Evidence-based risk stratification of patients with acute pulmonary embolism: Communication from the ISTH SSC Subcommittee on Predictive and Diagnostic Variables in Thrombotic Disease.
Publisher DOI
PubMed ID
41354154
Abstract
Background
Acute pulmonary embolism (PE) includes clinical presentations with a wide spectrum of severities, making risk stratification essential to guide the decision-making process in daily practice. However, international guidelines differ in definition of risk classes and consequent treatment recommendations.Objective
To summarize high quality evidence supporting four key management decisions in acute PE: hospitalization, intensive care unit (ICU) admission, reperfusion therapy and discharge.Methods
A multidisciplinary ISTH taskforce completed with international experts conducted a literature review focused on randomized trials and prospective management studies reporting hard clinical outcomes and assessed as having a low risk of bias, focused on any of the 4 management decisions detailed above.Results And Conclusions
Available evidence supports the use of either the Hestia criteria or (s)PESI combined with clinical judgment to select PE patients for outpatient treatment. In contrast, no PE-specific evidence exists to guide ICU admission. Reperfusion therapy in hemodynamically unstable patients is supported by one small, randomized trial, while currently available high-quality evidence does not support routine reperfusion therapy in hemodynamically stable patients; therefore, hemodynamic instability remains the only established indication for reperfusion therapy to date. The decision to discharge a PE patient may be supported by the use of sPESI combined with clinical assessment of stability. All in all, substantial evidence gaps persist, underscoring the need for further research to inform clinical practice and future guidelines.
Acute pulmonary embolism (PE) includes clinical presentations with a wide spectrum of severities, making risk stratification essential to guide the decision-making process in daily practice. However, international guidelines differ in definition of risk classes and consequent treatment recommendations.Objective
To summarize high quality evidence supporting four key management decisions in acute PE: hospitalization, intensive care unit (ICU) admission, reperfusion therapy and discharge.Methods
A multidisciplinary ISTH taskforce completed with international experts conducted a literature review focused on randomized trials and prospective management studies reporting hard clinical outcomes and assessed as having a low risk of bias, focused on any of the 4 management decisions detailed above.Results And Conclusions
Available evidence supports the use of either the Hestia criteria or (s)PESI combined with clinical judgment to select PE patients for outpatient treatment. In contrast, no PE-specific evidence exists to guide ICU admission. Reperfusion therapy in hemodynamically unstable patients is supported by one small, randomized trial, while currently available high-quality evidence does not support routine reperfusion therapy in hemodynamically stable patients; therefore, hemodynamic instability remains the only established indication for reperfusion therapy to date. The decision to discharge a PE patient may be supported by the use of sPESI combined with clinical assessment of stability. All in all, substantial evidence gaps persist, underscoring the need for further research to inform clinical practice and future guidelines.
Date Issued
2026-03
Publication Type
Article
Subject(s)
Subjects
acute pulmonary embolism
•
risk assessment tool
•
risk stratification
Language(s)
en
Author(s)
Talerico, Rosa | |
de Wit, Kerstin | |
Barco, Stefano | |
Bonorino, Jose | |
den Uil, Corstiaan | |
Kraemer, Carlos Elzo | |
Germini, Federico | |
Iding, Aaron | |
Jones, Aubrey | |
Konstantinides, Stavros | |
Masias, Camila | |
Parks, Anna L | |
Robert-Ebadi, Helia | |
Vedovati, Maria Cristina | |
Vinson, David R | |
Woller, Scott C | |
Klok, Frederikus A |
Additional Credits
Journal
Journal of Thrombosis and Haemostasis
Publisher
Elsevier
ISSN
1538-7836
1538-7933
Access(Rights)
embargo