Can patients with pulmonary embolism be managed as an outpatient?

Abstract

Suspected deep vein thrombosis (DVT) and pulmonary embolism (PE) are two of the commonest presentations to hospitals. Increasingly, physicians are comfortable in managing DVT as an outpatient especially with the arrival of non-vitamin K based anticoagulants which have facilitated this approach. However, most patients who are confirmed to have a PE are still managed as an inpatient. Is there a possibility that at least some of these patients can be managed for their thrombotic condition out of hospital? First, it would be useful to ascertain whether outpatient management of PE is necessary. The diagnosis of PE is increasing due to several reasons. This is primarily due to an increased awareness of this condition, especially in high-risk population including those who recently had surgery or prolonged periods of immobility and those with chronic medical conditions. Second, there are an increased number of requests for computerized tomography (CT) of the thorax; for staging of newly diagnosed malignancy and to exclude pathology for non-specific symptoms for the fear of medico-legal consequences.1 These scans are picking up two types of PE—‘incidental’ PE defined as evidence of thrombosis detected on imaging studies performed for other indications such as cancer staging (1–2% of all CT thorax) and ‘sub-segmental’ PE which are clots restricted to the smaller segments of the pulmonary artery which may be of clinical consequence.2,3 Sub-segmental PE is the consequence of more sensitive CT imaging technique which has resulted in the incidence of emboli confined to sub-segmental arteries increasing from …