Davies C W H, Wimperis J, Green E S, Pendry K, Killen J, Mehdi I, Tiplady C, Kesteven P, Rose P, Oldfield W
Royal Berkshire Hospital NHS Trust, Reading, UK.
Eur Respir J. 2007 Oct;30(4):708-14. doi: 10.1183/09031936.00140506. Epub 2007 Jun 13.
The aim of the present study was to assess whether patients with pulmonary embolism (PE) could be managed as outpatients after early discharge from hospital using low molecular weight heparin instead of remaining as in-patients until effective oral anticoagulation was achieved. Phase 1 of the study identified criteria for the safe discharge of selected patients; phase 2 treated a cohort of low-risk patients with PE as outpatients with tinzaparin using existing deep venous thrombosis services. In phase 1, 127 (56.4%) of 225 patients were considered unsuitable for outpatient management. Reasons included: admission for another medical reason; additional monitoring or requirement for oxygen; bleeding disorders; previous PE/further PE while on warfarin; co-existing major deep venous thrombosis; likelihood of poor compliance; significant immobility; and pregnancy. In phase 2, 157 patients with PE received outpatient anticoagulation therapy. There were no deaths, bleeding or recurrent thromboembolic events during acute treatment with low molecular weight heparin. The median (range) length of hospital stay was 1.0 (1-4) day, with a median saving of 5.0 (1-42) bed-days per patient. Patients were highly satisfied with outpatient management; 144 (96.6%) indicated that they would prefer treatment as outpatients for a subsequent pulmonary embolism. 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.
本研究的目的是评估肺栓塞（PE）患者在早期出院后使用低分子量肝素进行门诊治疗，而非住院直至实现有效的口服抗凝治疗是否可行。研究的第一阶段确定了选定患者安全出院的标准；第二阶段使用现有的深静脉血栓形成服务，将一组低风险PE患者作为门诊患者用替扎肝素进行治疗。在第一阶段，225名患者中有127名（56.4%）被认为不适合门诊治疗。原因包括：因其他医疗原因入院；需要额外监测或吸氧；出血性疾病；服用华法林时曾发生PE/再次发生PE；并存严重深静脉血栓形成；依从性差的可能性；严重行动不便；以及妊娠。在第二阶段，157名PE患者接受了门诊抗凝治疗。在使用低分子量肝素进行急性治疗期间，未发生死亡、出血或复发性血栓栓塞事件。住院时间中位数（范围）为1.0（1 - 4）天，每名患者平均节省床位5.0（1 - 42）天。患者对门诊治疗高度满意；144名（96.6%）表示他们更愿意在后续发生肺栓塞时接受门诊治疗。对于选定的低风险患者，肺栓塞的早期出院和门诊治疗似乎是安全且可接受的，并且可以利用现有的门诊深静脉血栓形成服务来实施。
