Safety of treating acute pulmonary embolism at home: an individual patient data meta-analysis
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Le résumé fourni par la source
BACKGROUND AND AIMS: Home treatment is considered safe in acute pulmonary embolism (PE) patients selected by a validated triage tool (e.g. simplified PE severity index score or Hestia rule), but there is uncertainty regarding the applicability in underrepresented subgroups. The aim was to evaluate the safety of home treatment by performing an individual patient-level data meta-analysis. METHODS: Ten prospective cohort studies or randomized controlled trials were identified in a systematic search, totalling 2694 PE patients treated at home (discharged within 24 h) and identified by a predefined triage tool. The 14- and 30-day incidences of all-cause mortality and adverse events (combined endpoint of recurrent venous thromboembolism, major bleeding, and/or all-cause mortality) were evaluated. The relative risk (RR) for 14- and 30-day mortalities and adverse events is calculated in subgroups using a random effects model. RESULTS: The 14- and 30-day mortalities were 0.11% [95% confidence interval (CI) 0.0-0.24, I2 = 0) and 0.30% (95% CI 0.09-0.51, I2 = 0). The 14- and 30-day incidences of adverse events were 0.56% (95% CI 0.28-0.84, I2 = 0) and 1.2% (95% CI 0.79-1.6, I2 = 0). Cancer was associated with increased 30-day mortality [RR 4.9; 95% prediction interval (PI) 2.7-9.1; I2 = 0]. Pre-existing cardiopulmonary disease, abnormal troponin, and abnormal (N-terminal pro-)B-type natriuretic peptide [(NT-pro)BNP] at presentation were associated with an increased incidence of 14-day adverse events [RR 3.5 (95% PI 1.5-7.9, I2 = 0), 2.5 (95% PI 1.3-4.9, I2 = 0), and 3.9 (95% PI 1.6-9.8, I2 = 0), respectively], but not mortality. At 30 days, cancer, abnormal troponin, and abnormal (NT-pro)BNP were associated with an increased incidence of adverse events [RR 2.7 (95% PI 1.4-5.2, I2 = 0), 2.9 (95% PI 1.5-5.7, I2 = 0), and 3.3 (95% PI 1.6-7.1, I2 = 0), respectively]. CONCLUSIONS: The incidence of adverse events in home-treated PE patients, selected by a validated triage tool, was very low. Patients with cancer had a three- to five-fold higher incidence of adverse events and death. Patients with increased troponin or (NT-pro)BNP had a three-fold higher risk of adverse events, driven by recurrent venous thromboembolism and bleeding.
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Safety of treating acute pulmonary embolism at home: an individual patient data meta-analysis
- Date Crossref
- 12/07/2024
- Éditeur
- Oxford University Press (OUP)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Leiden University Medical Center Department of Medicine—Thrombosis and Hemostasis pays non établi dans la noticeOrganisme public
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Centre National de la Recherche Scientifique pays non établi dans la noticeOrganisme public
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Inserm pays non établi dans la noticeOrganisme public
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Centre Hospitalier Universitaire d'Angers pays non établi dans la noticeÉtablissement de santé
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French Clinical Research Infrastructure Network pays non établi dans la noticeStructure de recherche
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Université d'Angers pays non établi dans la noticeUniversité ou école supérieure
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Utrecht University pays non établi dans la noticeUniversité ou école supérieure
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University Medical Center Utrecht Department of Epidemiology pays non établi dans la noticeÉtablissement de santé
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Université de Bretagne Occidentale Département de Médecine Interne et Pneumologie pays non établi dans la noticeUniversité ou école supérieure
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Cliniques Universitaires Saint-Luc Emergency Department pays non établi dans la noticeÉtablissement de santé
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UCLouvain pays non établi dans la noticeUniversité ou école supérieure
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Centre Hospitalier Universitaire Vaudois pays non établi dans la noticeÉtablissement de santé
Department of Medicine—Thrombosis and Hemostasis — Leiden University Medical Center, Centre National de la Recherche Scientifique et Inserm, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.