February 27, 2024

Outpatient Treatment of Low-Risk PE - Part 2 of 3

Dr. Kabrhel will go through the steps we can take to safely discharge a patient with PE.

Faculty: Dr. Christopher Kabrhel MD, MPH

Director, Center for Vascular Emergencies, Department of Emergency Medicine | Professor of Emergency Medicine, Harvard Medical School | MGH Endowed Chair in Emergency Medicine

Dr. Kabrhel has more than 15 years of experience performing research into the epidemiology, diagnosis, risk stratification and treatment of acute venous thromboembolism

Read the Full Transcript

- 60 to 70% of PE are low risk and have a mortality rate of about 1%, which means lots of PE patients can safely be treated at home. This reduces patient exposure to hospital-acquired illnesses, inpatient bed use, and cost. So here are the steps you need to know to safely discharge a patient with a PE. Step one, assess a patient's ability to manage outpatient therapy. Patients with unstable psychosocial situations are probably not good candidates for outpatient treatment. Step two, assess the risk the PE poses to the patient. PE with high risk features, like right ventricular strain or an elevated troponin, should generally be admitted. Scoring systems like the Hestia Criteria can also help. Step three, assess the patient's risk of bleeding. Don't discharge a patient who's actively bleeding. That's pretty obvious, but also think twice before discharging a patient with a history of recent surgery, stroke, trauma, or major bleeding. Selecting and starting an appropriate anticoagulant is important, but that's the topic of another video. Do make sure that the patient can get their meds after they leave the ED. Giving the first dose of an anticoagulant before the patient leaves the ED is also smart. Step five, all patients with PE need to follow up after they leave the ED. It helps to make advanced arrangements with our clinic colleagues. Step six is educating the patients about signs of worsening PE or bleeding so that they know when to come back to the emergency department. If you follow all these steps, 25 to 30% of patients diagnosed with PE in the ED can be discharged home. For more details, check out ACEP's point of care tool on the treatment of low risk PE.

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