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Outpatient PE Management — EECC MCQ

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ModeratePulmonary Vascular DiseaseOutpatient PE ManagementEECC

A 55-year-old man with suspected PE has a simplified PESI score of 0 (no age >80, cancer, chronic cardiopulmonary disease, HR ≥110, SBP <100, or SpO₂ <90%). Troponin and RV function are normal. Can he be managed as an outpatient?

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Correct answer: E — Yes — low-risk PE (sPESI 0 with normal troponin and RV function) can be managed with early discharge and outpatient anticoagulation using a DOAC, per the Hestia criteria or sPESI pathway; this applies to approximately 30-50% of PE patients

The ESC 2019 PE Guidelines recommend risk stratification using sPESI or Hestia criteria to identify low-risk PE patients suitable for early discharge: (1) sPESI = 0 (no adverse features) AND normal troponin AND normal RV on echo/CT → low-risk; (2) Hestia criteria: checklist of 11 exclusion criteria (haemodynamic instability, need for thrombolysis, active bleeding, need for oxygen, IV pain management, etc.) — if all negative, early discharge is safe. Home treatment: DOAC monotherapy (rivaroxaban 15 mg bd × 3 weeks then 20 mg daily, or apixaban 10 mg bd × 7 days then 5 mg bd). Studies (HOME-PE, OPTALYSE PE) confirm safety of outpatient management for low-risk PE with 30-day mortality <2% and VTE recurrence <2%. This approach reduces healthcare costs and improves patient satisfaction.

Reference: ESC (2019): PE Guidelines; HOME-PE Trial