Thuisbehandeling van patiënten met longembolie*

To evaluate the efficacy and safety of outpatient treatment according to predefined criteria (the Hestia criteria) in patients with acute pulmonary embolism.

Design

Cohort study conducted in 12 hospitals in the Netherlands (Dutch Trial Register NTR1319).

Method

Patients 18 years or older with acute pulmonary embolism were triaged for eligibility for outpatient treatment based on the 11 Hestia criteria. The treatment started with low-molecular-weight heparin (nadroparin) combined with vitamin K antagonists. All patients eligible for outpatient treatment according to the Hestia criteria were sent home either immediately or within 24 h after the pulmonary embolism was diagnosed. The primary outcome measure for the efficacy of outpatient treatment was recurrent venous thromboembolism during a 3-month period; secondary outcome measures were major haemorrhage and total mortality regardless of cause.

Results

During the 2008-2010 period, a total of 297 patients received outpatient treatment, comprising 51% of the patients with acute pulmonary embolism triaged according to the criteria. All patients completed the full 3-month follow-up period. Six patients (2.0%; 95%-CI: 0.8-4.3%) had recurrent venous thromboembolism, 1 of whom had deep venous thrombosis and 5 pulmonary embolism. Three patients died during the 3-month follow-up period; however, none from fatal pulmonary embolism. One patient died of intracranial haemorrhage; the other 2 patients died from a malignancy. In addition to the patient with intracranial bleeding, 1 other patient had a major bleeding event (0.7%; 95%-CI: 0.1-2.4%).

Conclusion

Outpatient anticoagulant treatment is potentially effective and safe for patients with acute pulmonary embolism who have been selected according to the Hestia criteria. These results need to be confirmed by a randomized controlled trial.

Conflict of interest: none declared. Financial support: The institution where W. Zondag and M. Huisman are employed received an unrestricted research grant from GlaxoSmithKline.