Saturday, November 19, 2016

PE Management

emDocs - November 18, 2016 - Authors: Long B and Koyfman A - Edited by: Santistevan J
  • Patients with confirmed PE are classically admitted for treatment and monitoring of anticoagulation, with over 90% managed in-hospital.
  • Literature suggests outpatient treatment is non-inferior, particularly with novel oral anticoagulants. Recurrent thromboembolism, risk of bleeding, and incidence of major adverse outcome are similar in patients treated as outpatient versus inpatient.
  • sPESI, PESI, and ESC possess strong literature support for outpatient PE stratification, with adequate sensitivity for predicting low risk adverse event.
  • The HAS-BLED score and Outpatient Bleeding Risk Index allow assessment of bleeding risk.
  • Patient compliance, presence of psychosocial barriers, or alternative need for admission should be considered in patient disposition. Consideration of these important aspects with risk stratification and use of NOAC therapy can allow for safe, efficacious treatment as outpatient."