Efficacy and Safety of Outpatient Management, Early and Standard Discharge Approaches in Low and Intermediate-Low Risk Patients with Pulmonary Embolism

Outpatient management and early discharge for patients with pulmonary embolism (PE) who are at low and intermediate-low risk for early mortality are emerging approaches that are gaining increased attention. Objective. This study aims to evaluate the efficacy and safety of different management strategies for patients with PE: early hospital discharge, outpatient care, and standard inpatient treatment. Material and methods. The study cohort comprised 127 patients recently diagnosed with PE, categorized into those with hospital stays of 3–4 days (early discharge) or 5 days or more (standard inpatient treatment), as well as patients receiving outpatient care. The primary efficacy outcome measured was the incidence of symptomatic recurrent venous thromboembolism (VTE) and/or VTE-related death following the initiation of anticoagulant therapy. The primary safety outcome assessed was the bleeding rate, along with evaluations of VTE-related and all-cause mortality rates. Results. The outpatient group included 50 patients, the early discharge group 37, and the standard inpatient group 40. The mean ages were 65±10, 63.6±12.1, and 61.5±12.4 years, respectively. No fatal VTE recurrences were reported in any group. Bleeding rates were 2% (1 patient) in the outpatient group, 5.4% (2 patients) in the early discharge group, and 0% in the standard inpatient group (p=1). Re-admission rates were similar across the groups: 2 patients (4%) in the outpatient group, 1 patient (2.7%) in the early discharge group, and 1 patient (2.5%) in the standard inpatient group (p=1). The rates of VTE recurrence were comparable among the groups. Chronic heart failure emerged as the only potential predictor for VTE recurrence (odds ratio [OR] 5.02; 95% confidence interval [CI] 1.03–24.51). Outpatient management did not lead to an increased rate of VTE recurrence (OR 0.63; 95% CI 0.12–3.35). Conclusion. Both outpatient management and early discharge for hemodynamically stable patients with PE at low and intermediate-low risk of 30-day mortality are safe and effective alternatives to standard inpatient treatment.