Summary
Usage The Hestia Criteria risk assess patients with PE to guide decisions regarding inpatient vs. outpatient PE treatment. The Hestia Criteria have been validated in several studies. A 2011 validation study determined that patients who were negative for any of the Hestia Criteria:Can be selected for outpatient PE treatment.VTE recurred in 2% of patients (CI 0.8- 4.3.) None of the recurrences were fatal.None of the patients experienced a recurrent VTE within 7 days of the index event (a period equaling the average duration of hospital admission for PE.)A 2013 validation study determined the Hestia Criteria can safely select patients with PE for outpatient treatment, irrespective of right ventricular function. An additional 2013 validation study suggested a proportion of patients classified as high risk by sPESI score, for reasons such as malignant disease, advanced age, or cardiopulmonary comorbidities, can be safely treated at home under Hestia Criteria. A 2015 study utilizing the Hestia Criteria suggested the safety of oral rivaroxaban for the treatment of outpatient PE (rivaroxaban dose: 15mg by mouth twice daily for 21 days, followed by 20mg once daily). The predictive accuracy of the Hestia Criteria was confirmed in 2016 by den Exeter (3 month risk of recurrent VTE was 1.1%, CI 0.2-3.2%) and Weeda (acceptable predictive accuracy in patients with advanced age, active malignancy, or cardiopulmonary disease.)Summary If any of the following Hestia criteria is/are present, the patient is considered "Not Low Risk" and is recommended for inpatient PE treatment. Patients receive +1 point for each present element (no points if absent).Hemodynamically unstableThrombolysis or embolectomy indicatedNeed for supplemental oxygen (> 24 hours)PE diagnosed while actively anticoagulatedNeed for IV pain medication (> 24 hours)Presence of compelling indication or social reason for admission (> 24 hours)Creatinine Clearance < 30 ml/minPresence of severe liver impairmentPregnancyDocumented history of Heparin-Induced Thrombocytopenia