Hestia Criteria for Outpatient Management of Pulmonary Embolism

Identify patients with acute PE who may be appropriate for outpatient management


The Hestia Criteria were derived to establish which patients with acute pulmonary embolism (PE) are low-risk for mortality and eligible for outpatient management. Traditional management for acute PE involves admission and anticoagulation, however, prior evidence had shown that of a subset of selected patients had been safely treated outside of hospital.

The study authors isolated 11 exclusion criteria to stratify patients as "Low-Risk" or "Not Low-Risk" and the presence of any one of these variables deemed the patient not suitable for an outpatient strategy.

The 2011 prospective cohort original study followed patients with acute PE across 12 hospitals in the Netherlands. Patients were triaged as low-risk using the predefined criteria for outpatient management and followed for 3 months after initial presentation. Within the 297 patients that were managed out of hospital, 2.0% (95% CI 0.8-4.3%) had recurrent VTE and no patients died of pulmonary embolism. Validation of the Hestia criteria has taken place several times since the original working group with similar results for this subset of patients.

    Variable & Associated Points
  • Hemodynamically unstable (Yes +1, No 0).
  • Thrombolysis or embolectomy needed (Yes +1, No 0)
  • Active bleeding or high risk for bleeding (Yes +1, No 0)
  • > 24 hours on supplemental oxygen required to maintain SaO2 >90% (Yes +1, No 0)
  • PE diagnosed while on anticoagulation (Yes +1, No 0)
  • Severe pain needing IV medication required for > 24 hours (Yes +1, No 0)
  • Medical or social reason for admission > 24 hours (Yes +1, No 0)
  • Creatinine clearance < 30 mL/min by Cockcroft-Gault (Yes +1, No 0)
  • Severe liver impairment (Yes +1, No 0)
  • Pregnant (Yes +1, No 0)
  • Documented history of heparin-induced thrombocytopenia (HIT) (Yes +1, No 0)


Zondag W, Mos IC, Creemers-schild D, et al.

J Thromb Haemost. 2011; 9(8):1500-7.

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1. Hemodynamically unstable?

More Information

Systolic BP < 100mmHg and HR > 100 or
Requires ICU level admission/care or
Clinician judgement

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