Print this page. The left column is for the hospital stay; the right for the months after. Each line is something NICE NG158 or the European and US guidelines say should happen. A blank box is a question to ask, not a verdict.
In hospital
| Done | What should have happened | Ref. |
|---|---|---|
| ☐ | History, examination and chest X-ray to look for other causes; ECG | 1.1.15 |
| ☐ | Wells score recorded (likely >4 / unlikely ≤4) | 1.1.17 |
| ☐ | If unlikely: D-dimer within 4 hours, age-adjusted if over 50, taken before any anticoagulant | 1.1.21, 1.1.14 |
| ☐ | If likely, or D-dimer positive: CTPA immediately, or V/Q if CTPA unsuitable | 1.1.18 |
| ☐ | If the scan or D-dimer could not be done in time: anticoagulation started while waiting | 1.1.18, 1.1.21 |
| ☐ | Baseline bloods taken (FBC, kidney, liver, PT, APTT) and reviewed within 24 hours; treatment not delayed for them | 1.3.4 |
| ☐ | Troponin and BNP measured; lactate if unwell | ESC / AHA |
| ☐ | Severity graded: sPESI (or PESI/Hestia), right ventricle on CT or echo | ESC / AHA |
| ☐ | Echocardiogram if unwell, borderline, or biomarkers raised | ESC / AHA |
| ☐ | Anticoagulant chosen for the situation: apixaban or rivaroxaban unless kidney failure, cancer, antiphospholipid syndrome, extreme weight or instability | 1.3.7–1.3.20 |
| ☐ | If sent home: written information, direct contact number, out-of-hours details | 1.2.4 |
| ☐ | If intermediate-high risk: monitored bed, escalation trigger documented, regional centre or PERT discussed | AHA |
| ☐ | If unstable: heparin infusion and thrombolysis considered | 1.3.12, 1.6.2 |
| ☐ | If a filter was placed: reason recorded and a removal plan written | 1.7.4 |
| ☐ | Anticoagulant alert card given | 1.5.2 |
| ☐ | Provoked or unprovoked written on the discharge letter, with the reason | 1.4 |
| ☐ | Date and owner of the 3-month review written down | 1.4.1 |
After hospital
| Done | What should happen | Ref. |
|---|---|---|
| ☐ | Combined pill, patch, ring or oral HRT stopped and replaced | 1.4 (provoked) |
| ☐ | 3-month review (3–6 with cancer): stop, continue or change discussed, with the reasoning | 1.4.1–1.4.4 |
| ☐ | Bleeding risk assessed (HAS-BLED); a score of 4 or more prompted a stopping discussion | 1.4.6 |
| ☐ | If stopping: written symptoms to watch for, direct contact, out-of-hours details | 1.4.2 |
| ☐ | If continuing: current drug continued if tolerated; apixaban considered if not; extended dose discussed after 6 months | 1.4.7–1.4.9 |
| ☐ | Unprovoked: history reviewed, physical examination done, baseline bloods reviewed for cancer | 1.8.1 |
| ☐ | No further cancer tests unless symptoms or signs; screening programmes up to date | 1.8.2 |
| ☐ | Thrombophilia tests only if stopping is planned and the criteria are met; done weeks after the event with haematology input | 1.9 |
| ☐ | Antiphospholipid antibodies if unprovoked and stopping is planned | 1.9.3 |
| ☐ | Inherited thrombophilia if unprovoked, stopping planned, and a first-degree relative has had a clot | 1.9.4 |
| ☐ | Symptoms and exercise capacity reviewed at 3–6 months | ESC / AHA |
| ☐ | If still breathless: echocardiogram; V/Q scan and pulmonary hypertension referral if abnormal | ESC / AHA |
| ☐ | Filter removed once anticoagulation established | 1.7.2 |
| ☐ | Annual review of recurrence risk, bleeding risk, general health and preferences while on treatment | 1.4.12 |
| ☐ | Previous VTE flagged for prophylaxis at any future admission or operation | NG89 |
| ☐ | Pregnancy planning, if relevant, arranged through obstetric haematology before conception | RCOG |
The two scores on one card
| Simplified PESI — one point each; 0 is low risk | Hestia — any "yes" means not suitable for home treatment |
|---|---|
| Age over 80 | Haemodynamically unstable |
| Cancer | Thrombolysis or embolectomy needed |
| Chronic heart or lung disease | Active bleeding or high bleeding risk |
| Heart rate 110 or more | More than 24 hours of oxygen needed to keep saturation over 90% |
| Systolic blood pressure under 100 | PE diagnosed while already anticoagulated |
| Oxygen saturation under 90% | Severe pain needing intravenous medication for more than 24 hours |
| Another medical or social reason for admission for more than 24 hours | |
| Creatinine clearance under 30 | |
| Severe liver impairment | |
| Pregnant | |
| Documented history of heparin-induced thrombocytopenia |
Numbers in the reference column are NICE NG158 recommendation numbers. "ESC / AHA" means the European Society of Cardiology 2019 guideline and the 2026 AHA/ACC multisociety guideline, which agree on that item. NG89 is NICE's guideline on reducing VTE risk in hospital. RCOG is the Royal College of Obstetricians and Gynaecologists.