Pulmonary embolism: risk stratification

Hestia Criteria

Hemodynamically unstable

SBP <100 mmHg and HR >100, needing ICU care, or by clinician judgment

Thrombolysis or embolectomy needed

For reasons other than hemodynamic instability

Active bleeding or high risk for bleeding

GI bleeding or surgery ≤2 weeks ago, stroke ≤1 month ago, bleeding disorder or platelet count <75 × 10⁹/L, uncontrolled HTN (SBP >180 or DBP >110), or by clinician judgment

>24 hrs on supplemental oxygen required to maintain SaO₂ >90%

PE diagnosed while on anticoagulation

Severe pain needing IV pain medication required >24 hr

Medical or social reason for admission >24 hr (infection, malignancy, no support system)

Creatinine clearance <30 mL/min by Cockcroft-Gault

Severe liver impairment By clinician judgment

Pregnant

Documented history of heparin-induced thrombocytopenia (HIT)

Result

Low risk
The patient is eligible for outpatient treatment, with an estimated 0% mortality and 2% risk of VTE recurrence.

References

1) Zondag W, Mos IC, Creemers-Schild D, Hoogerbrugge AD, Dekkers OM, Dolsma J, Eijsvogel M, Faber LM, Hofstee HM, Hovens MM, Jonkers GJ, van Kralingen KW, Kruip MJ, Vlasveld T, de Vreede MJ, Huisman MV; Hestia Study Investigators. Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study. J Thromb Haemost. 2011 Aug;9(8):1500-7. doi: 10.1111/j.1538-7836.2011.04388.x. PMID: 21645235.

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