*For medical professionals' reference only
Pulmonary embolism (PE) is a type of disease mainly caused by pulmonary circulatory dysfunction caused by various emboli blocking the pulmonary artery or its branches.
Although PE is often acute and life-threatening,
for low-risk acute PE, the guidelines also recommend that patients receive home treatment. However, the current standards for home treatment are mostly based on observational research, and there is no uniform standard
.Recently, the European Heart Journal published a study comparing two standard randomized controlled studies of PE home treatment. Let's take a look.
Research method
PE patients with normal blood pressure from 26 hospitals in France, Belgium, Sweden and the Netherlands were randomly divided into pulmonary embolism severity index (sPESI) and Hestia criteria, combined with the opinions of the attending physician Determine whether to conduct home treatment.
Table 1 Pulmonary Embolism Severity Index (sPESI)
Note: Add the scores of each item of sEPSI. If the sEPSI score is 0, the 30-day mortality rate is low risk, and the patient can be treated at home. If the sEPSI score is greater than 0, the 30-day risk of death is higher and hospitalization is required.
Table 2
If the answer to all questions is "No", the Hestia test is negative and the patient can be treated at home.
If one answer is "yes", the patient needs to be hospitalized.
a: The following conditions need to be met, and the doctor needs to judge, systolic blood pressure <100mmhg>100bpm; need to enter the intensive care unit for treatment. b: Gastrointestinal bleeding in the past 14 days, recent stroke (within 4 weeks),Recently surgery (within 2 weeks), coagulopathy or thrombocytopenia (platelets<75x10^9/l),>180mmHg or systolic blood pressure>110mmHg) c: calculated according to Cockcroft-Gault formula d: Judging by the doctor
The endpoint of the study is the composite endpoint of 30-day venous thrombosis recurrence, major bleeding, and all-cause death (non-inferiority test, 2.5% absolute risk difference), and within 24 hours after randomization The incidence of incidents in which patients were discharged home.
study results
study enrolled a total of 1975 patients from January 2017 to July 2019. The primary endpoint event occurred in 3.82% (34/891) patients in the
Hestia group, and the primary endpoint event occurred in 3.57% (32/896) patients in the
sPESI group. In the
ITT analysis population, the
Hestia group had 38.4% (374/984) home treatment, and the
sPESI group had 36.3% (361/986) home treatment (superiority analysis, P=0.41). The incidence of
30-day composite endpoint was 1.33% (5/375) in the Hestia group and 1.11% (4/359) in the sPESI group.
Research conclusion
Hestia and sPESI standards to evaluate the home treatment standards of acute PE patients have similar safety and effectiveness.
is judged by the doctor in charge according to any of the above criteria, and more than 1/3 of the patients can be treated safely at home.
Figure 1
Source:
Triaging acute pulmonary embolism for home treatment by Hestia or simplified PESI criteria: the HOME-PE randomized trial. Eur Heart J. 2021 Aug 7;ehab373. doi: 10.1093/eurheartj/ehab373 .
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