CHEST Guidelines-Cautionary-Notes-About-Outpatient-Treatment-of-Acu

Cautionary-Notes-About-Outpatient-Treatment-of-Acu

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The article by Dr. Samuel Z. Goldhaber discusses the cautious approach towards outpatient treatment for acute pulmonary embolism (PE) compared to deep vein thrombosis (DVT). While DVT is non-lethal if the thrombus remains in the vein, PE can be fatal, causing hesitation in adopting outpatient treatment protocols for PE. Proper risk stratification is crucial for identifying suitable candidates for outpatient care, such as younger patients with stable right ventricular function and no significant comorbidities.<br /><br />Interest in the outpatient treatment of PE is higher in Europe compared to the United States due to differences in legal and healthcare system factors. Studies have explored the feasibility of home treatment, including the ongoing European HoT-PE trial with rivaroxaban, aiming to confirm the safety and effectiveness of outpatient treatment for low-risk PE patients.<br /><br />The article highlights a study conducted in Utah by Intermountain Healthcare, where patients were successfully treated without hospitalization. This trial emphasized quick risk stratification through echocardiography and venous ultrasound and enrolled only those with low risk, determined using the Pulmonary Embolism Severity Index (PESI). The study was successful, with only 1 out of 200 patients experiencing a major outcome related to PE treatment.<br /><br />Dr. Goldhaber emphasizes the importance of education about PE complications and risk factors for individuals considered for outpatient treatment. The article also contrasts the higher rate of medical malpractice lawsuits in states like New Jersey, which complicates the implementation of similar protocols there.<br /><br />Ultimately, the study underscores the potential of innovative, collaborative care approaches in transforming practices, making outpatient treatment a safe option for selected low-risk PE patients, potentially reshaping standard care practices for this condition.

Keywords

outpatient treatment

pulmonary embolism

deep vein thrombosis

risk stratification

HoT-PE trial

rivaroxaban

Pulmonary Embolism Severity Index

Intermountain Healthcare

medical malpractice

collaborative care