Elf J E, Jögi J, Bajc M
Vascular Center, Skåne University Hospital, Ruth Lundskogs Gata 10, 205 02, Malmö, Sweden,
J Thromb Thrombolysis. 2015 Feb;39(2):166-72. doi: 10.1007/s11239-014-1097-y.
Most patients with acute pulmonary embolism (PE) are still treated as inpatients. This is a retrospective cohort study of patients with acute PE, diagnosed using V/P SPECT between 2007 and 2011. Patients were treated at home if they were hemodynamically stable, did not require oxygen or parenteral analgetics, had no contraindications to anticoagulant treatment and V/P SPECT showed an extension of the PE of less than 40%. The aim of the study was to evaluate the efficacy and safety of home treatment with our algorithm. During the study period 416 outpatients were diagnosed with acute symptomatic PE of whom in total 260 (62.5%) were discharged home from the emergency unit and another 47 (11%) within 24 h from admission. During 3 months follow-up one (0.3%) patient had a recurrent thrombotic event. Eleven (3.6%) patients had a major or clinically relevant bleed and the overall mortality was 2% (n = 6). There were no PE-related mortality. Home treatment should be considered and is safe in the majority of hemodynamically stable outpatients with small to medium size PE, quantified using V/P SPECT.
大多数急性肺栓塞（PE）患者仍作为住院患者接受治疗。这是一项对2007年至2011年间使用V/P SPECT诊断的急性PE患者的回顾性队列研究。如果患者血流动力学稳定，不需要吸氧或胃肠外镇痛药，没有抗凝治疗的禁忌证且V/P SPECT显示PE扩展小于40%，则在家中接受治疗。本研究的目的是评估采用我们的方案进行家庭治疗的疗效和安全性。在研究期间，416例门诊患者被诊断为急性症状性PE，其中共有260例（62.5%）从急诊科出院回家，另有47例（11%）在入院后24小时内出院。在3个月的随访期间，1例（0.3%）患者发生复发性血栓事件。11例（3.6%）患者发生大出血或具有临床相关性的出血，总死亡率为2%（n = 6）。没有与PE相关的死亡。对于大多数血流动力学稳定、使用V/P SPECT定量为中小规模PE的门诊患者，应考虑家庭治疗且这种治疗是安全的。
