{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T15:50:17Z","timestamp":1781884217186,"version":"3.54.5"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T00:00:00Z","timestamp":1724284800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009804","name":"Kaiser Permanente Northern California Community Health Programme","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009804","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Outpatient treatment of pregnant patients with acute pulmonary embolism (PE) is recommended by some obstetric and haematology societies but has not been described in the literature. Little is known about patient selection and clinical outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>We report two cases of pregnant patients diagnosed with acute PE. The first, at 9 weeks of gestational age, presented to the emergency department with 12\u2005h of pleuritic chest pain and was diagnosed with segmental PE. She was normotensive and tachycardic without evidence of right ventricular dysfunction. She received multispecialty evaluation, was deemed suitable for outpatient management, and, after 12\u2005h of monitoring, was discharged home on enoxaparin with close follow-up. The second case, at 30 weeks of gestational age, presented to obstetrics clinic with 3 days of dyspnoea. Vital signs were normal except for tachycardia. She was referred to labour and delivery, where she was diagnosed with segmental PE. Her vital signs were stable, and she had no evidence of right ventricular dysfunction. After 6\u2005h of monitoring, she was discharged home on enoxaparin with close follow-up. Neither patient developed antenatal complications from their PE or its treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>This case series is the first to our knowledge to describe patient and treatment characteristics of pregnant patients with acute PE cared for as outpatients. We propose a definition for this phenomenon and discuss the benefits of and provisional selection criteria for outpatient PE management, while engaging with professional society guidelines and the literature. This understudied practice warrants further research.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytae441","type":"journal-article","created":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T15:22:39Z","timestamp":1724340159000},"source":"Crossref","is-referenced-by-count":1,"title":["Expanding outpatient management of low-risk pulmonary embolism to the pregnant population: a case series"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6559-1858","authenticated-orcid":false,"given":"David R","family":"Vinson","sequence":"first","affiliation":[{"name":"The Permanente Medical Group , 1800 Harrison St., Oakland, CA 94612, USA"},{"name":"Kaiser Permanente Northern California Division of Research , 4480 Hacienda Dr., Pleasanton, CA 94588, USA"},{"name":"Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center , 1600 Eureka Road, Roseville, CA 95661, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1063-6155","authenticated-orcid":false,"given":"Nareg H","family":"Roubinian","sequence":"additional","affiliation":[{"name":"The Permanente Medical Group , 1800 Harrison St., Oakland, CA 94612, USA"},{"name":"Kaiser Permanente Northern California Division of Research , 4480 Hacienda Dr., Pleasanton, CA 94588, USA"},{"name":"Department of Pulmonary and Critical Care Medicine, Kaiser Permanente Oakland Medical Center , Oakland, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3095-0288","authenticated-orcid":false,"given":"Ashok P","family":"Pai","sequence":"additional","affiliation":[{"name":"The Permanente Medical Group , 1800 Harrison St., Oakland, CA 94612, USA"},{"name":"Kaiser Permanente Northern California Division of Research , 4480 Hacienda Dr., Pleasanton, CA 94588, USA"},{"name":"Department of Hematology and Oncology, Kaiser Permanente Oakland Medical Center , Oakland, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4523-5009","authenticated-orcid":false,"given":"Jeffrey D","family":"Sperling","sequence":"additional","affiliation":[{"name":"The Permanente Medical Group , 1800 Harrison St., Oakland, CA 94612, USA"},{"name":"Department of Maternal-Fetal Medicine, Kaiser Permanente Modesto Medical Center , Modesto, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,8,22]]},"reference":[{"key":"2024092113511845100_ytae441-B1","doi-asserted-by":"crossref","first-page":"3146","DOI":"10.1093\/eurheartj\/ehab373","article-title":"Triaging acute pulmonary embolism for home treatment by Hestia or simplified PESI criteria: the HOME-PE randomized trial","volume":"42","author":"Roy","year":"2021","journal-title":"Eur Heart J"},{"key":"2024092113511845100_ytae441-B2","doi-asserted-by":"crossref","first-page":"19","DOI":"10.7812\/TPP\/19.163","article-title":"Comprehensive outpatient management of low-risk pulmonary embolism: can primary care do this? A narrative review","volume":"24","author":"Vinson","year":"2020","journal-title":"Perm J"},{"key":"2024092113511845100_ytae441-B3","doi-asserted-by":"crossref","first-page":"855","DOI":"10.7326\/M18-1206","article-title":"Increasing safe outpatient management of emergency department patients with pulmonary embolism: a controlled pragmatic trial","volume":"169","author":"Vinson","year":"2018","journal-title":"Ann Intern Med"},{"key":"2024092113511845100_ytae441-B4","doi-asserted-by":"crossref","first-page":"3620","DOI":"10.1007\/s11606-021-07289-0","article-title":"Management and outcomes of adults diagnosed with acute pulmonary embolism in primary care: community-based retrospective cohort study","volume":"37","author":"Vinson","year":"2022","journal-title":"J Gen Intern Med"},{"key":"2024092113511845100_ytae441-B5","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1093\/eurheartj\/ehz405","article-title":"2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)","volume":"41","author":"Konstantinides","year":"2020","journal-title":"Eur Heart J"},{"key":"2024092113511845100_ytae441-B6","doi-asserted-by":"crossref","first-page":"e545","DOI":"10.1016\/j.chest.2021.07.055","article-title":"Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report","volume":"160","author":"Stevens","year":"2021","journal-title":"Chest"},{"key":"2024092113511845100_ytae441-B7","doi-asserted-by":"crossref","first-page":"3317","DOI":"10.1182\/bloodadvances.2018024802","article-title":"American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy","volume":"2","author":"Bates","year":"2018","journal-title":"Blood Adv"},{"key":"2024092113511845100_ytae441-B8","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1111\/j.1365-2141.2007.06826.x","article-title":"The management of antenatal venous thromboembolism in the UK and Ireland: a prospective multicentre observational survey","volume":"139","author":"Voke","year":"2007","journal-title":"Br J Haematol"},{"key":"2024092113511845100_ytae441-B9","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1097\/AOG.0000000000002706","article-title":"ACOG practice bulletin no. 196: thromboembolism in pregnancy","volume":"132","author":"American College of Obstetricians and Gynecologists","year":"2018","journal-title":"Obstet Gynecol"},{"key":"2024092113511845100_ytae441-B10","doi-asserted-by":"crossref","first-page":"ii1","DOI":"10.1136\/thoraxjnl-2018-211539","article-title":"British Thoracic Society guideline for the initial outpatient management of pulmonary embolism (PE)","volume":"73","author":"Howard","year":"2018","journal-title":"Thorax"},{"key":"2024092113511845100_ytae441-B11","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1111\/j.1538-7836.2011.04388.x","article-title":"Outpatient treatment in patients with acute pulmonary embolism: the Hestia study","volume":"9","author":"Zondag","year":"2011","journal-title":"J Thromb Haemost"},{"key":"2024092113511845100_ytae441-B12","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/S0140-6736(11)60824-6","article-title":"Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial","volume":"378","author":"Aujesky","year":"2011","journal-title":"Lancet"},{"key":"2024092113511845100_ytae441-B13","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1164\/rccm.201108-1575ST","article-title":"An official American Thoracic Society\/Society of Thoracic Radiology clinical practice guideline: evaluation of suspected pulmonary embolism in pregnancy","volume":"184","author":"Leung","year":"2011","journal-title":"Am J Respir Crit Care Med"},{"key":"2024092113511845100_ytae441-B14","doi-asserted-by":"crossref","first-page":"20","DOI":"10.7812\/TPP\/20.303","article-title":"Outpatient management\u201d of pulmonary embolism defined in the primary literature: a narrative review","volume":"25","author":"Shan","year":"2021","journal-title":"Perm J"},{"key":"2024092113511845100_ytae441-B15","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1111\/jth.13629","article-title":"Net clinical benefit of hospitalization versus outpatient management of patients with acute pulmonary embolism","volume":"15","author":"Roy","year":"2017","journal-title":"J Thromb Haemost"},{"key":"2024092113511845100_ytae441-B16","doi-asserted-by":"crossref","first-page":"e12588","DOI":"10.1002\/emp2.12588","article-title":"A clinical decision framework to guide the outpatient treatment of emergency department patients diagnosed with acute pulmonary embolism or deep vein thrombosis: results from a multidisciplinary consensus panel","volume":"2","author":"Kabrhel","year":"2021","journal-title":"J Am Coll Emerg Physicians Open"},{"key":"2024092113511845100_ytae441-B17","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1097\/AOG.0000000000003721","article-title":"Gestation-specific vital sign reference ranges in pregnancy","volume":"135","author":"Green","year":"2020","journal-title":"Obstet Gynecol"},{"key":"2024092113511845100_ytae441-B18","doi-asserted-by":"crossref","first-page":"e000748","DOI":"10.1136\/bmjmed-2023-000748","article-title":"Development of a national maternity early warning score: centile based score development and Delphi informed escalation pathways","volume":"3","author":"Gerry","year":"2024","journal-title":"BMJ Med"},{"key":"2024092113511845100_ytae441-B19","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1136\/emermed-2021-211506","article-title":"Use of the National Early Warning Score for predicting deterioration of patients with acute pulmonary embolism: a post-hoc analysis of the YEARS study","volume":"40","author":"Bavalia","year":"2023","journal-title":"Emerg Med J"},{"key":"2024092113511845100_ytae441-B20","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s12245-010-0206-8","article-title":"Outcomes considered most important by emergency physicians when determining disposition of patients with pulmonary embolism","volume":"3","author":"Kabrhel","year":"2010","journal-title":"Int J Emerg Med"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytae441\/58885731\/ytae441.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/8\/9\/ytae441\/59217121\/ytae441.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/8\/9\/ytae441\/59217121\/ytae441.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,21]],"date-time":"2024-09-21T13:51:35Z","timestamp":1726926695000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytae441\/7738438"}},"subtitle":[],"editor":[{"given":"Emmanouil","family":"Androulakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Georgios","family":"Benetos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Andreas","family":"Giannopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Daniel","family":"Messiha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Leo","family":"Bergau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Jana","family":"Kupusovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Christoph","family":"Jensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Nikolaos","family":"Spinthakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,8,22]]},"references-count":20,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2024,9,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytae441","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,9]]},"published":{"date-parts":[[2024,8,22]]},"article-number":"ytae441"}}