Early discharge and home treatment after acute pulmonary embolism

Summary: Early identification of patients with acute pulmonary embolism (PE) who can be safely managed in the outpatient setting has become a central priority in contemporary clinical practice. While haemodynamic instability mandates urgent reperfusion, most patients are hemodynamically stable at admission and therefore require refined risk stratification to guide therapeutic decisions and determine the appropriate level of care. The 2019 European Society of Cardiology guidelines emphasise the importance of identifying low-risk patients who may be eligible for early discharge (within 24–48 h) and home-based anticoagulation. Over the past decade, substantial progress has been made in validating clinical, biochemical, and haemodynamic criteria capable of reliably stratifying low-risk patients. The introduction of direct oral anticoagulants further simplified anticoagulation pathways, enabling shorter hospital stays and safer outpatient management. Nevertheless, the implementation of early discharge and outpatient treatment strategies remains highly heterogeneous across countries, reflecting variations in national recommendations, healthcare system organisation, and resource availability. This review aims to synthesise the current evidence on outpatient management of acute PE, with a focus on risk-stratification strategies, cost-effectiveness considerations, and contemporary guideline recommendations.