Value of Cardiac Troponin and sPESI in Treatment of Pulmonary Thromboembolism at Outpatient Setting

Lung. 2015 Aug;193(4):559-65. doi: 10.1007/s00408-015-9727-5. Epub 2015 Apr 4.


Background: Currently, guidelines do not recommend any standard approach for treatment of pulmonary thromboembolism (PTE) at outpatient setting. We investigated the efficacy and safety of a 90-day anticoagulant treatment of outpatients diagnosed with PTE who had negative troponin levels and low-risk simplified pulmonary embolism severity index (sPESI) at presentation.

Methods: This prospective cohort study included a total of 206 patients with objectively confirmed acute symptomatic PTE. Any troponin negative (cTn-) and low sPESI patients (as classified Group-1) were treated in outpatient setting. The primary endpoint was all-cause mortality during the first 90 days, and the secondary endpoint included non-fatal symptomatic recurrent PTE or non-fatal major bleeding. Presence of cancer was excluded from sPESI score.

Results: Fifty-two of 206 patients were eligible for had Group-1, and 31 were treated at outpatients settings. The 90-day all-cause mortality rate was 3.2 % among patients who received outpatient treatment. Otherwise cTn+ and high-risk sPESI 90-day mortality rate was 43.7 %. No difference was found in terms of secondary endpoints between the patients who received outpatient treatment and those who received inpatient treatment in Group-1 (p = NS). In our study, cancer was present in 16 (51.6 %) of the 31 outpatients.

Conclusion: We observed that patients with acute PTE, low-risk sPESI, and negative troponin levels can be safely treated in the outpatient settings. Also the presence of cancer alone does not necessitate hospitalization.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Ambulatory Care*
  • Anticoagulants / therapeutic use
  • Cause of Death
  • Female
  • Hemorrhage / chemically induced*
  • Heparin, Low-Molecular-Weight / therapeutic use
  • Hospital Mortality
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Prospective Studies
  • Pulmonary Embolism / blood
  • Pulmonary Embolism / drug therapy*
  • Pulmonary Embolism / mortality*
  • Recurrence
  • Severity of Illness Index*
  • Troponin / blood*


  • Anticoagulants
  • Heparin, Low-Molecular-Weight
  • Troponin