Department of General Practice, School for Public Health and Primary Care (CAPHRI) and Laboratory for Clinical Thrombosis and Haemostasis, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
J Thromb Haemost. 2010 Nov;8(11):2412-7. doi: 10.1111/j.1538-7836.2010.04041.x.
Data regarding outpatient treatment of pulmonary embolism (PE) is scarce. This study evaluates the safety of outpatient management of acute PE.
This is a retrospective cohort study of consecutive patients presenting at the Ottawa Hospital with acute PE diagnosed between 1 January 2007 and 31 December 2008. PE was defined as an arterial filling defect on CTPA or a high probability V/Q scan. Patients were managed as outpatients if they were hemodynamically stable, did not require supplemental oxygenation and did not have contraindications to low-molecular-weight heparin therapy.
In this cohort of 473 patients with acute PE, 260 (55.0%) were treated as outpatients and 213 (45.0%) were admitted to the hospital. The majority of the patients were admitted because of severe comorbidities (45.5%) or hypoxia (22.1%). No outpatient died of fatal PE during the 3-month follow-up period. At the end of follow-up, the overall mortality was 5.0% (95% CI, 2.7-8.4%). The rates of recurrent venous thromboembolism (VTE) in outpatients were 0.4% (95% CI, 0.0-2.1%) and 3.8% (95% CI, 1.9-7.0%) within 14 days and 3 months, respectively. The rates of major bleeding episodes were 0% (95% CI, 0-1.4%) and 1.5% (95% CI, 0.4-3.9%) within 14 days and 3 months, respectively. Four (1.5%) outpatients were admitted to the hospital within 14 days.
A majority of patients with acute PE can be managed as outpatients with a low risk of mortality, recurrent VTE and major bleeding episodes.
关于肺栓塞（PE）门诊治疗的数据很少。本研究评估了急性 PE 门诊管理的安全性。
这是一项回顾性队列研究，纳入了 2007 年 1 月 1 日至 2008 年 12 月 31 日期间在渥太华医院就诊的急性 PE 连续患者。PE 定义为 CTPA 上的动脉充盈缺损或高概率 V/Q 扫描。如果患者血流动力学稳定，不需要补充吸氧，并且没有低分子肝素治疗的禁忌症，则可以作为门诊患者进行管理。
在该队列中，473 例急性 PE 患者中，260 例（55.0%）接受门诊治疗，213 例（45.0%）住院治疗。大多数患者因严重合并症（45.5%）或缺氧（22.1%）住院。在 3 个月的随访期间，没有门诊患者死于致命性 PE。随访结束时，总体死亡率为 5.0%（95%CI，2.7-8.4%）。门诊患者在 14 天和 3 个月时分别发生复发性静脉血栓栓塞症（VTE）的发生率为 0.4%（95%CI，0.0-2.1%）和 3.8%（95%CI，1.9-7.0%）。主要出血事件的发生率分别为 0%（95%CI，0-1.4%）和 1.5%（95%CI，0.4-3.9%），在 14 天和 3 个月时。4 例（1.5%）门诊患者在 14 天内住院。
大多数急性 PE 患者可作为门诊患者进行管理，死亡率、复发性 VTE 和主要出血事件的风险较低。
