Home treatment of acute pulmonary embolism: state of the art in 2018

Abstract

Purpose of review: Historically, because of the necessity of parenteral anticoagulation, patients with acute pulmonary embolism are hospitalized until stable oral anticoagulation is achieved. Despite improvements in prognostic risk stratification and the introduction of the direct oral anticoagulants, home treatment is still not widely applied. Main advantages of home treatment involve improvement of quality of life and significant healthcare cost reduction. In this review, we summarized recent published data on home treatment of patients with acute pulmonary embolism.

Recent findings: Although a significant decrease in mean duration of hospital admission for pulmonary embolism has been demonstrated over the last decade in Europe, most pulmonary embolism patients are currently hospitalized while they might be treated in an outpatient setting. In recent years, five major studies have been performed, in which the decision to initiate home treatment was based on the Hestia criteria in most patients. Over 98% of patients treated at home had an uncomplicated course.

Summary: Home treatment of acute pulmonary embolism is suggested to be feasible and safe in 30-55% of all patients. Results of ongoing trials will provide more insight in the optimal strategy to select patients with pulmonary embolism who are eligible for home treatment and likely will result in more widespread application of this practice.