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Randomised controlled trial
In selected lower risk patients with acute pulmonary embolism, outpatient treatment is not associated with increased risk of adverse outcomes compared with standard inpatient care
  1. Philip Stephen Wells
  1. Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to Philip Stephen Wells
    Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Box 206, Ottawa, ON K1H 8L6, Canada; pwells{at}toh.on.ca

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Context

Treatment of venous thromboembolism has evolved considerably over the last twenty years. The use of subcutaneous low molecular weight heparin without a requirement for monitoring has lessened the burden of treatment and opened the door for outpatient therapy.1 This is a well-accepted practise for patients with deep vein thrombosis (DVT), but concern has remained for similar treatment of pulmonary embolism.

Some of the reluctance to treat as an outpatient is emotional, given that many patients with DVT already have an asymptomatic pulmonary embolism.2 There clearly is legitimate concern as well, given the high risk of complications with pulmonary embolism, including higher death and in some studies, higher risk of recurrence.3 Our group and others in Canada and Europe have been treating patients with a pulmonary embolism on an outpatient basis using loosely defined criteria: eligible patients must have no hypoxia, hypotension, no need for …

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