Outpatient treatment of pulmonary thromboembolism: Recommendations and our experiences

Abstract

Due to more common diagnoses of pulmonary thromboembolism in clinical practice, it is necessary to initiate outpatient treatments. Such a decision is based on the clinical picture, risk factors, risk of bleeding, comorbidities, laboratory findings, adherence, and social factors. Patients meeting PESI I, PESI II, and sPESI criteria of low mortality risk, as well as patients with a Hestia score 0, may start receiving outpatient treatment. Even though low-molecular-weight heparin (LMWH) and direct oral anticoagulants can be administered together, as well as LMWH and oral vitamin K antagonists, the gold standard is to use only new, direct oral anticoagulants. Outpatient treatment lasts at least 3 months, depending on several factors, first of all on risk factors reversibility. Doctors still rarely decide to start outpatient treatment of pulmonary thromboembolism, even though studies show that this kind of treatment is safe, that it reduces the number of unnecessary hospital admissions and risk of infections, cuts the costs, and enables a better quality of life.