This article is more than 5 years old. Information may no longer be current.
Hestia criteria predicted patients with pulmonary embolism eligible for outpatient treatment
Click Here to Manage Email Alerts
52nd ASH Annual Meeting
ORLANDO — An 11-item questionnaire safely identified patients with pulmonary embolism who could be treated in an outpatient setting.
Only 2% patients evaluated by the Hestia criteria and treated as outpatients had recurrent venous thromboembolism, said Menno Huisman, MD, PhD, associate professor in the department of medicine at Leiden University Medical Center. Huisman discussed results during a press conference at the 52nd American Society of Hematology Annual Meeting.
“The Hestia criteria are efficacious and safe in helping doctors determine which acute pulmonary embolism patients can be safely treated out-of-hospital,” he said. “This set of criteria serves as an easy-to-use model for clinicians who treat PE patients.”
In an open-label, single-arm, multicenter clinical trial, 297 patients diagnosed with acute pulmonary embolism were triaged with the predefined Hestia criteria for eligibility for outpatient treatment starting with therapeutic weight-adjusted doses of low-molecular–weight heparin followed by vitamin K antagonists. Eligible patients were sent home either immediately or within 24 hours after diagnosis.
Outpatient treatment was deemed effective if the upper limit of the 95% confidence interval of the incidence of recurrent VTE did not exceed 7%.
Researchers observed five pulmonary embolisms and one DVT, for a rate of recurrent VTE of 2% (95% CI, 0.8-4.3).
Three patients died during the 3-month follow-up, though none as a result of fatal pulmonary embolism. One patient died due to intracranial hemorrhage and two others died due to progressive malignancy. One other patient had a major bleeding event (95% CI, 0.08%-2.4%). Fifteen other patients had non-major bleeding events.
Huisman said researchers have started the Vesta study to get follow-up data on the Hestia study. He expected to have results in about 30 months. – by Jason Harris
For more information:
The question of whether a patient with pulmonary embolism can be sent home is a very important issue and this trial adds to that knowledge base very nicely. If we can send 50% and maybe even 60% or 70% of these patients out-of-hospital — today in the United States they are in-hospital an average of 10 days — that is going to be a new step forward, not only cost savings, but also in patient quality of life.
- Harry R. Büller, MD, PhD
Professor of
Medicine, Academic Medical Center at the University of Amsterdam
 |
Follow HemOncToday.com on Twitter. |