Acute Pulmonary Embolism Risk Stratification & Treatment — free guideline decision tool

This tool stratifies acute pulmonary embolism by hemodynamics, sPESI/PESI, right-heart function, and troponin, and gives the reperfusion or anticoagulation direction per ESC 2019.

Unstable → high-risk, systemic thrombolysis + anticoagulation. Stable: RV + troponin both positive → intermediate-high (monitor, rescue thrombolysis); one positive/high score → intermediate-low; sPESI = 0 and normal RV/troponin → low-risk. NOAC preferred.

Use to assign risk and treatment: high-risk PE needs immediate reperfusion, while stable patients are anticoagulated and monitored, with rescue reperfusion reserved for decompensation.

Intermediate-high-risk PE is anticoagulated with close monitoring, reserving rescue reperfusion for hemodynamic decompensation rather than upfront thrombolysis. (original synthesis · not guideline verbatim) Low-risk patients meeting criteria (e.g. Hestia) may be considered for early discharge or home treatment. NOACs are preferred except in severe renal impairment, antiphospholipid syndrome, or pregnancy, with at least 3 months of therapy.

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Inputs: Hemodynamically unstable (shock/persistent hypotension) Yes, sPESI ≥ 1 or PESI III-V (suggests risk) Yes, Right-heart dysfunction (TTE/CTPA, RV/LV ≥ 1.0) Present, Elevated troponin Present → Result: Risk stratification High-risk PE（Decision: Hemodynamically unstable (shock or persistent hypotension) = high-risk, Reperfusion: Immediate systemic thrombolysis (preferred, greatest benefit within 48 h of onset); thrombolysis contraindicated or failed → catheter-directed therapy or surgical embolectomy, Anticoagulation/support: Simultaneously start parenteral anticoagulation (unfractionated heparin); hemodynamic support (cautious fluids, norepinephrine if needed), ECMO bridging possible） Inputs: Hemodynamically unstable (shock/persistent hypotension) No, sPESI ≥ 1 or PESI III-V (suggests risk) No (sPESI = 0), Right-heart dysfunction (TTE/CTPA, RV/LV ≥ 1.0) Absent, Elevated troponin Absent → Result: Risk stratification Low-risk PE（Decision: Hemodynamically stable; sPESI = 0, Management: Anticoagulation suffices (NOAC preferred); eligible patients may be considered for early discharge/home treatment (e.g. Hestia criteria), Anticoagulation: NOAC preferred (except severe renal impairment, antiphospholipid syndrome, pregnancy, etc., where LMWH/warfarin is used); at least 3 months, assess extension by provoking factors and recurrence risk）