Pulmonary embolism patient discharge care

Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
Pulmonary embolism patient are at increased risk of second attack of PE (If un-treated almost 1/3 patient die, usually from recurrent PE) and therefore a patient should be discharged only after proper diagnosis and discharge medication. Information pertaining the safety of outpatient treatment of pulmonary embolism is still inadequate due to the lack of a randomized control trial comparing in-patient and outpatient management.

Discharge Criteria
High-risk PE patients have a 30-day mortality of greater than 15%, and thus hospital admission is necessary.

Hemodynamically stability is not the criteria for discharge, patients who are hemodynamically stable but with right ventricular dysfunction should be admitted.

Patients having a low-risk score and do not require supplemental oxygen are potential candidates for early discharge and outpatient treatment. Patients with absent Right ventricular dysfunction and a normal troponin level can be discharged and put on out-patient treatment.

Discharge Medications
Outpatient administration of LMWH is as safe as unfractionated heparin administered in hospital for the treatment of DVT.