Recently, a number of methods have been developed to determine the risk of serious complications and death in pulmonary embolism, which should help to identify patients with a low risk of complications. Such patients can be shown out-patient treatment, they will not necessarily be hospitalized in the clinic. The most reliable among the diagnostic methods is the Pulmonary Embolism Severity Index (PESI), based on 11 simple and clearly formulated criteria, reports MediSwiss. Ru.

In one recent study involving 599 patients with pulmonary embolism, 36% of patients with PESI were identified as having a low risk, with a possible mortality of only 0.9% in 30 days (negative predictions of 99.1%).. Even for serious complications (thromboembolic relapse, increased hemorrhage), the negative value of PESI predictions was very good (97.2%).

Thus, PESI is a fairly simple and clearly formulated forecasting tool that allows the allocation of patients with a low risk of unfavorable development of the disease, for which possible outpatient treatment or reduced stay in the clinic.

Today, outpatient treatment for varicose veins and deep vein thrombosis is included in the recommendations of many leading organizations, for example, the British Thoracic Society and the American College of Chest Physicians,.

Venous thromboembolic disease, that is, deep vein thrombosis and / or pulmonary embolism, is one of the most common diseases that can lead to death. Recent studies have shown that for some patients with nonmassive pulmonary embolism - and this is defined as pulmonary embolism without arterial hypotension and without severe respiratory insufficiency - outpatient treatment with low molecular weight heparin is very reliable and effective.

Based on these results, the British Thoracic Society and the American College of Physicians for Thoracic Diseases recommend outpatient treatment with low-molecular-weight heparin for carefully selected patients with non-mild pulmonary embolism. Despite numerous advantages (better quality of life, higher physical and social activity, shorter hospital stay and lower cost), non-significant pulmonary embolism is treated only rarely on an outpatient basis.

To date, no studies have been conducted to compare the clinical course of nonmassive pulmonary embolism in hospitalized patients and those who underwent outpatient treatment. The recommendation to treat patients with nonmassive embolism is based primarily on studies with a small number of cases.

The example with deep vein thrombosis shows that at first the reliability of the method should be supported by clinical studies, and only after that the doctors will be able to switch to outpatient treatment of nonmassive pulmonary embolism. A study to test the reliability and efficacy of outpatient treatment of patients with low risk for PESI is currently being conducted in Switzerland and other countries.

Medicinform. Net.

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