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Outpatient PE Management — RACP Adult Medicine MCQ

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ModerateRespiratoryOutpatient PE ManagementRACP Adult Medicine

A 38-year-old woman presents with acute onset dyspnoea, pleuritic chest pain, and haemoptysis. She has recently started the combined oral contraceptive pill. CTPA confirms bilateral subsegmental pulmonary emboli. She is haemodynamically stable. Her sPESI score is 0 (low risk). What is the appropriate management setting and anticoagulant?

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Correct answer: B — Outpatient management with apixaban or rivaroxaban

Low-risk PE (sPESI 0 or PESI class I–II) in haemodynamically stable patients can be managed as outpatients with a DOAC (apixaban: 10 mg BD for 7 days then 5 mg BD; or rivaroxaban: 15 mg BD for 3 weeks then 20 mg daily). The Hestia criteria and sPESI score guide outpatient eligibility. Requirements include: no haemodynamic instability, no high bleeding risk, no need for supplemental oxygen, adequate social support, and reliable follow-up. The OCP should be permanently ceased and an alternative non-oestrogen contraceptive recommended.

Reference: eTG – 2025 – Haematology; ESC – 2019 – PE Guidelines