Pulmonary Embolism Risk Stratification (ESC/ERS 2019)
Pulmonary Embolism Risk Stratification (ESC/ERS 2019): Suspected PE → Hemodynamically Unstable? → HIGH-RISK PE → Anticoagulation.
Interactive Decision Tree
Algorithm Steps
- ▶Start
Suspected PE
Clinical suspicion of pulmonary embolism
- ◆Decision
Hemodynamically Unstable?
Cardiac arrest, shock, hypotension
If Yes:
- ⚠Warning
HIGH-RISK PE
Immediate action required
- Anticoagulation + PRIMARY REPERFUSION
- Thrombolysis (Class I)
- Surgical/catheter if lysis fails
- ●Action
Anticoagulation
DOAC preferred (Class I)
- Apixaban or Rivaroxaban
- LMWH over UFH for most
- Duration: 3mo minimum
If No:
- ●Action
Calculate sPESI
Simplified PE Severity Index
- Age >80 (+1)
- Cancer (+1)
- Cardiopulm disease (+1)
- HR ≥110 (+1)
- SBP <100 (+1)
- SpO2 <90% (+1)
- ◆Decision
sPESI Score?
- ●Action
LOW RISK (sPESI 0)
Consider home treatment
- DOAC preferred
- Close follow-up
- Patient education
- ●Action
sPESI ≥1
Further stratify with RV + Troponin
- ◆Decision
RV Dysfunction + Troponin+?
If Yes:
- ⚠Warning
Intermediate-HIGH
ICU, rescue reperfusion ready
If No:
- ●Action
Intermediate-LOW
Ward, monitor closely
Guideline Source
2019 ESC/ERS Guidelines for Pulmonary Embolism
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
Applicable Regions
EU: ESC/ERS 2019 guidelines
US: ACCP guidelines similar approach
Next steps
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Related Resources
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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