Dept. of Thrombosis and Haemostasis, Leiden University Medical Centre, the Netherlands.
Eur Respir J. 2013 Mar;41(3):588-92. doi: 10.1183/09031936.00030412. Epub 2012 Jul 12.
We investigated whether the clinical criteria used in the Hestia study for selection of pulmonary embolism (PE) patients for outpatient treatment could discriminate PE patients with high and low risk for adverse clinical outcome. We performed a cohort study with PE patients who were triaged with 11 criteria for outpatient treatment. Patients not eligible for outpatient treatment were treated in hospital. Study outcomes were recurrent venous thromboembolism, major bleeding and all-cause mortality during 3 months. In total, 530 patients were included, of which 297 were treated at home. In the outpatient group, six patients (2.0%, 95% CI 0.7-4.3%) had recurrent venous thromboembolism versus nine in-patients (3.9%, 95% CI 1.9-7.0%). Three patients (1.0%, 95% CI 0.2-2.9) died during the 3-months follow-up in the outpatient group versus 22 patients (9.6%, 95% CI 6.3-14) in the in-patient group (p<0.05). None of the outpatients died as a result of fatal PE versus five (2.2%) in-patients (p<0.05). In the outpatient group, 0.7% (95% CI 0.08-2.4) had major bleeding events versus 4.8% (95% CI 2.4-8.4) of in-patients (p<0.05). This study showed that the Hestia criteria can discriminate PE patients with low risk from patients with high risk for adverse clinical outcome. The low-risk patients can safely be treated at home.
我们研究了 Hestia 研究中用于选择肺栓塞（PE）患者进行门诊治疗的临床标准是否可以区分具有高和低不良临床结局风险的 PE 患者。我们进行了一项队列研究，纳入了使用 11 项标准进行门诊治疗的 PE 患者。不符合门诊治疗条件的患者在医院接受治疗。研究结果是 3 个月内复发性静脉血栓栓塞、大出血和全因死亡率。共有 530 例患者入组，其中 297 例在家治疗。在门诊组中，有 6 例（2.0%，95%CI 0.7-4.3%）发生复发性静脉血栓栓塞，而 9 例在住院患者（3.9%，95%CI 1.9-7.0%）。门诊组 3 例（1.0%，95%CI 0.2-2.9%）在 3 个月随访期间死亡，而住院组 22 例（9.6%，95%CI 6.3-14）（p<0.05）。在门诊组中，无患者因致命性 PE 死亡，而住院组有 5 例（2.2%）（p<0.05）。在门诊组中，0.7%（95%CI 0.08-2.4%）发生大出血事件，而住院组为 4.8%（95%CI 2.4-8.4%）（p<0.05）。本研究表明，Hestia 标准可以区分具有低风险和高风险不良临床结局的 PE 患者。低风险患者可以安全地在家中接受治疗。
