Home › Cardiology › Hestia

Hestia Criteria for Outpatient Pulmonary Embolism Treatment

Hestia is an 11-item checklist for confirmed acute PE: if all answers are "no", the patient is eligible for outpatient anticoagulation (2.0% recurrent VTE, 1.0% mortality at 3 months in the derivation study). Any "yes" means admit.

Hemodynamically unstable (SBP <100 with HR >100, needs ICU, or catecholamines) (yes/no, +1)
Thrombolysis or embolectomy needed (yes/no, +1)
Active bleeding or high risk of bleeding (yes/no, +1)
Oxygen needed >24 h to keep SaO₂ >90% (yes/no, +1)
PE diagnosed while on anticoagulation (yes/no, +1)
Severe pain needing IV analgesia >24 h (yes/no, +1)
Medical or social reason for admission >24 h (yes/no, +1)
Creatinine clearance <30 mL/min (yes/no, +1)
Severe liver impairment (yes/no, +1)
Pregnant (yes/no, +1)
Documented history of heparin-induced thrombocytopenia (yes/no, +1)

—

Interpretation

Result	Meaning
0 criteria	Eligible for outpatient treatment
≥ 1 criterion	Admit / inpatient treatment

Formula

Count of 11 yes/no criteria: hemodynamic instability · thrombolysis/embolectomy needed · active bleeding or high bleeding risk · O₂ >24 h for SaO₂ >90% · PE on anticoagulation · IV analgesia >24 h · medical/social reason to admit >24 h · CrCl <30 · severe liver impairment · pregnancy · history of HIT. Any positive → not eligible.

Clinical pearls

Hestia was non-inferior to sPESI for selecting outpatients in the randomized HOME-PE trial; either is acceptable.
The "medical or social reason" item is deliberately broad: clinician judgement (support at home, adherence, follow-up access) is built in.
RV dysfunction on imaging or raised troponin is not a Hestia item; many centres still admit those patients.

Examples

hestia for confirmed pe, stable, no oxygen, not pregnant, no bleeding hestia criteria pe on apixaban can this pe go home: hestia all negative

FAQ

Which PE patients can be treated at home?

Those with no Hestia criteria (or sPESI 0) who are stable, have no bleeding concerns and have adequate support and follow-up.

Hestia or sPESI?

Both are validated; HOME-PE found Hestia triage non-inferior to sPESI with similar safety.

Evidence

Zondag W et al. Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study. J Thromb Haemost 2011;9:1500–7.

Cardiology · Reviewed 2026-10-14 · Methodology