Key Points
- To evaluate whether low-risk emergency department patients diagnosed with deep vein thrombosis or pulmonary embolism can be safely discharged for immediate home treatment with rivaroxaban.
- Prospective study involving 106 low-risk emergency department patients diagnosed with deep vein thrombosis (DVT) or pulmonary embolism (PE) across two urban emergency departments.
- Low-risk status was classified using modified Hestia criteria, and enrolled patients were discharged home on rivaroxaban with clinic follow-up at 2 to 5 weeks and 3 to 6 months.
- Outcomes included venous thromboembolism (VTE) recurrence and major or clinically relevant nonmajor bleeding over a mean follow-up of 389 days.
- Among 106 treated patients (68% DVT, 28% PE, 5% both), 0 patients experienced VTE recurrence while on therapy (0%, 95% CI 0% to 3.4%).
- No patients experienced major or clinically relevant nonmajor bleeding while receiving rivaroxaban therapy (0%, 95% CI 0% to 3.4%).
- Three patients (2.8%, 95% CI 1% to 8%) experienced recurrent DVT after the cessation of rivaroxaban treatment.
Structured PICO
Does immediate discharge and home treatment with rivaroxaban prevent VTE recurrence and bleeding in patients with low-risk venous thromboembolism?
PPopulation106 patients with low-risk venous thromboembolism (deep vein thrombosis and/or pulmonary embolism) diagnosed in two urban U.S. emergency departments. Low-risk was determined by a modified version of the Hestia criteria.
IInterventionImmediate discharge and home treatment with rivaroxaban, with clinic follow-up at 2 to 5 weeks and 3 to 6 months.
OOutcomeVenous thromboembolism (VTE) recurrence or major/clinically relevant nonmajor bleeding during treatment.hard clinical
Immediate discharge and home treatment with rivaroxaban for low-risk VTE appears safe and effective, with no recurrences or major bleeding observed during therapy in this cohort.