Safety of Outpatient Management of Pulmonary Embolism Diagnosed in the ED

Safety of Outpatient Management of Pulmonary Embolism Diagnosed in the ED

Authors: Alkhaldi T, Hecht N, Woo MY, Nemnom M-J, Stiell I
Journal: CJEM, July 2026

Conclusions:

  • Outpatient management of low-risk pulmonary embolism diagnosed in the ED appeared safe in this two-ED Canadian cohort.

  • Among patients discharged by ED physicians with thrombosis clinic follow-up within 48 hours, no patients deteriorated, required escalation of PE treatment, or were admitted for PE within 5 days.

  • Practical takeaway: selected stable PE patients can likely be discharged safely from the ED when paired with reliable anticoagulation initiation and rapid specialty follow-up.

Practice Takeaways:

  • This supports ED discharge for carefully selected PE patients when the system has:

    • Stable vital signs

    • Low-risk clinical profile

    • No need for oxygen or advanced therapy

    • No major bleeding contraindication

    • Ability to start anticoagulation immediately

    • Reliable follow-up within 48 hours

  • The thrombosis clinic is likely a key part of the safety signal; outpatient PE pathways need more than “here’s apixaban, good luck.”

  • A nearly 9% short-term return rate is worth noting, but the important finding is that these returns did not represent clinical collapse or failed outpatient management.

  • This is especially relevant for EDs trying to reduce avoidable admissions while maintaining safety for low-risk PE.

  • Limitations: retrospective design, descriptive statistics only, and results may not generalize to sites without rapid PE/thrombosis follow-up infrastructure.

Results:

  • Screened: 300 patients.

  • Confirmed PE: 253 patients.

  • Final analysis: 243 patients after exclusions.

  • Disposition:

    • Discharged/outpatient management: 101 patients (41.6%)

    • Admitted: 58.4%

  • Discharged patients were younger:

    • Discharged: mean age 55.0 years

    • Admitted: mean age 64.9 years

  • DOAC use among discharged patients: 61.4%

  • 5-day ED returns among discharged patients:

    • Overall: 9/101 (8.9%)

    • Returned due to PE: 5/101 (5.0%)

    • Returned for other reasons: 4/101 (4.0%)

  • Among PE-related return visits:

    • No clinical deterioration

    • No escalation of treatment

    • No admissions

  • Among non-PE returns:

    • No clinical deterioration

    • 2 patients admitted for other reasons

Methods:

  • Health-record review of confirmed PE patients from 2 large EDs within a tertiary care hospital.

  • Stable patients were discharged by ED physicians, usually without consultation.

  • Discharged patients were followed in a specialized thrombosis clinic within 48 hours.

  • Anticoagulation follow-up was coordinated through that clinic.

  • Primary outcome:

    • Return to ED within 5 days due to early clinical deterioration requiring escalation of treatment.

  • Data were abstracted using a standardized collection form and reported descriptively.

Alkhaldi T, Hecht N, Woo MY, Nemnom MJ, Stiell I. Safety of outpatient management of pulmonary embolism diagnosed in the emergency department. CJEM. 2026 Jul 25. doi: 10.1007/s43678-026-01231-1. Epub ahead of print. PMID: 42501275.

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