Outpatient Treatment of Pulmonary Embolism with Dalteparin
M. J. Kovacs (1) , D. Anderson (2) , B. Morrow (1) , L. Gray (2) , D. Touchie (3) , P. S. Wells (3)
From the (1) London Health Sciences Centre, University of Western Ontario, London, Ontario, (2) Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, (3) Ottawa Civic Hospital, Ottawa, Ontario, Canada
Summary Background: Pulmonary embolism is a common complication ofdeep vein thrombosis. It has been established that low molecular weightheparin may be used to treat deep vein thrombosis or pulmonary embolismand randomized studies have established that outpatient managementof deep vein thrombosis with low molecular weight heparin is atleast as effective as in-hospital management with unfractionated heparin.Methods: This was a prospective cohort study of eligible patientswith pulmonary embolism managed as outpatients using dalteparin(200 U/kg s/c daily) for a minimum of five days and warfarin for 3months. Outpatients included those managed exclusively out of hospitaland those managed initially for 1-3 days as inpatients who then completedtherapy out of hospital. Reasons for admission included hemo-dynamicinstability; hypoxia requiring oxygen therapy; admission foranother medical reason; severe pain requiring parenteral analgesia orhigh risk of major bleeding. Patients were followed for three months forclinically apparent recurrent venous thromboembolism and bleeding.Results: Between three teaching hospitals, a total of 158 patients withpulmonary embolism were identified. Fifty patients were managed asinpatients and 108 as outpatients. Of the outpatients, 27 were managedfor an average of 2.5 days as inpatients and then completed dalteparintherapy as outpatients. The remaining 81 patients were managed exclusivelyas outpatients with dalteparin. For all outpatients the overallsymptomatic recurrence rate of venous thromboembolism was 5.6%(6/108) with only 1.9% (2/108) major bleeds. There were a total of fourdeaths with none due to pulmonary embolism or major bleed. Conclusions:This prospective study suggests that outpatient management ofpulmonary embolism is feasible and safe for the majority of patients.