Outpatient Clot Care Overlooked by Docs

Current practice guidelines suggest that certain low-risk patients with pulmonary embolism (PE) can be treated in the outpatient setting, but physicians rarely follow them. A new randomized, multicenter study shows that outpatient care can sometimes be used in place of inpatient care — reducing hospitalizations and costs.

“The findings support a shift in clinical management of PE for a substantial portion of low-risk patients, which may reduce hospitalizations and costs,” says Donald M. Yealy, MD, senior author of the study and chairman of the department of emergency medicine at the University of Pittsburgh School of Medicine.

Yealy and colleagues looked at more than 300 patients in 19 emergency departments in Switzerland, Belgium, France, and the United States who had been randomly assigned to inpatient or outpatient care between February 2007 and June 2010. These patients were stable and judged to have a low risk of death.

Outpatient care was as safe and as effective as inpatient care. One outpatient developed recurrent venous thromboembolism within 90 days. Of the patients who received inpatient care, none developed that condition.

Patient satisfaction rates regarding care were comparable, exceeding 90 percent for both groups, and both groups had essentially the same numbers of hospital readmissions, emergency department visits, and outpatient visits to a physician’s office within 90 days. However, the savings from reductions in hospital stays might be partially offset by increased frequency of home-nursing visits.

“Findings were consistent with previous research that show that outpatient care of PE is associated with low rates of recurrent venous thromboembolism, major bleeding, and death,” says Yealy. “Patients with PE prefer outpatient treatment, and these reassuring trial results should prompt physicians to consider such care more often for low-risk patients.”

Thomas Morrow, MD, a former medical director at Matria Health and a current member of the MANAGED CARE Editorial Board, says that while the study is optimistic, “There are issues like ensuring patient access to a pharmacy that stocks the medication, and patient compliance” that need to be addressed before a patient is considered a candidate.

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