Outpatient Management of Pulmonary Embolism

August 3, 2021

In the past, patients with pulmonary embolism (PE) were managed as inpatients, partly due to the need to titrate anticoagulation to therapeutic levels. But ACEP and the American College of Chest Physicians now recommend that selected low-risk patients be managed as outpatients. Newer direct oral anticoagulants do not require injections or anticoagulation testing, making outpatient treatment more reasonable for a subset of patients. Outpatient management is a safe and less expensive option for many low-risk patients, one that decreases rates of hospital-related infections.

To identify low-risk patients, physicians can use different risk-stratification scores which may differ based on institutional protocols. These include the PE Severity Index, the Simplified PESI, and the Hestia criteria.

Review “Outpatient Management of Pulmonary Embolism” before you answer the question.

Which of the following patients with PE have red flags signifying that they are probably NOT good candidates for outpatient care?

A) The patient is hemodynamically unstable.

B) The patient has chronic cardiopulmonary disease.

C) The patient’s systolic blood pressure is less than 100 mg Hg, and they have altered mental status.

D) The patient cannot reasonably be relied on to attend a follow-up visit as requested.

E) All of the above.