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No place like home: treating low-risk blood clots

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MURRAY, Utah (Intermountain Medical Center) — A new study by researchers at Intermountain Medical Center in Murray found that patients with low-risk blood clots may be better off receiving treatment at home versus being admitted to the hospital.

The study, published in the August issue of the journal CHEST, tracked 200 patients between 2013 to 2016 who were treated for acute pulmonary embolisms or serious lung blood clots in five Intermountain Healthcare emergency departments, including Intermountain’s Level I trauma center, Intermountain Medical Center.  

Through a series of tests including echocardiograms and ultrasounds, the 200 patients were determined to have a low risk of developing severe complications from the blood clots. Instead of being admitted to the hospital, they were given an outpatient management strategy, which included steps like an oral anticoagulant or blood thinner, and/or blood thinner injections administered at home, and close follow up in clinics.

The patients were then tracked for 90 days. Researchers found that only one out of 200 patients enrolled in the study had any follow-up incidents that required hospitalization, and that patient’s hospitalization was the result of an accident. The study also found that patients were much more satisfied with at-home care.

“We found a large subset of patients with blood clots who’d do well at home – in fact who probably did better at home,” said Joseph Bledsoe, MD, research director in emergency medicine at Intermountain Medical Center. “When patients are sent home versus staying in the hospital, they’re at lower risk of getting another infection. It’s a lot less expensive, too.”

Currently, the standard of care in the United States for acute pulmonary embolisms, which affect more than 200,000 patients in the U.S. annually, is hospitalization for all patients. That’s recommended, in part, because their overall mortality rate is 17 percent.

However, the lower mortality rate among some appropriately risk-stratified patients suggests that at-home care, which has become the norm in some European countries, leads to better outcomes for those patients overall and less chance of a hospital-introduced infection, said Dr. Bledsoe.

“Our findings show that if you appropriately risk stratify patients, there are a lot of people with blood clots who are safe to go home,” he said.

35-year-old Angela Brown of Millcreek had a blood clot in her leg and 2 in her lungs this past April. She did not have to stay in the hospital.
‘they released me later that same night. They went over my medication, and made sure I understood how to take it and do as much as i feel comfortable doing.’

Since the study was completed, Intermountain Medical Center has changed its practices.
Dr. Bledsoe, ‘we are now treating people at home fairly routinely.’

Dr. Bledsoe is also helping to implement these new practices throughout the Intermountain Healthcare system. He’s working nationally with other hospitals. 

Angela says she’s all for better outcomes, happier patients, and saves them thousands of dollars in hospital bills. 
‘I felt more comfortable being in my own environment. Being in the hospital is really intimidating to me and it makes things feel worse and it was comforting that the doctors felt it was safe for me to go home and take care of myself.’

Dr. Bledsoe says the next step for researchers is for similar research to be conducted outside of the Intermountain Healthcare system to confirm the results, and with a larger group of people.

Members of the Intermountain Healthcare research team include Scott Woller, MD; Scott Stevens, MD; Todd Allen, MD; Valerie Aston, MBA, CCRP; Richard Patten, MD; Lydia Dong, MD, MS; James Lloyd, BS; Benjamin Horne, PhD; Greg Elliott, MD; and Troy Madsen, MD, from the University of Utah.

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