Guidelines on Diagnosis and Management of Acute Pulmonary Embolism

As many as 40,000 patients in Germany die of acute pulmonary embolism (PE) each year. The updated (2008) ESC guidelines emphasize the importance of adjusting management strategies to the clinical severity of PE, i.e. the death or complication risk in the acute phase. Haemodynamically unstable patients with suspected high-risk PE should undergo emergency CT pulmonary angiography (CTPA) or, alternatively, echocardiography. If PE is confirmed, thrombolysis or surgical embolectomy should be performed without delay. In normotensive patients (non-high-risk PE), diagnostic algorithms based on multi-detector CTPA are generally preferred. Initial anticoagulation includes low-molecular- weight heparin or fondaparinux. However, selected normotensive patients with right ventricular (RV) dysfunction and/or myocardial injury may benefit from early thrombolysis (intermediate-risk group). Oral anticoagulation for secondary prophylaxis should be continued for at least 3 months. In patients with unprovoked PE, stable INR and low bleeding risk, indefinite anticoagulation may be considered.