It is estimated that about 237,000 non-fatal and294,000 fatal cases of pulmonary embolism occur inthe United States each year [1]. Acute pulmonaryembolism generally can be classified as eithermassive pulmonary embolism or non-massive stablepulmonary embolism[2]. Patients with massive acutepulmonary embolism have a poor prognosis and thefirst fewhours is the critical period when the majorityof deaths occur. It is during this narrow window whenprompt diagnosis and rigorous treatment strategiescan save lives [3]. Hemodynamic instability withsystemic hypotension, cardiogenic shock, severedyspnea, or respiratory failure at the time ofpresentation defines a physiologically massive pulmonaryembolism. Massive acute pulmonary embolismis associated with increased risk for earlymortality [2,3]. According to reports from theInternational Cooperative Pulmonary Embolism Registry(ICOPER), the incidence of mortality at 3 monthsin patients with hemodynamic instability was 58%compared with 15% in patients who were hemodynamicallystable [4].The question is whether this lattergroup be treated as inpatients or outpatients.
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