT nurse-led services and on-call medical staff. This concern is similar to that seen during the development of outpatient DVT management during the late 1990s, and may have influenced the ability to enter all suitable patients with PE into the present study. This score uses clinical parameters in combination with age, male sex and risk factors, such as cardiorespiratory disease and cancer. If PESI is used, parameters of the hemodynamic profile of the patients are included in the risk stratification, but RV function is not. The second one involves dedicated outpatient follow-up including sufficient patient education and facilities for specialized follow-up visits. Patients were excluded if: 1) Anticoagulation status was not documented at time of discharge; 2) There was an inability to identify the patient on a social security index; 3) There was previous IVC filter placement; 4) There was retrieval of IVC filter within one year; 5) There was confirmation of pulmonary embolism by an outside facility; 6) There was active malignancy; 7) The patient … The patient remained clinically stable during the following days, allowing a progressive reduction of the flow. Clinical guidelines recommend early discharge of patients with low-risk pulmonary embolism (LRPE). Mostly, patients are saved a hospital admission, which may lead to less anxiety, better quality of life, and higher patient satisfaction. Her physical examination and electrocardiogram were unremarkable. The patient was hemodynamically stable and required no other treatment than (oral) anticoagulation. Does the patient have severe liver impairment? Their presentation, hospital courses, complications, and follow-up are reviewed. Both home treatment and early discharge involve a much shorter hospitalization than the 7 to 14 days that has been described as the mean admission duration in several European countries.13  In the United States, the median duration of hospital admission for PE was reported to be close to a week.14. The first one concerns the selection of patients for home treatment. CT pulmonary angiography showing acute pulmonary embolism. Severe pain needing intravenous pain medication for more than 24 h? This is a pulmonary embolism (PE). Clinical guidelines recommend early discharge of patients with low-risk pulmonary embolism (LRPE). Diagnosis of pulmonary embolism in hospitalised patients: retrospective survey of an institutional standard. Kovacs et al. While performing the present study, the present authors were aware of the apprehension of medical colleagues concerning the safety of outpatient PE management. 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