Clinical controversies in the management of acute pulmonary embolism: evaluation of four important but controversial aspects of acute pulmonary embolism management that are still subject of debate and research

Figures & data

Table 1. Hestia criteria and sPESI score for eligibility of home-treatment.

Hestia	Answer	sPESI	Points
Is the patient hemodynamically unstable? ^a	Yes/No	Age >80 years	1
Is thrombolysis or embolectomy necessary?	Yes/No	History of cancer	1
Active bleeding or high risk of bleeding? ^b	Yes/No	Chronic cardiopulmonary disease	1
More than 24 h of oxygen supply to maintain oxygen saturation > 90%?	Yes/No	Systolic blood pressure <100mmHg	1
Is pulmonary embolism diagnosed during anticoagulant treatment?	Yes/No	Heart rate ≥110 b.p.m.	1
Severe pain needing intravenous pain medication for more than 24 h?	Yes/No	Arterial oxygen saturation <90%	1
Medical or social reason for treatment in the hospital for more than 24 h (infection, malignancy, no support system)?	Yes/No
Does the patient have a creatinine clearance of < 30 mL/min? ^c	Yes/No
Does the patient have severe liver impairment? ^d	Yes/No
Is the patient pregnant?	Yes/No
Does the patient have a documented history of heparin-induced thrombocytopenia?	Yes/No
If all questions can be answered with ‘No’ the patient has a negative Hestia and is eligible for home treatment		If the sPESI score is 0 points, a patient is eligible for home treatment.

^a Include the following criteria, but leave these to the discretion of the investigator: systolic blood pressure < 100 mmHg with heart rate > 100 beats min^–1; condition requiring admission to an intensive care unit. ^b Gastrointestinal bleeding in the preceding 14 days, recent stroke (< 4 weeks ago), recent operation (< 2 weeks ago), bleeding disorder or thrombocytopenia (platelet count <75· 109 L–1),uncontrolled hypertension (systolic blood pressure > 180 mmHg or diastolic blood pressure > 110 mmHg). ^c Calculated creatinine clearance according to the Cockroft–Gault formula. ^dLeft to the discretion of the physician.

Figure 1. Pathway of acute pulmonary embolism treatment.