Vnitr Lek 2015, 61(5):431-438

Outpatient treatment of venous thromboembolic disease

Radovan Malý^1,3,*, Jaroslav Malý²

¹ I. interní kardioangiologická klinika LF UK a FN Hradec Králové, přednosta doc. MUDr. Josef Šťástek, Ph.D.

² IV. interní hematologická klinika LF UK a FN Hradec Králové, přednosta doc. MUDr. Pavel Žák, Ph.D.

³ Ústav ošetřovatelství, Fakulta veřejných politik, Slezská Univerzita Opava, vedoucí ústavu PhDr. Jana Haluzíková, Ph.D.

Venous thromboembolic disease which includes both venous thrombosis and pulmonary embolism, is a frequent and potentially fatal disease. Based on the introduction of low-molecular-weight heparins (LMWH) into practice it has been proved that outpatient treatment of venous thrombosis is effective and safe for a large number of patients with VTE. The growing volume of data on LMWH outpatient treatment in recent years shows that up to 50 % of patients with clinically stable pulmonary embolism can be treated at home. In spite of these facts home treatment of pulmonary embolism has not been established as part of common practice as yet. If we were to summarize the conditions for home treatment, we would consider outpatient care for patients at low risk based on auxiliary criteria, free from hemodynamic instability (primarily without a shock state), free from right ventricular failure, prior chronic heart or lung disease, serious comorbidities (gastrointestinal tract disease, kidney disease, blood diseases, advanced cancers), at low risk of early thromboembolism recurrence, free from other indications for hospitalization (pain requiring parenteral analgesics, infections etc.), at low risk of bleeding and with guaranteed patient's cooperation and well-organized home care.

Keywords: outpatient treatment of pulmonary embolism; PESI; pulmonary embolism related risk factors

Received: March 2, 2015; Accepted: April 8, 2015; Published: May 1, 2015  Show citation