The creation and implementation of an outpatient pulmonary embolism treatment protocol

ABSTRACT

The ability to rapidly and accurately risk-stratify patients with venous thromboembolism (VTE), and the availability of direct acting oral anticoagulants have reduced the need for intravenous anticoagulation for patients with deep vein thrombosis (DVT) and pulmonary embolism (PE). Emergency physicians are generally reluctant to discharge patients with VTE without defined and reliable follow up in place, and VTE patients treated with anticoagulants can be at risk for complications related to recurrent VTE and bleeding. In addition, screening for associated diseases (e.g. cancer, hypercoagulable states) may be indicated. Therefore, the outpatient treatment of low risk VTE requires coordinated effort and reliable follow up. By leveraging detailed outcome data and collaborative relationships, we have created a protocol for the safe outpatient treatment of patients with low risk DVT and PE. Our protocol is data driven and designed to address barriers to outpatient VTE management. We expect our protocol to result in improved patient satisfaction, more efficient emergency department (ED) throughput, and decreased cost. Applied nationally, the outpatient treatment of select patients with DVT and PE could have major public health and economic impact.

KEYWORDS:

• Pulmonary Embolism
• Deep Vein Thrombosis
• Venous Thromboembolism
• Outpatient
• Treatment
• Anticoagulation
• Emergency Department

Declaration of interest

C Kabrhel has received grants to his institution from Siemens Healthcare, Diagnostica Stago, Janssen and Boehringer-Ingelheim. C Kabrhel also has a consulting agreement with Siemens Healthcare, Diagnostica Stago and Janssen, through his institution. C Baugh receives grants and has a consulting agreement with Janssen, through his institution. C Baugh is on the Advisory Board for Roche Diagnostics. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This manuscript was not funded.