Home
Search
Study Topics
Glossary
|
|
|
|
|
Sponsors and Collaborators: |
University of Lausanne Hospitals Swiss National Science Foundation |
---|---|
Information provided by: | University of Lausanne Hospitals |
ClinicalTrials.gov Identifier: | NCT00425542 |
The purpose of this randomized clinical trial is to determine whether outpatient treatment is as effective and safe as inpatient treatment among low-risk patients with pulmonary embolism.
Condition | Intervention | Phase |
---|---|---|
Pulmonary Embolism |
Other: Outpatient care (vs traditional inpatient care) |
Phase III |
Study Type: | Interventional |
Study Design: | Health Services Research, Randomized, Open Label, Active Control, Parallel Assignment, Safety/Efficacy Study |
Official Title: | Outpatient Treatment of Low-Risk Patients With Pulmonary Embolism: a Randomized-Controlled Trial |
Estimated Enrollment: | 294 |
Study Start Date: | January 2007 |
Estimated Primary Completion Date: | December 2009 (Final data collection date for primary outcome measure) |
Arms | Assigned Interventions |
---|---|
Outpatient treatment: Experimental |
Other: Outpatient care (vs traditional inpatient care)
Patients randomized to the outpatient arm are discharged from the emergency department within 24 hours after randomization. Patients randomized to the inpatient arm are admitted to the hospital and are discharged based on the decision of the managing physician at the hospital.
|
Inpatient care: No Intervention |
Pulmonary embolism (PE) is a worldwide health problem, with an estimated incidence of up to 69 cases per 100,000 persons annually. In the U.S., 101,000 patients were hospitalized with a primary diagnosis of PE in 2002, resulting in direct medical costs of $720 million. There is growing evidence that outpatient treatment with low-molecular-weight heparin (LMWH) is an effective and safe option for up to 50% of patients with non-massive PE. Despite this evidence, outpatient treatment of PE is uncommon because (1) explicit criteria that identify patients who are at low-risk of adverse medical outcomes have not been available, and (2) randomized trials demonstrating the effectiveness and safety of outpatient treatment have not been performed. We developed a clinical prognostic model that accurately identifies patients with PE who are at low-risk for short-term mortality, symptomatic recurrent venous thromboembolism (VTE), and major bleeding. This model provides clinicians an easily applied, explicit risk stratification tool for patients with PE, addressing a key barrier to outpatient treatment. The broad objective of this clinical trial is to address the other major barrier to outpatient treatment of low-risk patients with non-massive PE, the effectiveness and safety of outpatient management. We will randomize low-risk patients (identified using our prognostic model) with PE from hospital emergency departments to receive outpatient or inpatient treatment with LMWH for ≥5 days, followed by oral anticoagulation.
The specific aims of the project are to compare (1) the frequency of recurrent VTE, (2) the frequency of major bleeding and all-cause mortality, and (3) medical resource utilization and patient satisfaction with care among patients randomized to receive outpatient or inpatient treatment with LMWH. The primary study outcome will be the rate of symptomatic recurrent VTE at 3 months after randomization. The secondary outcomes will be the rate of major bleeding and all-cause mortality. The ancillary outcomes will be medical resource utilization and patient satisfaction with care. The hypotheses guiding this trial are that outpatient treatment with LMWH is as effective and safe as inpatient treatment with LMWH, and is also associated with reduced medical resource utilization and increase patient satisfaction with care. This study is innovative because it translates a validated prognostic model into clinical practice and represents the first direct comparison of outpatient versus inpatient treatment of low-risk patients with PE. Successful completion of this project will provide a strong scientific basis for treating low-risk patients with PE in the outpatient setting. Outpatient management of low-risk patients with PE is likely to improve quality and efficiency of care by reducing resource utilization and increasing patient satisfaction with care. Our findings will have importance to physicians, hospitals, and policy-makers who are committed to optimizing patient safety and providing high-quality, cost-effective care.
Ages Eligible for Study: | 18 Years and older |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Exclusion Criteria:
Contact: Drahomir Aujesky, MD, MSc | +41 21 314 04 81 | drahomir.aujesky@chuv.ch |
Belgium | |
University of Leuven | Recruiting |
Leuven, Belgium, 3000 | |
Contact: Peter Verhamme, MD | |
University Hospital Saint-Luc, Université Catholique de Louvain | Recruiting |
Brussels, Belgium, 1200 | |
Contact: Franck Verschuren, MD | |
France | |
University of Angers | Recruiting |
Angers, France | |
Contact: Pierre-Marie Roy PMRoy@chu-angers.fr | |
Principal Investigator: Pierre-Marie Roy | |
University of Dijon | Recruiting |
Dijon, France | |
Contact: Didier Honnart, MD | |
Principal Investigator: Didier Honnart, MD | |
University Hospital of Brest | Recruiting |
Brest, France | |
Contact: Emmanuelle Le Moigne, MD | |
Principal Investigator: Emmanuelle Le Moigne, MD | |
University of Argenteuil | Recruiting |
Argenteuil, France | |
Contact: Catherine Legall, MD | |
Principal Investigator: Catherine Legall, MD | |
Hôpital Henri Mondor, Créteil | Recruiting |
Paris, France | |
Contact: Bertrand Renaud bertrand.renaud@hmn.ap-hop-paris.fr | |
Principal Investigator: Bertrand Renaud | |
University of Boulogne | Recruiting |
Boulogne, France | |
Contact: David Elkharrat | |
University de Clermond-Ferrand | Recruiting |
Clermond-Ferrand, France | |
Contact: Jeannot Schmidt | |
University of Nantes | Recruiting |
Nantes, France | |
Contact: Dominique Elkouri | |
Switzerland | |
University Hospital of Lausanne | Recruiting |
Lausanne, Switzerland, 1011 | |
Contact: Drahomir Aujesky, MD, MSc +41 21 314 04 81 drahomir.aujesky@chuv.ch | |
Principal Investigator: Drahomir Aujesky, MD, MSc | |
Kantonsspital Baden | Recruiting |
Baden, Switzerland | |
Contact: Michael Egloff, MD | |
Principal Investigator: Michael Egloff, MD | |
University of Geneva | Recruiting |
Geneva, Switzerland, 1211 | |
Contact: Arnaud Perrier, MD | |
Kantonsspital St. Gallen | Recruiting |
St. Gallen, Switzerland, 9007 | |
Contact: Joseph Osterwalder, MD |
Principal Investigator: | Drahomir Aujesky, MD, MSc | University of Lausanne, Switzerland |
Responsible Party: | University of Lausanne ( Drahomir Aujesky, MD, Senior Staff Physician ) |
Study ID Numbers: | 3200B0-112165 |
Study First Received: | January 22, 2007 |
Last Updated: | January 15, 2009 |
ClinicalTrials.gov Identifier: | NCT00425542 History of Changes |
Health Authority: | Switzerland: Swissmedic |
Pulmonary embolism Outpatient care Prognosis |
Embolism and Thrombosis Pulmonary Embolism Respiratory Tract Diseases Embolism |
Lung Diseases Vascular Diseases Thrombosis |
Embolism and Thrombosis Pulmonary Embolism Respiratory Tract Diseases Embolism |
Lung Diseases Vascular Diseases Cardiovascular Diseases |