Treatment of Acute PE Out of the Hospital Summary of the Evidence Our recommendation in AT9 was based on: (1) two trials that randomized patients with acute PE to receive LMWH for only 3 days in the hospital121 or entirely at compared with being treated with LMWH in the hospital for a longer period; (2) 15 observational studies, 9 of which were prospective, that evaluated treatment of acute PE out of the hospital1 ; and (3) longstanding experience treating DVT without admission to a hospital. Since AT9, no further randomized trials have evaluated out-of-hospital treatment of acute PE. Several additional prospective and retrospective observational studies have reported ndings consistent with earlier reports, and the ndings of all of these studies have been included in recent meta- analyses that have addressed treatment of acute PE out of the hospital.123-125 Studies that evaluated NOACs for the acute treatment of PE did not report the proportion of patients who were treated entirely out of hospital, but it is probable that this was uncommon. Treatment of acute PE with a NOAC that does not require initial heparin therapy (eg, rivaroxaban, apixaban) facilitates treatment without hospital admission. Consistent with AT9, we suggest that patients who satisfy all of the following criteria are suitable for treatment of acute PE out of the hospital: (1) clinically stable with good cardiopulmonary reserve; (2) no contraindications such as recent bleeding, severe renal or liver disease, or severe thrombocytopenia ); (3) expected to be compliant with treatment; and (4) the patient feels well enough to be treated at home. 