Emergency Department Discharge of Pulmonary Embolus Patients.

Journal Article (Journal Article;Multicenter Study;Pragmatic Clinical Trial)

BACKGROUND: Hospitalization for low-risk pulmonary embolism (PE) is common, expensive, and of questionable benefit. OBJECTIVE: The objective was to determine if low-risk PE patients discharged from the emergency department (ED) on rivaroxaban require fewer hospital days compared to standard of care (SOC). METHODS: Multicenter, open-label randomized trial in low-risk PE defined by Hestia criteria. Adult subjects were randomized to early ED discharge on rivaroxaban or SOC. Primary outcome was total number of initial hospital hours, plus hours of hospitalization for bleeding or venous thromboembolism (VTE), 30 days after randomization. A 90-day composite safety endpoint was defined as major bleeding, clinically relevant nonmajor bleeding, and mortality. RESULTS: Of 114 randomized subjects, 51 were early discharge and 63 were SOC. Of 112 (98.2%) receiving at least one dose of study drug, 99 (86.8%) completed the study. Initial hospital LOS was 4.8 hours versus 33.6 hours, with a mean difference of -28.8 hours (95% confidence interval [CI] = -42.55 to -15.12 hours) for early discharge versus SOC, respectively. At 90 days, mean total hospital days (for any reason) were less for early discharge than SOC, 19.2 hours versus 43.2 hours, with a mean difference of 26.4 hours (95% CI = -46.97 to -3.34 hours). At 90 days, there were no bleeding events, recurrent VTE, or deaths. The composite safety endpoint was similar in both groups, with a difference in proportions of 0.005 (95% CI = -0.18 to 0.19). Total costs were $1,496 for early discharge and $4,234 for SOC, with a median difference of $2,496 (95% CI = -$2,999 to -$2,151). CONCLUSIONS: Low-risk ED PE patients receiving early discharge on rivaroxaban have similar outcomes to SOC, but fewer total hospital days and lower costs over 30 days.

Full Text

Duke Authors

Cited Authors

  • Frank Peacock, W; Coleman, CI; Diercks, DB; Francis, S; Kabrhel, C; Keay, C; Kline, JA; Manteuffel, J; Wildgoose, P; Xiang, J; Singer, AJ

Published Date

  • September 2018

Published In

Volume / Issue

  • 25 / 9

Start / End Page

  • 995 - 1003

PubMed ID

  • 29757489

Pubmed Central ID

  • PMC6175358

Electronic International Standard Serial Number (EISSN)

  • 1553-2712

Digital Object Identifier (DOI)

  • 10.1111/acem.13451


  • eng

Conference Location

  • United States