Acute venous thromboembolism (VTE) remains the third most common cause of cardiovascular death, following myocardial infarction and stroke. It represents a global health threat with a significant economic burden. Risk stratification for short-term adverse events is crucial for the management of acute pulmonary embolism (PE). Over the past decade, management of acute PE has evolved toward greater individualization, guided by risk stratification. Supported by the results of recent randomized clinical trials, American and European guidelines recommend considering outpatient therapy for patients with low-risk PE if adequate outpatient follow-up can be provided. Nevertheless, only a minority of them are currently treated as outpatients.

In this manuscript, we examine risk stratification for acute PE and describe the main validated risk scores for low-risk PE, along with their limitations. In addition, we review several clinical trials comparing outpatient treatment with standard hospitalization. Furthermore, we address the barriers recognized by Emergency Department (ED) physicians that hinder the adoption of an outpatient management strategy. Additionally, we discuss the importance of implementing quality interventions and robust educational programs for ED physicians, as well as web-based point-of care tools, including electronic calculators of validated risk scores. We also emphasize key points for patient education and adequate follow-up to increase the rate of outpatient management.