The Hestia clinical decision rule is an exclusion checklist. Outpatient treatment is considered only when all 11 criteria are answered No.

#	Criterion (exclusion if Yes)
1	Haemodynamically unstable (systolic BP <100 mmHg with heart rate >100 beats per minute, or requiring ICU-level care).
2	Thrombolysis or surgical embolectomy necessary.
3	Active bleeding or high risk of bleeding (for example gastrointestinal bleeding in the previous 14 days, recent stroke <4 weeks, recent major surgery <2 weeks, bleeding disorder or thrombocytopenia, uncontrolled hypertension).
4	More than 24 hours of supplemental oxygen required to maintain oxygen saturation >90%.
5	Pulmonary embolism diagnosed while on therapeutic anticoagulant treatment.
6	Severe pain requiring intravenous analgesia for more than 24 hours.
7	Medical or social reason for hospital treatment >24 hours (for example active infection, malignancy needing inpatient care, inadequate social support).
8	Creatinine clearance <30 mL/min (typically by Cockcroft–Gault).
9	Severe liver impairment judged clinically significant.
10	Pregnancy.
11	Documented history of heparin-induced thrombocytopenia (HIT).

Rule: If any criterion is Yes, the patient is not considered suitable for outpatient PE treatment under the Hestia rule.

Hestia Criteria for Outpatient Pulmonary Embolism Treatment