The median length of hospitalization was 34 hours, and … Pulmonary embolism can be very serious. You will probably take a prescription blood-thinning medicine to prevent blood clots. CorrespondenceFrederikus A. Klok, Department of Medicine–Thrombosis and Hemostasis, Leiden University Medical Center, LUMC Room C7-14, Albinusdreef 2, 2300RC, Leiden, the Netherlands; e-mail: f.a.klok@lumc.nl. The protocol in many hospitals says absolutely not: The vast majority of PE patients are routinely admitted for several days to monitor their condition and supervise the start of anticoagulants. This editorial refers to ‘Early discharge and home treatment of patients with low-risk pulmonary embolism with the oral factor Xa inhibitor rivaroxaban: an international multicentre single-arm clinical trial’ †, by S. Barco et al., on page 509. Their presentation, hospital courses, complications, and follow-up are reviewed. These symptoms may mean another blood clot. After a diagnosis of pulmonary embolism, all patients should be assessed for risk of recurrent venous thromboembolism to guide duration of anticoagulation. This study measured the overall impact of early discharge of LRPE patients on clinical outcomes and costs in the Veterans Health Administration population. Ultimately, these adverse outcome scores and other criteria, such as those derived from the present study and that by Kovacs et al. In addition, patients had to fulfill several pragmatic criteria to rule out other factors necessitating hospital admission (ie, being independent from oxygen therapy and having an established support system at home). This is a pulmonary embolism (PE). This potential for bias has not been formally assessed in either study. If the answer to one of the questions is yes, the patient cannot be treated at home in the Hestia Study. Such patients may even prefer being at home surrounded by relatives over hospital admission. As a significant proportion of patients with DVT also have silent PE (as defined by high-probability V’/Q’ scans) 3–6, it is likely that many patients who receive outpatient treatment for DVT have also received outpatient treatment of PE. AU - Banala, Srinivas R. AU - Yeung, Sai Ching Jim. 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Hence, in our practice, we use the Hestia criteria without further explicit (imaging) biomarkers. Patients indicated a high level of satisfaction with their care.9. Both received standard thromboprophylaxis during the index hospitalization and had no strong predisposing risk … Discharging those patients from the emergency ward would decrease health care costs by an estimated $1 billion each year.15  In the Dutch setting, a recent post hoc analysis of the YEARS study identified a net cost reduction of €1.500 for each patient treated at home. received research grants from ZonMW, Boehringer Ingelheim Bayer Health Care, and Pfizer-Bristol-Myers Squibb; and received consultancy and lecture fees from Pfizer-Bristol-Myers Squibb, Boehringer Ingelheim, Bayer Health Care, and Aspen. The incidence of major bleeding exceeded the noninferiority threshold in the home treatment group (1.8% vs 0%). Clinical guidelines recommend early discharge of patients with low-risk pulmonary embolism (LRPE). M.V.H. Previous smaller studies have also identified subgroups of PE patients who appeared to be suitable for safe outpatient management of PE. Does the patient have a creatinine clearance of < 30 mL/min? The first one concerns the selection of patients for home treatment. Department of Medicine—Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. Potential VTE-related medical resource use during follow-up was the same between groups.5. After the intervention, the proportion of patients treated at home increased considerably, with a relative increase of 61% (18% preintervention to 28% postintervention), whereas no change was found in the control sites (15% preintervention and 14% postintervention). The first one concerns the selection of patients for home treatment. Discharge Instructions for Pulmonary Embolism. 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