🫁 Acute Pulmonary Embolism Risk Stratification & Treatment
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.
Acute Pulmonary Embolism Risk Stratification & Treatment
Hemodynamically unstable (shock/persistent hypotension)
sPESI ≥ 1 or PESI III-V (suggests risk)
Right-heart dysfunction (TTE/CTPA, RV/LV ≥ 1.0)
Elevated troponin
When to use
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.
How it works
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.
Key points
- 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.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.