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Pulmonary Embolism Risk Stratification (ESC/ERS 2019)

Pulmonary Embolism Risk Stratification (ESC/ERS 2019): Suspected PE → Hemodynamically Unstable? → HIGH-RISK PE → Anticoagulation.

Pathway Overview

11 steps

Algorithm Steps

11 total

  1. 01Start

    Suspected PE

    Clinical suspicion of pulmonary embolism

  2. 02Decision

    Hemodynamically Unstable?

    Cardiac arrest, shock, hypotension

  3. If Yes
    1. 03Warning

      HIGH-RISK PE

      Immediate action required

      • Anticoagulation + PRIMARY REPERFUSION
      • Thrombolysis (Class I)
      • Surgical/catheter if lysis fails
    2. 04Action

      Anticoagulation

      DOAC preferred (Class I)

      • Apixaban or Rivaroxaban
      • LMWH over UFH for most
      • Duration: 3mo minimum
    If No
    1. 05Action

      Calculate sPESI

      Simplified PE Severity Index

      • Age >80 (+1)
      • Cancer (+1)
      • Cardiopulm disease (+1)
      • HR ≥110 (+1)
      • SBP <100 (+1)
      • SpO2 <90% (+1)
    2. 06Decision

      sPESI Score?

    3. 07Action

      LOW RISK (sPESI 0)

      Consider home treatment

      • DOAC preferred
      • Close follow-up
      • Patient education
    4. Path rejoins step 04Shared downstream outcome
    5. 08Action

      sPESI ≥1

      Further stratify with RV + Troponin

    6. 09Decision

      RV Dysfunction + Troponin+?

    7. If Yes
      1. 10Warning

        Intermediate-HIGH

        ICU, rescue reperfusion ready

      2. Path rejoins step 04Shared downstream outcome
      If No
      1. 11Action

        Intermediate-LOW

        Ward, monitor closely

      2. Path rejoins step 04Shared downstream outcome

Guideline Source

2019 ESC/ERS Guidelines for Pulmonary Embolism

DOI: 10.1093/eurheartj/ehz405View Guideline

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • Wells score calculator not integrated
  • sPESI simplified
  • Does not address thrombolysis dosing

Contraindicated Populations

pediatricpregnancy

Applicable Regions

EUUS

EU: ESC/ERS 2019 guidelines

US: ACCP guidelines similar approach

Version 1Next review: 2026-01-01

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Frequently Asked Questions

What is the Pulmonary Embolism Risk Stratification (ESC/ERS 2019)?

The Pulmonary Embolism Risk Stratification (ESC/ERS 2019) is a diagnostic clinical algorithm for Cardiology. It provides a structured decision tree to guide clinical decision-making, based on 2019 ESC/ERS Guidelines for Pulmonary Embolism.

What guideline is the Pulmonary Embolism Risk Stratification (ESC/ERS 2019) based on?

This algorithm is based on 2019 ESC/ERS Guidelines for Pulmonary Embolism (DOI: 10.1093/eurheartj/ehz405).

What are the limitations of the Pulmonary Embolism Risk Stratification (ESC/ERS 2019)?

Known limitations include: Wells score calculator not integrated; sPESI simplified; Does not address thrombolysis dosing. Individual patient factors may require deviation from these recommendations.

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