Outpatient Treatment of Hemodynamically Stable Patients with Pulmonary Embolism

Objective. To evaluate the efficacy and safety of outpatient treatment of pulmonary embolism (PE) using standard anticoagulant therapy (ACT) with direct oral anticoagulants. Material and methods. A prospective, observational study was conducted in patients with PE. The analysis included fifty patients with a first-time diagnosis of PE who received outpatient treatment. Outpatient management was defined as discharge from the emergency (diagnostic) department after completion of additional evaluation and confirmation of PE. The primary outcomes were the incidence of symptomatic recurrent venous thromboembolism (VTE) and bleeding events following initiation of ACT. Secondary outcomes included VTE-related mortality and all-cause mortality, readmission to emergency departments, and non-adherence to ACT. Results. The mean age of patients was 65±10 years, with a predominance of women (n=29; 58%). The most common presenting symptoms were lower extremity edema (24%) and dyspnea (16%). PE involved the segmental and subsegmental pulmonary arteries in 84% of patients, submassive PE was diagnosed in 10% of subjects, and massive PE — in 4%. Furthermore, 44 (88%) of patients developed PE in addition to oncological disease. Recurrent VTE within 3 months was observed in 1 (2%) patient. No major or clinically relevant bleeding events occurred, and minor bleeding was reported in 1 (2%) patient. Non-adherence to ACT was noted in 2 (4%) patients. During the study, five deaths (10%) occurred, none of which were VTE-related. Conclusion. Outpatient management of hemodynamically stable patients with pulmonary embolism is effective and safe when proper risk stratification and careful evaluation of individual complication risks are ensured.