Thursday, July 24, 2014


UW Health - Nikki Pernot - 22/12/2012
This guideline contains strategies and recommendations designed to assist clinicians in delivering and supporting effective outpatient treatment for pulmonary embolism. 
Practice Recommendations 
Eligibility Criteria for Outpatient Pulmonary Embolism management: 
• ≥ 18 years of age 
• Diagnosis of acute pulmonary embolism 
• Able and willing to comply with home care 
• Able to obtain necessary medications 
  If patient meets the eligibility criteria, calculate the PESI score based on table included 
 in the guideline. If PESI score is ≥ 86, hospitalize the patient. If PESI score is ≤ 85, 
 continue to the exclusion criteria: 
 Exclusion Criteria: 
• Intracardiac or central vein thrombus 
• Central PE (main pulmonary artery) 
• Requires admission for reasons other than acute PE/DVT 
• Not appropriate for long term anticoagulation (fall risk, unreliable, or unable to comply 
with follow up) 
• Any stroke in the last 6 weeks 
• Brain, spinal, or ophthy surgery in the last 6 weeks 
• Non-cutaneous surgery in the last 2 weeks 
• GI bleed in the last 2 weeks 
• Active major bleeding 
• History of HIT or heparin “allergy” 
• Theraputic anticoagulation at the time of diagnosis (e.g. INR ≥ 2) 
• Thrombocytopenia (< 75,000) 
• Other coagulopathy 
• Creatinine clearance , 30 mL/min 
• Hypoxia (< 90% at any time in the ED) 
• Hypotension (SBP , 100mmHg at any time in the ED) 
• RV strain on echocardiogram (if obtained) 
• Treated with thrombolytics in the ED 
• Pregnant 
• > 150 kg 
• BMI < 18
If no to all exclusion criteria, then the patient may be discharged with proper Home care instructions"