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Pulmonary embolism, Ambulatory treatment, Cost effectiveness
Objective: Evidence has emerged that out-patient management of pulmonary embolism may be an appropriate option in selected patients. This report is based on a safety data on a Pulmonary Embolism Ambulatory Treatment program.
Methods: An observational study in acute assessment unit from 2000-2006, of all consecutive patients with confirmed pulmonary embolism (high probability ventilation-perfusion scan or computerized tomography pulmonary angiography), have been evaluated. Exclusion criteria were oxygen saturation less than 92%; systolic blood pressure less than 100 mm Hg; significant cardiopulmonary or renal disease, and a bleeding risk. Patient treated initially with low molecular weight heparin followed by oral anticoagulants when diagnosis was confirmed and were assessed at 3 and 6 months.
Results: Sixty-one patients (33 females), median age 55 (range; 16-89 years) were eligible. Patients needed a maximum of 13 appointments. Risk factors included surgery (8.2%), cancer (8.2%), long travel (14.8%), previous thromboembolism (14.8%), hormonal replacement therapy (3.3%) and contraceptive pill (8.2%). No risk factor was identified at 37.7%. The mortality was zero at 6 months. No complications were recorded. Four patients required hospital admission, all within the first week; all were discharged within 24 hours. The median length of stay for patients with uncomplicated pulmonary embolism was 7 days; implementation of the pulmonary embolism ambulatory treatment program saved 427 bed days.
Conclusion: The pulmonary embolism ambulatory treatment program was cost-effective and was not associated with serious complications. Further evaluation of these programs could help establish the safety and cost-effectiveness of this approach.