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    Hestia Criteria for Outpatient Pulmonary Embolism Treatment

    Identifies low-risk PE patients safe for outpatient treatment.
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    INSTRUCTIONS

    Use in hemodynamically stable patients with acute pulmonary embolism (PE).

    When to Use
    Pearls/Pitfalls
    Why Use

    Hemodynamically stable patients with acute PE.

    • Acute PE is associated with potentially life-threatening complications in the short term; therefore, careful risk stratification must be used when attempting to identify candidates for outpatient management.
    • Not all patients deemed low-risk will have acute life threatening complications, and not all necessitate inpatient management. This tool only helps identify those who are low risk, and does not necessarily predict those who are high risk.
    • Safely triages patients for outpatient management.
    • Easily applied in a clinical setting at the bedside.
    • Associated with decreased length of stay and lower costs.
    • Associated with fewer in-hospital complications.
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    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    Patients identified as candidates for outpatient management:

    • Must be counseled about risks of outpatient treatment and should be given close return precautions.
    • Should remain in the hospital if there is any evidence of hemodynamic instability.
    • Should be counseled on risks of bleeding once started on novel oral anticoagulant (NOAC) therapy.

    Management

    • Most hospitals have particular DVT/PE order sets or guidelines for management.
    • Management typically includes the following:
      • Heparin drip or enoxaparin with bridging to warfarin.
      • Serial PT/PTT.
      • Telemetry and monitoring.
    • Alternative:
      • Treatment with a NOAC.

    Critical Actions

    • Does not apply in patients with hemodynamic instability or those not being considered for outpatient management.
    • If the patient is being considered for outpatient management, this tool may be used to help justify avoiding inpatient hospitalization.
    • No decision rule should trump clinical gestalt.
    Content Contributors
    • Daniel McFarland, MD
    Reviewed By
    • Anand Swaminathan, MD
    About the Creator
    Dr. Wendy Zondag
    Are you Dr. Wendy Zondag?
    Content Contributors
    • Daniel McFarland, MD
    Reviewed By
    • Anand Swaminathan, MD