Last PE post, we discussed PEITHO, TOPCOAT, MOPPETT, and the lysis of massive and submassive PEs. So what do we do for the un-submassive and unmassive PEs?
The Outpatient Treatment of Pulmonary Embolism (OTPE) study compared outpatient vs inpatient treatment of low-risk patients with acute PE. Patients were treated with lovenox bridge to coumadin either as outpatient or inpatient (171 v. 168 patients). Patients were followed for 90 days, with follow up calls at days 1-7, 14, 30, 60, 90. Only 1 outpatient developed a recurrent VTE, two outpatients developed “major bleeding” within 2 weeks – both IM hematomas. Neither recurrent VTE or major bleeding between the two groups was statistically significant. Likewise, one person in each group died from non-VTE and nontreatment-related causes. 99% of participants completed the
Press-Ganey, satisifaction survey with 92% of outpatients and 95% of inpatients being satisfied or very satisfied with their care. As for bounce backs? Readmissions, ED visits, and PMD visits were similar in the two arms. The total number of home nursing visits was higher among outpatients (14% vs 6% of patients), but the mean time spent in the hospital was obviously greater for inpatients (3.9 days vs 0.6 days).
I question whether or not outpatient treatment at most facilities would be >90% satisfied, but certainly intriguing. Gazing into my crystal ball, I suspect the day will come when we are either admitting & providing lytics, or discharging from the ED on Xarelto / Pradaxa / other. For PE risk score, you may use Hestia or PESI .