Aujesky D, Roy PM, Verschuren F et al. Lancet 2011;378:41–8.
The present study was carried out to assess the effectiveness, safety, and efficiency of outpatient versus inpatient care for low-risk (Pulmonary Embolism Severity Index score class I or II) patients with acute, symptomatic pulmonary embolism. Outpatient treatment included twice-daily injections of enoxoparin followed by early initiation of oral anticoagulation with vitamin K antagonists. Similar treatment was offered for the inpatients. The authors found that outpatient treatment was not inferior to inpatient treatment for the recurrence of symptomatic, objectively confirmed venous thromboembolism within 90 days of randomization. Furthermore, the study showed non-inferiority for major bleeding at 14 days but not for 90 days.
Treatment for symptomatic pulmonary embolism (PE) is mainly in-hospital based. In the recent literature, home-based outpatient care has been proposed for selected hemodynamically stable PE patients. However, previous studies of outpatient care for patients with PE were restricted by their small sample sizes, retrospective designs, and the absence of a randomized control group for comparison with inpatient care.