Key result
Outpatient DOAC therapy proves safe in low-risk PE, yielding zero bleeding hospitalizations over 16 months.
Why the study?
Diagnoses of pulmonary thromboembolism are becoming more common, creating a need for outpatient treatment, yet physicians rarely initiate outpatient management despite evidence of its safety and benefits.
May support outpatient DOAC use in low-risk PE but should not yet change practice; leaves open need for randomized confirmation.
Due to more common diagnoses of pulmonary thromboembolism in clinical practice, it is necessary to initiate outpatient treatments. Such a decision is based on the clinical picture, risk factors, risk of bleeding, comorbidities, laboratory findings, adherence, and social factors. Patients meeting PESI I, PESI II, and sPESI criteria of low mortality risk, as well as patients with a Hestia score 0, may start receiving outpatient treatment. Even though low-molecular-weight heparin (LMWH) and direct oral anticoagulants can be administered together, as well as LMWH and oral vitamin K antagonists, the gold standard is to use only new, direct oral anticoagulants. Outpatient treatment lasts at least 3 months, depending on several factors, first of all on risk factors reversibility. Doctors still rarely decide to start outpatient treatment of pulmonary thromboembolism, even though studies show that this kind of treatment is safe, that it reduces the number of unnecessary hospital admissions and risk of infections, cuts the costs, and enables a better quality of life.
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Laban et al. (2023) conducted a review in Pulmonary thromboembolism. Outpatient anticoagulation therapy (direct oral anticoagulants such as apixaban or rivaroxaban, or low-molecular-weight heparin plus vitamin K antagonists) vs. Inpatient hospitalization was evaluated. Outpatient anticoagulation with DOACs is safe for low-risk pulmonary embolism patients (PESI I/II, sPESI 0, Hestia 0), resulting in 0 hospitalizations for bleeding or non-compliance over 16 months.
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