TY - JOUR T1 - British Thoracic Society Guideline for the initial outpatient management of pulmonary embolism (PE) JF - Thorax JO - Thorax SP - ii1 LP - ii29 DO - 10.1136/thoraxjnl-2018-211539 VL - 73 IS - Suppl 2 AU - Luke S G E Howard AU - Steven Barden AU - Robin Condliffe AU - Vincent Connolly AU - Christopher W H Davies AU - James Donaldson AU - Bernard Everett AU - Catherine Free AU - Daniel Horner AU - Laura Hunter AU - Jasvinder Kaler AU - Catherine Nelson-Piercy AU - Emma O’Dowd AU - Raj Patel AU - Wendy Preston AU - Karen Sheares AU - Campbell Tait Y1 - 2018/07/01 UR - http://thorax.bmj.com/content/73/Suppl_2/ii1.abstract N2 - Outcomes of outpatient care for low-risk pulmonary embolism (PE)RecommendationsPatients with PE should be assessed for suitability for management as outpatients (OPs). Grade BPatients assessed as low risk and suitable for OP management should be offered treatment in an OP setting where a robust pathway exists for follow-up and monitoring. Grade BInclusion and exclusion criteria for OP management or early dischargeRecommendationsPatients with confirmed PE should be risk-stratified using a validated clinical risk score. Grade BPatients in Pulmonary Embolism Severity Index (PESI) class I/II, simplified version of the PESI (sPESI) 0 or meeting the Hestia criteria should be considered for OP management of PE. Grade BWhere PESI or sPESI is used and indicates a low risk, a set of exclusion criteria should be applied to patients being considered for outpatient management of confirmed PE. Grade BExclusion criteria include:Haemodynamic instability (HR>110bpm; systolic blood pressure (SBP)<100 mm Hg; requirement for inotropes and critical care; requirement for thrombolysis or embolectomy).Oxygen saturations < 90% on air.Active bleeding or risk of major bleeding (eg. recent gastrointestinal (GI) bleed or surgery, previous intracranial bleeding, uncontrolled hypertension).On full-dose anticoagulation at the time of the PE.Severe pain (eg. requiring opiates).Other medical comorbidities requiring hospital admission.Chronic kidney disease (CKD) stages 4 or 5 (estimated glomerular filtration rate (eGFR)<30 mL/min) or severe liver disease.Heparin-induced thrombocytopenia (HIT) within the last year and where there is no alternative to repeating heparin treatment.Social reasons which may include inability to return home, inadequate care at home, lack of telephone communication, concerns over compliance, etc.No specific assessment of bleeding risk is required in patients who are deemed low risk by PESI/sPESI/Hestia criteria. Grade BMeasurement of right ventricular (RV):left ventricular (LV) ratio on CT or assessment of RV function on echocardiography is not obligatory for the identification of low-risk patients for OP management. Grade CWhere RV … ER -