We identified 13 studies (1657 patients) with outpatients (discharge less than 24 h), three studies (256 patients) with early discharge patients (discharged within 72 h) and five studies (383 patients) with inpatients. The pooled incidence of recurrent venous thromboembolism was 1.7% (95% CI 0.92–3.1%) in outpatients, 1.1% (0.22–5.4%) in patients discharged early and 1.2% (0.16–8.1%) in inpatients. The pooled incidence of major bleeding was 0.97% (0.58–1.6%) in outpatients, 0.78% (0.16–3.7%) in early discharge patients and 1.0% (0.39–2.8%) in inpatients. The pooled incidence of mortality was 1.9% (0.79–4.6%) in outpatients, 2.3% (1.1–5.1%) in early discharge patients and 0.74% (0.04–11%) in inpatients.
Incidences of recurrent venous thromboembolism, major bleeding and, after correction for malignancies, mortality were comparable between outpatients, patients discharged early and inpatients. We conclude that home treatment or early discharge of selected low-risk patients with pulmonary embolism is as safe as inpatient treatment.
Via Hospital Medicine Virtual Journal Club.