Trial reportAcademic emergency medicine : official journal of the Society for Academic Emergency Medicine2018
Emergency Department Discharge of Pulmonary Embolus Patients.
Trial report in Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
31 citing papers in PubMed, 8 syntheses or guidelines pooled it.
- Brazilian guidelines for the pharmacological treatment of pulmonary embolism. Official document of the Brazilian Thoracic Association based on the GRADE methodology.Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia · 2025Guideline
- Oral direct thrombin inhibitors or oral factor Xa inhibitors versus conventional anticoagulants for the treatment of deep vein thrombosis.The Cochrane database of systematic reviews · 2023Pooled it
- Oral direct thrombin inhibitors or oral factor Xa inhibitors versus conventional anticoagulants for the treatment of pulmonary embolism.The Cochrane database of systematic reviews · 2023Pooled it
- Outpatient versus inpatient treatment for acute pulmonary embolism.The Cochrane database of systematic reviews · 2022Pooled it
- American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism.Blood advances · 2020Guideline
- Home vs hospital treatment of low-risk venous thromboembolism: a systematic review and meta-analysis.Blood advances · 2020Pooled it
- Comprehensive Outpatient Management of Low-Risk Pulmonary Embolism: Can Primary Care Do This? A Narrative Review.The Permanente journal · 2020Pooled it
- Outpatient versus inpatient treatment for acute pulmonary embolism.The Cochrane database of systematic reviews · 2019Pooled it
- Monotherapy Anticoagulation to Expedite Home Treatment of Patients Diagnosed With Venous Thromboembolism in the Emergency Department: A Pragmatic Effectiveness Trial.Circulation. Cardiovascular quality and outcomes · 2021Trial
- Emergency Department Discharge of Pulmonary Embolus Patients.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2018Trial
- Initiation of an emergency department discharge pathway for low-risk patients with venous thromboembolism: Factors impact real-world practice.Vascular medicine (London, England) · 2026Article
- Safety of outpatient management of pulmonary embolism diagnosed in the emergency department.CJEM · 2026Article
- Outpatient Management of Pulmonary Embolism Patients with Direct Oral Anticoagulants: A Systematic Review.Journal of clinical medicine · 2025Review
- Performance of an Electronic Health Record-Based Automated Pulmonary Embolism Severity Index Score Calculator: Cohort Study in the Emergency Department.JMIR medical informatics · 2025Article
- Article
- Home Treatment for Low-risk Pulmonary Embolism: Is it Happening?Journal of community hospital internal medicine perspectives · 2024Article
- Early discharge and home treatment of patients with acute pulmonary embolism in the tertiary care setting.Internal and emergency medicine · 2024Article
- Disposition of emergency department patients with acute pulmonary embolism after ambulance arrival.Journal of the American College of Emergency Physicians open · 2023Article
- Barriers and Facilitators to the Outpatient Management of Low-risk Pulmonary Embolism From the Emergency Department.Annals of emergency medicine · 2023Article
- Adverse Clinical Outcomes Among Patients With Acute Low-risk Pulmonary Embolism and Concerning Computed Tomography Imaging Findings.JAMA network open · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors.
Funding
Abstract
backgroundHospitalization for low-risk pulmonary embolism (PE) is common, expensive, and of questionable benefit.
objectiveThe objective was to determine if low-risk PE patients discharged from the emergency department (ED) on rivaroxaban require fewer hospital days compared to standard of care (SOC).
methodsMulticenter, open-label randomized trial in low-risk PE defined by Hestia criteria. Adult subjects were randomized to early ED discharge on rivaroxaban or SOC. Primary outcome was total number of initial hospital hours, plus hours of hospitalization for bleeding or venous thromboembolism (VTE), 30 days after randomization. A 90-day composite safety endpoint was defined as major bleeding, clinically relevant nonmajor bleeding, and mortality.
resultsOf 114 randomized subjects, 51 were early discharge and 63 were SOC. Of 112 (98.2%) receiving at least one dose of study drug, 99 (86.8%) completed the study. Initial hospital LOS was 4.8 hours versus 33.6 hours, with a mean difference of -28.8 hours (95% confidence interval [CI] = -42.55 to -15.12 hours) for early discharge versus SOC, respectively. At 90 days, mean total hospital days (for any reason) were less for early discharge than SOC, 19.2 hours versus 43.2 hours, with a mean difference of 26.4 hours (95% CI = -46.97 to -3.34 hours). At 90 days, there were no bleeding events, recurrent VTE, or deaths. The composite safety endpoint was similar in both groups, with a difference in proportions of 0.005 (95% CI = -0.18 to 0.19). Total costs were $1,496 for early discharge and $4,234 for SOC, with a median difference of $2,496 (95% CI = -$2,999 to -$2,151).
conclusionsLow-risk ED PE patients receiving early discharge on rivaroxaban have similar outcomes to SOC, but fewer total hospital days and lower costs over 30 days.
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