Written by Samuel Rouleau
Spoon Feed
A single-center retrospective study in Canada found that discharge of select patients with pulmonary embolism was safe.
Send those low-risk clots home
Growing evidence supports the safety of discharging patients with low-risk PE from the ED. This study, a two-site retrospective study in Canada, further reinforces the evidence. They conducted a review of adult patients with acute PE in their ED and found that 101 (41.6%) of 243 patients diagnosed with PE in the ED were discharged. Notably, 30 of the discharged patients also had concurrent DVT. Only 9 patients (8.9%) returned to the ED within 5 days, 5 of whom returned for PE related reasons, though none suffered clinical deterioration. 62 patients received DOACs in the ED; the remainder received LMWH.
A few important caveats. All discharged patients received rapid follow-up in a thrombosis clinic (wish I could work in that system)! All dispositions were determined independently by ED physicians without consultation, which is what makes this study unique. The routine use of PE clinical risk scores was not documented or protocolized.
How will this change my practice?
I already discharge select patients with low-risk PE from the ED, and this is further evidence to support that practice.
- Please use a clinical risk score before discharging a patient with PE. I prefer the Hestia as it reminds me of social/follow-up factors to consider. PESI works too, but do not rely on sPESI for disposition decisions.
- Many times, my patients cannot get rapid follow-up. In my view, a reliable patient who will return to the ED if feeling worse constitutes acceptable follow-up.
- The EARTH Criteria for home management of PE are worth checking out.
- If you really need something to help you sleep after a long night shift, check out this chapter in the PERT Consortium Handbook that summarizes the literature on low-risk PE management.
Source
Safety of outpatient management of pulmonary embolism diagnosed in the emergency department. CJEM. 2026 Jul 25. doi: 10.1007/s43678-026-01231-1. Epub ahead of print. PMID: 42501275.
